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Related post: pressed with the result, and in operating upon other old patients,
this one being seventy-two years of age, he should certainly
make the perineal opening, while in younger ones he would
also favor this opening and the suturing of the bladder wound
as recently advocated before the society by Dr. McBurney.
Recurrent Appendicitis.— Order Ditropan Xl Online Dr. J. A. Wyeth presented a pa- Purchase Ditropan Xl Online
tient, sixteen years old, who had been sent to him by Dr.
Ground, with the following history: The first trouble had be-
gun in Generic Ditropan Xl June, 1887, when he had vomiting and felt severe pain
in the right iliac fossa. Previous to this attack his bowels had
been Order Ditropan Xl regular. The attack lasted very nearly two days and was
attended with no fever. About two months later he had his
second attack, when he experienced symptoms similar to those
present in the first one. The third attack occurred in January,
1888, and was quite severe. The greatest amount of pain was
midway between the umbilicus and the right anterior superior
spinous process. The temperature in this third attack ran as
high as 103° F., and a tumor was found in the right iliac fossa
which was quite firm. This attack had lasted about two weeks.
In May, 1888, he had his fourth attack, which was the severest
of all, the vomiting and abdominal pains being very distressing.
About the fifth day a tumor was found in the right inguinal
fossa. Peritonitis had then developed and extended over a con-
siderable portion of the abdomen. There was marked tym-
panites and the temperature ran as high as 104°. In this attack
he failed rapidly and had chills, and about the twelfth day the
tumor was aspirated and some pus was obtained. This fourth
attack lasted four weeks. Up to the time of his entering the
Polyclinic Hospital, in February, 1890, he had had sixteen at-
tacks, which had recurred at intervals, of a month or two and
were similar to those already described. During the attacks he
was constipated, but in the intervals his bowels were regular
and his appetite was good. Vomiting was present in almost
every attack and a tumor of pronounced character was to bo
made out in about half of the attacks, but when it Purchase Ditropan Xl was absent a
marked sense of resistance could be noticed.
On March Uth, while in the hospital being prepared for an
operation, he had another attack, which lasted about a week
and caused the ojieration to be postponed.
On March '27th the boy was operated on by the speaker.
Considerable dithculty was experienced in finding the appendix,
on account of extensive adhesions. At last a very small, firm
'Mpendix was found, about two inches in length and of about
diameter of the little finger. It was adherent to the perito-
Mifum and was bound down beneath and parallel with the iliac
artery. It was tied ofi' and found to contain no foreign body.
Although the boy had had sixteen attacks of localized perito-
iiiti--, there did not seem to bo any active Intlammation present,
' the appearance was that of a catarrhal condition. The
i" aker was by no means certain that the appendix had been
â–  i\nne responsible for the trouble. The patient had made an un-
interrupted recovery and was now quite restored to a condition
, of normal good health.
Dr. Robert Abbe asked if there had been any relief in Dr.
Stimson's case where an opening had been made to lessen the
pain of pressure by gas. He understood that the gas liberated
was only for a distance of twelve inches from the point of the
pain.
Dr. Stimsos replied that there had been an immediate and
abundant discharge Buy Ditropan Xl Online of fasces through the opening.
Dr. Wyeth mentioned a case in which the patient was in a
moribund condition from obstruction. To relieve the disten-
tion he had opened the abdominal cavity, taken the first loop
of intestine that presented, and cut a hole in it. There had
been a copious discharge of gas, the patient had begun to
breathe, the obstruction was removed, and the woman had re-
covered.
The President mentioned a case in wliich laparotomy was
done for a wound of a large artery in the abdominal cavity,
and in which there was paresis of the intestinal canal. In the
search for the vessel almost all the intestines were turned out
of the abdominal cavity. They were bound and bunched to-
gether by the exudations of a former peritonitis and dilated to
their fullest extent. He had found it necessary to make four
or five short incisions at various points before he could reduce
them. Of course, these incisions were sutured when the gases
had escaped.
Dr. J. D. Bryant said that, although the fact appeared to
be well established that the escape of gas in these cases was
somewhat limited, he would add two more cases in support of
that fact. In these cases a small aspirating needle was passed
obliquely through the intestinal wall. Only a limited portion
of the intestine was emptied of gas, and that mainly by the in-
fluence of external pressure on the intestine at either side of
the point of puncture. In one of these cases great difficulty
was experienced in closing the puncture properly with sutures.
The speaker's experience thus far led him to consider intestinal
puncture under these circumstances as of doubtful expediency
from all standpoints.
Dr. Wyeth, in reply to a question by Dr. Murray, said he
had not operated in his case of appendicitis during the acute Buy Cheap Ditropan Xl
stage of the sixteenth attack, Buy Ditropan Xl as the boy had already recovered
from all the previous ones, and he thought it advisable imder

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