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Related post: terized by a want of co-ordination in the temperature, pulse, and respi-
ration. The pulse is small and rapid and subject to sudden changes
from very slight causes. The expression of the countenance is very
bad, both in the fatal cases and in those which recover. Vomiting may
be absent, but it is usually present and distressing in character. At-
tacks of dyspnoea are of frequent occurrence, with accelerated breathing
in the intervals. These phenomena may be regarded as immediate or
as secondary. In the first form they may be mistaken for shock and
are due to irritation of the nerves by the ligatures which have Skelaxin Online been re-
quired. In the second form they have not appeared until after an in-
terval of several days in the author's operations, and have all occurred
in cases of hysterectomy in which metallic ligatures were used. Of all
the post-operative reflex accidents, it is believed that the guttural reflex
or spitting {cradwtement) is the most important and most characteris-
tic, and it is of very common Buy Skelaxin Online occurrence after the Buy Skelaxin operations which
have been referred to — that is, those upon the utero-ovarian apparatus.
It has never been observed by the author in connection with other ab- Purchase Skelaxin
dominal operations. Patients describe it by saying that they have a
desire to spit, but are unable to do so. This symptom was at first ob-
served by the author only in connection with the reflexes which followed
hysterectomy, but it was subsequently seen in connection with two
cases of ovarian cyst, operations for which ended fatally. It may occur
when the pulse is not much accelerated and the temperature normal.
It may precede nausea and vomiting, and sometimes seems to be a pro-
drome of such phenomena. It has its analogue in the salivation and
spitting which often occur during pregnancy, and Order Skelaxin has been recognized
as an utero-ovarian reflex in connection with circumuterine ha;matocele.
With the guttural reflex may be associated a tendency to syncope, a
sensation of suffocation without marked acceleration of the respiration,
a small and mobile pulse, an anxious feeling, insomnia, and a pro-
nounced inclination to weep. In the diagnosis, the condition in which
the foregoing phenomena occur is to be distinguished from shock by
the fact that in the latter the phenomena are associated with depression
rather than excitation. Vomiting occurring soon after an operation
must be considered as due : o peritoneal or to the anaesthetic influence
rather than to reflex utero-ovarian derangement. Morphine or chloral
in small doses after operations is recommended as a preventive of these
reflex phenomena. Should these prove inefficacious, bromide of potas-
sium should be given. In performing the utero-ovarian operations silk
should be preferred as a ligature, and one should be particular to see
that a sufficient number Order Skelaxin Online of ligatures is used to effectually crush the
nerves and not merely pinch them. Suitable care in this respect will
obviate many of the accidents such as have been described, and those
who have obtained the best results undoubtedly owe them in large
measure to such care.
Curetting in Endometritis. — Boureau (" Nouv. arch, d'obst. et de
gyn.," June 25, 1888) offers the following conclusions respecting this
operation :
1. Intra-uterine therapeutics realizes the only logical and rational
treatment which is ajjplicable to lesions of the uterine mucous mem-
brane occurring in the evolution of an acute process.
2. Intra-uterine therapeutics should be radical, and necessitates the
use of destructive agents capable of removing the last vestiges of the
morbid tissue. Experience has shown that incomplete destruction of
the diseased mucous membrane is almost always followed by a recur-
rence of the trouble.
3. Chronic endometritis of the body of the uterus is one of the
most rebellious affections, and will yield only to destructive processes.
4. Such processes may Purchase Skelaxin Online be either caustics or cutting instruments. Cheap Skelaxin
5. The instruction which is furnished by a great number of cases
is that the curette is superior to caustics both as to its action and as to
security.
6. Curetting alone and curetting combined with ecouvillonage (spong-
ing or swabbing out) are operations which can be practiced with-
out submitting the patient to the least danger, always on the condition
that the contra-indications are observed and a rigorous antisepsis prac-
ticed before, during, and after the operations. The action of creasote
as a caustic does not have the same danger which attends the use of
those caustics which produce an eschar.
7. In the statistics of Doleris's clinic for 1887 one hundi-ed and
ten operations of curetting are recorded, with only one accident re-
sulting. This occurred in a turbulent patient in the form of a mild
attack of perimetritis from which she rapidly recovered. To these one
hundred and ten cases maybe added . nearly four hundred additional
ones performed in previous years without accident or complication
which was worthy of notice.
8. Antiseptic ecouvillonage may be practiced alone in all forms of
endometritis, especially in mild and recent cases. In long-standing
haemorrhagic, vegetating, and polypoid varieties it is better to combine
curetting with ecouvillonage.
9. The ecouvillon brushes the uterine cavity systematically, com-
pletes the action of the curette, and relieves the intra-uterine surface
of the debris left adherent by the curette. It also furnishes an excel-
lent opportunity whereby one may apply creasote to the surface which
has been scraped. Generic Skelaxin
10. Curetting m


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