. National Eclectic Medical Association quarterly. al strip gauze and gauze drains about the gall-bladder are placed as in the usual technique. In cases showing marked symptoms of general infection, extensivecholangitis and acute inflammation extending up to the liver, it is best toallow the free drainage through the tubes to continue until the bile becomesthinner and symptoms of infection abate; then we can begin a continuousirrigation as described below. After the patient has been returned to bed and recovering from theeffects of anesthesia, the caloris bottle with a liter of salin
. National Eclectic Medical Association quarterly. al strip gauze and gauze drains about the gall-bladder are placed as in the usual technique. In cases showing marked symptoms of general infection, extensivecholangitis and acute inflammation extending up to the liver, it is best toallow the free drainage through the tubes to continue until the bile becomesthinner and symptoms of infection abate; then we can begin a continuousirrigation as described below. After the patient has been returned to bed and recovering from theeffects of anesthesia, the caloris bottle with a liter of saline solu-tion at 140° F. with half a drachm of adrenalin solution added to the firstliter; then the outlet tube of the dropper is connected with the inner rub-ber irrigating tube—that which passes to the cysic duct—and a flow ofabout ninety drops per minute is started and continued for a period offour hours. After an hours interval of rest, the saline solution, used plain,is continued for another hour, and so on for about twenty-four to forty-. CONSERVATIVE GALL-BLADDER SURGERY. 131 eight alternating hours of flow and rest. After the third day the flow iscontinued at every sixth hour and allowed to flow for a period of sixty toninety minutes. Care should be taken not to over-saturate the patient, asthe duodenum will absorb saline rapidly. The adrenalin solution is em-ployed to reduce the inflammatory reaction of the tissues, due to operativeinterference, and by its absorption in the duodenum to act upon the cir-culatory system. The usual duration of irrigation is from six to eleven days. In somecases we are compelled to continue irrigation twenty-one days. The calorisbottle container is placed so that the dropping bulb is eighteen inches abovethe bed, and care must be exercised in the amount of pressure producedby the flow of the liquid, as too high pressure or too rapid flow will causepain similar to a biliary colic. In cases where we wish to obtain thedilating effect upon
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