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GENERAL SURGERY.

Experimental and Clinical Research on the Applica tion of Peroxide of Hydrogen in Surgery. This article represents the author's praise worthy efforts in having placed on a scientific basis the status of in surgery. As to its physiological and pharmaceutical properties, the author states that a 3 per cent. (weight) causes marked changes in both fresh and defibrinated blood, pro vided it is mixed in sufficient quantities with either. It kills in fusoria and probably other isolated cellular elements. Living tissues suffer none by virtue of any chemical influence of the peroxide of hydrogen. Any damage may be traceable merely to mechanical action of liberated oxygen gas. The injection of into the circulation, the peritoneum, or connective tissue kills the animals if sufficient peroxide be introduced. Death is caused by gas embolism of the lungs, nor could it be proven that death followed from any other cause. The application of (3 per cent.) on free surfaces or open cavities cause neither local nor constitutional disturbances, no matter what quantities be used. More to the point in its bearing on the modern anti bacterial treatment of wounds are the following conclusions of bacteriological experiments. A 3 per cent. is the equivalent of a I-I000 sublimate solution acting on bacteria suspended in aqueous solutions, but is superior to it in media rich in albuminous fluid and poor in cells ; where the latter predominate, it is again on a par with solution of sublimate. The bacterial properties of 1.5 per cent. is inferior to aqueous solutions of sublimate, but in media rich in albumen, wanting in cells, it is superior to it. A 2 per cent. solution of acetate of alumina can in no way compete with If the bacteria are in organic fluids, the antiseptic power of diminishes in direct pro portion to the extent of the catalysis of effected by the respective solutions. In so far as we can draw conclusions from test-tube reactions, the powerful antiseptic action of can be developed in urine and drinking water, provided decided quan tities of albumen are not present ; on the other hand, in condi tions met with in wounds whose catalytic tendencies will be marked, no more effect will attend its application than the use of or acetate of alumina under like conditions.

At the clinic of Tubingen I per cent. solutions were used on granulating and suppurating surfaces. The experience of the author concurs in the main with the practical results claimed by L. Championiere for whence he concludes that exerts a beneficial influence on the course of suppurating wounds, par ticularly putrid and gangrenous processes. On fresh operating wounds it causes neither local nor benign remote consequences. Foremost as the cause of its influence on septic processes is its mechanical action of foaming the secretions. The chemical ac tion, however, of by virtue of its nascent oxygen was not proven. Perhaps a direct action of on the tissues may exist. The foaming effects a cleansing of the wound surface without any injurious action, wherefore its superiority over acetate of alumina or sublimate solutions. Whilst its haemostatic properties may make it available to the otorrhinologist and the gynaecologist, in the strictly surgical field a chemical haemostatic is no longer sought. As a deodorizer, it is instantaneous, powerful, and has no equal. Beitrage zur klinischen Chirurgie, Band xxvii, Heft I.

II. Chloride of Zinc Cauterizations for Inoperable Tumors. By DR. FRIEDRICH VOELCKER (Heidelberg). The indication broadly stated for cauterizations begins when the knife and chisel have attained their limitations, fostered still further by the humane desire to separate the incurable from the inoperable, since, in the interest of humanity, the physician must heal as well as cure.

Carcinomata and malignant growths which, coming to the surface, are prone to ulcerate and which, because of their great extent, are deemed inoperable, constitute the principal class of cases for this treatment. At Czerny's clinic, where the limits for operative interference are pushed to an extraordinary extent, ninety-five cases are detailed of which 3 per cent. attained the three-year-cure standard. The remainder were in the main greatly benefited. The method of the application of zinc chloride consists in a preliminary curettement of all possible broken-down neoplastic tissues, then a thorough hmmostasis, waiting twenty four hours, if necessary. This accomplished, gauze, which has been steeped in variable strength of aqueous solution of zinc chloride and thoroughly dried, is applied to the raw surface and allowed to act, depending on the extent of slough desired. To guard against undue cauterization on adjoining mucous surfaces, the parts should be well greased with vaseline, or, as in the case of the vagina, it may be tamponed with dry cotton impregnated with a solution of bicarbonate of soda. By applying the zinc thus on the gauze every nook can be reached, and the gauze is easy of removal. For surface carcinomata, " Canquoin's Paste," of varying percentage and thickness, may be used. Aside of growths too extensive for operation, growths of limited extent, which because of their disintegrated condition are liable to con taminate by infection the wound in the act of removal, are also reserved for caustics. Another indication for the removal of limited neoplasms arises when diabetes or nephritis forbids operative interference. The proximity of the respiratory tract, the esophagus, serous membranes, hollow viscera, call forth con traindications for its use. Gersuny and Langenbuch determined experimentally that no danger need be feared from the action of zinc chloride on larger vessels, since it causes a thrombosis of them. The haemorrhage that is to be feared follows the hasty removal of the eschar or any early attempts at curetting. The action of zinc chloride is based on its dehydrating properties, which render the salt soluble, so that it penetrates into tissues destroying the red blood-cells, causing mummification of the tis sues. Others claim that its action on the cells is one of coagula tion necrosis. The cauterization of the wound surface entirely inhibits the absorptive power of the granulations, so that no toxic symptoms need be feared. After eight to twelve days the eschar is cast off. By such repeated cauterizations any desired extent of growth may be removed. Beitrage zur klinischen Chirurgie, Band xxvii, Schluss, Heft 3.

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