POSTOPERATIVE THERAPEUTICS


It happens at times, however, that complications of a very serious nature develop, and of these in abdominal operations, persistent vomiting and hiccough are the most important. They are usually caused by a focus of infection at the site of the operation. There is some degree of peritonitis present, which endangers the patients life. He must be examined for pneumonia as well.


Following nearly every operation in which a general anesthetic has been used, the patient suffers from some degree of nausea, vomiting, and stasis. This condition can usually be met by the surgeon, and in about there or four days the patient is off to a good recovery.

It happens at times, however, that complications of a very serious nature develop, and of these in abdominal operations, persistent vomiting and hiccough are the most important. They are usually caused by a focus of infection at the site of the operation. There is some degree of peritonitis present, which endangers the patients life. He must be examined for pneumonia as well. Because of the persistent vomiting he is rapidly dehydrated despite intravenous salines and glucose solutions.

At this stage the patient is in a critical state-the wound has probably become infected from within, the sutures are tearing the wound gaping and discharging pus. If, however, a remedy can be given, which will stop the vomiting hiccough, time and the resistance of the patient will be given a chance, and he may be saved. Where the vomiting and thirst are predominant symptoms, Phosphorus will most frequently be indicated, and will do what no other form of treatment can do. Where the hiccough alone is the dominant symptom, the remedy is harder to decide upon, as these are not quite so urgent as those of the persistent vomiting class. An antispasmodic remedy will most usually be needed, such as Belladonna, Hyoscyamus, Nux vomica, carbo, veg.,, etc.

There is usually little difficulty in being allowed to prescribe for your patient if he has reached such a strait. The surgeon is very worried at the way is patient is progressing, and is only too anxious to have some one else help bear the burden. It is your duty offer to prescribe. The patient and his family all want to do your best, and this best frequently ends by saving the patients life.

Now comes a period foe gradual recovery over a number of weeks. The patient has a large granulating wound discharging freely; he is weak, anaemic, and progress is very slow-here again your Homoeopathic prescribing will work wonders. According to his symptoms the proper constitutional remedy must be given. It is very frequently silica, and should be given in a very high dilution. If then following this, the patient has trouble with flatulence and bloating, or if he becomes irritable an constipated, or resentful about the operation, and the long duration in the hospital, I do not hesitate to give a few doses of low potency of Carbo veg., or Nux vomica, or Staphysagria, with the knowledge that the Silicea is still working away at his lifes foundation, shoring up the weak places, and setting him on his feet once more.

There is another class of case,where the homoeopathic remedy works wonders,and this is where a general infection follows a very miner operation such as sinus,antrum, or the incision of an abscess,or boil. In these cases, there are not present the symptoms peculiar to infections in the abdomen, and the symptoms presented by the patient in this general invasion of this being are usually those in an aggravated form that he complained of while the trouble was localized. In other words if he needed Belladonna or Hepar sulph. or Pulsatilla or Mercurius before the operative interference, it is entirely likely that he still needs that remedy. He, however, needs it much more urgently. TORONTO, ONT.

DISCUSSION.

DR.GRIMMER:The doctor spoke of Phosphorus being very often the remedy. It is in such cases as peritonitis and postoperative infection. It has the vomiting of water after it gets a little warm in the stomach, but there is one other remedy that competes with it and that is Pyrogen, which has the identical symptom, with the vomiting of water after it so warm in the stomach.

DR.ROBERTS: I was in hopes that Dr.McLaren would say something about surgical shock, that is, postoperative. If you ever get any of it, which you probably will if you have much surgery, dont forget Strontium carb.

DR.HEIMBACH:I should like to cite one case that was very serious. I wasnt in charge of the case when he was taken to the hospital, though he was my patient for a good many years.

In his place of business he was taken with an acute pain in the abdomen and they called a doctor who was near by. He called in the surgeon, and they took him to the hospital and operated on him, which was undoubtedly very necessary.

After that it was a very stormy procedure. He would feel better one day and the next day he would relapse and he just as bad, and finally his wife said to the surgeon, “Would you mind if we call Dr.Heimbach, our family physician, in consultation?”.

He said,. “I shall be glad to have him come.”.

So I was called in on the case and went over it very carefully and advised Arsenicum or China ars. 6x. He started to improve a little but it was a slow process and he had pleurisy and considerable fluid in his chest.

I looked over his diet list and he was practically getting no food but milk and eggs. The surgeon prescribed those to grain strength. I said, “Why not cut out the milk and eggs?”.

“Oh, he has got to have that to get strength.”.

I said, “No food will do anyone any good or give any strength if it is not the right thing.” But I could not persuade him to change the diet. I went to the wife and told her.

“Now,” I said, “the surgeon and I are not agreeing about the diet of this case, and I might as well bow out of it and quit. Unless the man quite his protein diet, I dont think he will recover. It is up to you, what you want to do,.”.

Well, what would you give him?”.

“I would give him fruit juice and vegetables, and I cant object to cream, but cut out the proteins. He is absorbing more foods from the chest than he can handle.”.

She got in touch with the nurse and they cut out the milk and eggs and our patient is alive today and tells better than he ever did in his life.

DR.BROWN:This is certainly a most interesting subject and most beautifully Handled. I have had some experience with postoperative work.

I recall one rather interesting case touching on surgical shock, of which Dr.Roberts spoke. It was a case of a woman seventy-three years old, who had a fibroid removed by allopathic surgery. She want along and, as is so likely to be the case with that kind of work under allopathic care, she was troubled a great deal with gas pains.

She had different kinds of enemas but still she was distending more and more and getting weaker. She was rather frail anyway. She had two or three nurses in attendance constantly. The condition we found to be desperate. I went in to see her one morning about quarter of nine and the surgeon had just left, and the nurses were almost hysterical. He had given several orders as to what to do, and if that doesnt work, fold your hands and let her die.

So far as I know, the nurses never forgave me. I sat down and looked her over a little The abdomen was as hard as a rock, almost ready to burst, and I said, “just stop everything and just dont kill her with too much kindness.”.

I gave her a dose of Podophyllum and went away and came back later and found she had had a profuse action of the bowel That patient made an uneventful recovery.

DR.MCLAREN: I will give you one minor case. We left Toronto Wednesday. On monday a man came into the office at five in the afternoon. Four weeks previously he cut the posterior surface of his thumb and went to the doctor on the corner. that hand was swollen, red and inflamed after four weeks, and it wasnt discharging, although the wound open.

The doctor had been probing and the patient complained bitterly of the pain this probing caused. He said, “Doctor, you have got to do something for me. I am a sick man.”.

There was a red streak startling up his arm.

I said, “Oh, you will be all right in a couple of days. You have got to be, because I am going to Detroit.,”.

He said, “Well, I certainly hope you are telling the truth, Doctor”.

The hand was very sensitive and I gave him three doses of Hepar sulph. and I told him to come back on Tuesday. On Tuesday he came back at five oclock and he was worse. The hand was more swollen and he had a temperature of 100. I had a lot of work to do and I couldnt sit down with the repertory, so I pulled out his record and looked to see what his constitutional repertory, so I pulled out his record and looked to see what his constitutional remedy was. This man had consulted me for bronchitis which he had for a long time, with a chill, and he is a chilly individual with sweaty feet, so I gave him silica CM, two doses.

“If you are not better tomorrow morning, I will go and see you. If you are better, you can come back at two. I am leaving at five.”.

When I got home at eleven there was a telephone message to call his house, and it seemed he was having a had time of it. It was swollen a treat deal more and the red streak was up to his axilla. I frequently notice that deal more and the red steak was up to his axilla. I frequently notice that deal more and the red streak was up to his axilla. I frequently noticed that these cases get much worse about an hour before they break, and I told his wife to immerse the arm in hot water and let it soak for about half an hour and then wind it up in a good hot wet towel with a dry one around it and let him try to get some sleep.

The first thing in the morning for telephone rang and the said, “It broke an hour and a half after you telephoned, and he is fine this morning. He will be up to see you are two. There is no temperature.”.

DR.EDWARDS:May I ask Dr,.McLaren how often he gives that CM, how far apart?.

DR,MCLAREN:Two doses, an hour apart.

The strict and conscientious homoeopath cannot attend as many patients daily as the allopath can. The much more detailed examination of the patient, the taking of notes, and the process of individualizing require a much longer time than the method of the allopathic school, which only follows general indications. However simple the principles of Homoeopathy appear it presents many difficulties when accurately studied and practised. This circumstance is rather an advantage than a disadvantage of Homoeopathy. Even the best physicians can only attend a few important cases in a limited time, and thus homoeopathy checks the mischief of our visiting practitioners, who walk or drive and have a prescription ready in their pocket for every named disease, and whose consulting room is the open road-PROFESSOR DR.RIECKE,1833.

Kenneth A Mclaren