. The Canada lancet and practitioner. oration, pyloric portion of stomacli. may be encysted in the lesser omental sac. The more depen-dent portion of the collections become rapidly purulent. In peforated gastric ulcer we are already confronted withseptic infection. We cannot therefore avail ourselves of themeasures introduced by Mikulicz, the injection of nucleinic acidto create a prophylactic leucocytosis. As yet the method recentlyapplied by the genius of Bier, in treating successfully acute andseptic inflammation by means of local congestion is notavailable. 192 DOMINION MEDICAL MONTHLY Our
. The Canada lancet and practitioner. oration, pyloric portion of stomacli. may be encysted in the lesser omental sac. The more depen-dent portion of the collections become rapidly purulent. In peforated gastric ulcer we are already confronted withseptic infection. We cannot therefore avail ourselves of themeasures introduced by Mikulicz, the injection of nucleinic acidto create a prophylactic leucocytosis. As yet the method recentlyapplied by the genius of Bier, in treating successfully acute andseptic inflammation by means of local congestion is notavailable. 192 DOMINION MEDICAL MONTHLY Our treatment at present consists in performing laparotomy,which enables us to prevent the further escape of gastric con-tent. It allows us not only to get rid of what has alreadyescaped, but in addition to cleanse the peitoneum by carefulwashing out. It enables us to close the rent and to establish freedrainage. To do all this a general anesthetic is required. When oncethe nature of the case is established it is wise to get free access. Case 7.— perforation exposed by opening lesser sac. by an extensive incision. We are guided in our search for theaperture by the lymph in its vicinity, by the nature of the escap-ing fluid, and the direction from which it wells. On identificationthe ulcer may be plugged with iodoform gauze, and we at oncethoroughly wash out the abdominal cavity with sterilized saltsolution. A counter opening should be made above the pubisand the glass nozzle of a douche introduced while the ulcer is DOMINION MEDICAL MONTHLY 193 being closed Excision of the ulcer is not to be means loss of time and loss of blood without corresponding gam. Where there is much perigastritis with unyielding or a friabletissue, a series of interrupted Lembert sutures (silk) may be in-troduced at some little distance from the margin of the ulcer andtightened up en masse. Over these a second series may be re-quired. Occasionally a preliminary stitch or two may b
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