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The use of medicines in surgical cases.

HERBERT T. COX, M.D., LOS ANGELES, CAL.

I do not expect to teach anyone very much, but it is often well to take stock of what we have and counsel with each other. As Eclectics we teach and practice one thing which gives us a distinction from other schools of medicine; that one thing is medicine itself.

All schools study the same physiology, bacteriology, pathology, anatomy, surgery, etc., but we as Eclectics study a rational materia medica, as proved by bedside experience. Our surgeons practice the same technique in operating as other surgeons, but should be equipped and are to get better results due to more efficient care of the patients by recognizing physiological as well as anatomical lesions.

How many surgeons pay too little attention to the patient's physiological condition, or pathological physiology, before the operation? Or, when the mechanical work of the operation has been completed, stand aside and expect nature to do all the rest, regardless of a handicapped physiology? From my limited observation, I believe that the Eclectic surgeon has a better batting average than his regular brother, due to his knowledge of medicine. Several surgeons of the Allopathic school have stated to me that they know nothing about medicine, and did not care to trouble their minds with it. Therefore, the excuse for the topic of this short paper is only to review a little physiology gone wrong that may be helped by medicine.

We are excluding from this paper the well-known and varied antiseptics, mechanical and physiotherapy measures used in surgery, as they are a part of the modus operandi and common to surgeons of all schools. We shall very briefly touch a few of the conditions where, the surgeon can call medicine to his aid. We shall divide the subject into two parts: (1) Pre-operative conditions; (2) post-operative conditions.

Pre-operative.—Unless the surgical condition is an emergency, after there are certain conditions which, if corrected or at least partially relieved, that would in the end work to a more speedy or thorough recovery of the patient. Some of these are:

1. Acidosis. This lessens resistance and vitality and may be increased by an anesthetic. It should be corrected by diet, alkaline salts, glyconda, etc.

2. Circulatory disturbance: (a) Of the heart, low blood pressure, weak heart muscle, etc.: Give cactus, hydrastis, belladonna, nux vomica, digitalis, etc.; (b) cardio-renal disturbances: Nephritis and high blood pressure should be treated with veratrum, the various nitrites, aromatic spirits of ammonia.

3. Anemias. Sunshine, diet; arsenic and iron by mouth or intravenously.

4. Cases of diabetes and albuminuria should be gotten into as good shape as possible, diabetes by diet, ext. jambul seed, iris, chionanthus, cellasin and insulin if necessary; albuminuria by diet, barosma, fragrant sumach and many other remedies often used.

5. Insufficient coagulation and long bleeding time should be brought to normal, if possible, by means of calcium salts by mouth or intravenously; diet. fibrogen, etc.

6. Many surgical cases, as peptic ulcer, thyroid cases, tubercular and syphilitic cases need a period of medical treatment before operation. Our leading surgeons of the regular school now question whether peptic ulcer is medical or surgical in treatment, and most of them admit that they get better results with medical treatment afterward, and if possible, before operation.

7. Small stones in the ureter or common bile duct. Here complete relaxation with subculoyd gelbia or lobelia in large and frequent doses, with the patient in bed and watched carefully, with X-ray and cystoscope, often produce results and save the patient's time.

8. Last but not least, see that the patient has a restful night, free from worry before the operation. It may not be necessary to give morphine, but a mild sedative may do the work, such as valerian, passiflora, chloratone, allonal, etc.

Post-operative.—The main post-operative conditions will now be touched upon:

1. Shock and circulatory failure should be combated by saline, adrenalin hypodermically or added to the saline solution, glucose solution, atropine, digitalis, camphor in oil, as indicated.

2. Intestinal gas. No ice-water, but hot water for the first few days. Useful here are nux and capsicum, physostigmum or physostigma sulphate, xanthoxylum, matricaria, soda bicarb.; pituitrin except in gastro-intestinal cases, including appendectomies.

3. Hiccough. Belladonna, morphine and atropine, gelsemium, capsicum, lobelia, luminal, Hoffman's anodyne.

4. Inactive conditions of the digestive organs, lack of digestion and assimilation. Here the Eclectic can use his well-known stomachics and tonics, and may not need more, but in some cases digestives may be needed until the gastric glands, liver and pancreas can do their own work, in which case coroid, pepsin, taka diastase, hydrochloric acid and pancreatin may be needed.

5. Infections, primary or secondary, as pyemia, septicemia, empyema, gallbladder infections, pyelitis, etc. Here our old friend echinacea is our standby, with baptisia, phytolacca, corydalis, stillingia, etc. Hexamethylin is useful in gall-bladder and it and salol in pyelitis, as indicated.

6. Slow-healing fractures, wounds and ulcers. This is often due to lack of lime salts. Here we think of sodium and calcium locophosphate, vitamine preparations, parathyroid compound. If due to anemia, that must be treated. If due to impure blood, use the vegetable alteratives, iodides, etc. If positive Wassermann, add salvarsan or neosalvarsan to the list.

7. Lastly, in most surgical cases, due to lack of exercise, the remedies which help the hepatic and gastro-intestinal circulation and function help the patient to a more speedy recovery, and should be carried into the convalescent period.

Many conditions, perhaps, have been omitted, but the field is broad, and the Eclectic surgeon is prepared, if he will not drift away from his teachings, to meet all these conditions with good results.

Discussion.

DR. E. B. SHEWMAN (Cincinnati, O.): There should be a borderline in medicine and surgery. There is a borderline in the treatment of medical and surgical cases. In my candid opinion, in many instances, a good many of our surgical patients are over-medicated, particularly post-operative cases. This is, perhaps, true also of the pre-operative cases. When the doctor spoke of emergencies, I am afraid that a good many of our surgeons have not come to a discriminating understanding of what an emergency really is and what it means. A great many of the patients who are taken into hospitals and operated upon today as emergency cases are not emergencies. They should have pre-operative work, but they are put on the operating-table, whereas a few hours or days of preparation might have added something to them, before surgical shock is added to their condition, with a bad terminal result. It has come to our observation in the last few years that in the patients who come in with puerperal eclampsia, instead of rushing them to the operating-table it is well to give them pre-operative glucose and build them up rather than to do an immediate operation.

The doctor spoke of albumin. You must remember that practically every case that has a considerable amount of pus in the body, particularly in the abdomen or chest, carries albumin, but albumin without the presence of casts, hyaline or granular, does not mean anything. Albumin is present in the presence of pus in the body, but is not a nephritic lesion and should not be treated as such. In the post-operative cases a good deal of the medication by mouth is not applicable immediately following the operation, because the patient is probably vomiting. We do not any longer see the extreme cases of surgical shock that we formerly saw, and I am still convinced that fluids in the body are necessary, because many of the patients at the time of operation, particularly for emergency, are already dehydrated. Salt solution at the time of operation and immediately following is very necessary, either by proctoclysis, intravenously, or any other way.

Dr. Cox (closing): I have nothing to add to the paper. I only tried to mention some of the things that may be used when necessary. I will admit that patients with chronic albuminuria may be put in better shape by proper pre-operative care.


National Eclectic Medical Association Quarterly, Vol. 19, 1927-28, was edited by Theodore Davis Adlerman, M.D.



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