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TOLBIKt. OHIO. The subject of this paper states an opinion which I have held for some time, the propriety of which, Order Imigran I be- lieve, will be established in the near future. The high death-rate and the unsuccessful medical treatment of pulmonary consumption are my apology for wishing to place this disease, in its incipient stage, in the category of surgical ailments. I am surprised that this has not been attempted, as the rcsult.s from surgical interfer- ence in tulterculous affections of the joints, lymphatics, and abdomen have lioen so gratifying that one would naturally expect, reasoning from analogy, a desin> to ap[>ly a similar treatment to the same affection wherever located. Tlie lungs, however, would scorn to offer a good field, for the rea.^on that our diagnostic resources arc such that the disease could lie brought under effec- timl treatment Ix'forc it had l>econie widely dissemi- nated. Most cases of pulmonary tuberrulosis begin with a single focal point of infection, and I reason, woro 818 PYLE: PNEUMONECTOMY IN INCIPIENT TUBERCULOSIS. |N. Y. Med. Jorn., we to secure this by a well-directed pneumonectomy, there is every reason to believe that Imigran Price this form of treat- ' ment would prove absolutely curative. From experi- ments which I have made on animals, I am satisfied that excision of diseased lung is not only a possibility, but comparatively easy of accomplishment. I com- menced my studies on the subject in question in the fall of 1894 and continued them through the winter of 1894 and 1895. Dogs were used for the experimental work. My observations at the time were interrupted, and I am sorry that I have Purchase Imigran been unable thus far to put the knowledge gained into execution on the human subject. However, I hope to do this before a great while, and will content myself for the present Buy Imigran Online in sub- mitting the most important points developed as a result of my Imigran Online experiments. I was anxious first to learn the requirements of suc- Generic Imigran cess in making a pneumonectomy, believing that when this was accomplished the way was clear for success- ful work upon diseased lungs. No preference was given to animals previously inoculated with tuberculous ma- terial, as the knowledge to be gained was of a technical nature and Imigran Tablets could be gained equally as well upon the healthy animal. First, in regard to the precautionary measures, the same observations apply here Purchase Imigran Online as in other surgical work. Those relating to cleanliness must be insisted upon, as the pleura and lung tissue may be a little less resistant to the lower forms of Imigran Mg surgical in- fection than some of the tissues of which we are more familiar. A cautery is necessary, and preference is given to good strong silkworm gut as the material for ligating the mass to be excised. A very important point is the location of the opening incision. It should be remembered that when the pleural cavity is opened, air enters and the lung collapses, leaving the thoracic cavity almost empty. The extreme points, the apex and the tip of the lower lobe of the lung are drawn so far away from corresponding points on the thoracic wall that if an opening is made immediately over the point where the excision is to take place, the Buy Imigran lung will be found not available. Therefore it Buy Cheap Imigran is better, when at- tempting the removal of either apex, to make the initial incision over and in line with the fourth rib, and, in any case, not higher than the third. This being de- termined, commence the incision near the outer margin of the sternum and carry it outwardly far enough to allow the easy introduction of the hand into the pleural cavity for the purpose of examining and withdrawing the desired lung. The rib should be removed next, and, in doing so, avoid the needless opening of the pleural cavity, as the introduction of air causes severe dyspnoea, which may just na well be postponed until preparations are complete to hurry the conclusion of the operation. The costal end should be divided first, and the rib care- fully peeled from its osseous and muscular coverings. f)f course, it is understood that the area of the diseased lung should be clearly in mind before beginning the operation. Upon opening the pleural cavity, the lung should be seized and engaged in the wound so as to obstruct the ingress of air, which will be found mate- rially to lessen the labored breathing and afford the patient the needed oxygen. The amount of lung to be removed having been determined, a ligature, prefer- ably of silkworm gut, should be thrown around the base of the mass, and dravra. so tight that the bronchi and lung tissue are forced into a solid mass. A narrow- bladed clamp should then be applied external to the ligature and the engaged piece of lung removed with the cautery. Imigran Cost After searing, the clamp should be re- moved and the disengaged stump dropped into the pleural cavity without further attention. The edges of the pleura should now be stitched together by means of a continuous suture and the superficial wound closed in like manner. Collodion makes an indispensable dressing for the purpose of hermetically sealing the opening into the pleural cavity. Labored breathing will be pronounced for the first twenty-four hours, but aft- erward will subside, due to the absorption of air im- prisoned in the pleural cavity. It would be possible to remove this air by means of an air pump, but I am of the opinion that there is an advantage in a partial collapse of the lung in securing rest to the amputated part during repair. This is certainly favorable to the ligature securing the stump and prevents adhesion be- tween the visceral and parietal pleura. One of the great dangers in the operation is death from hasmorrhage. This may occur from an accidental slipping of the ligature or from extravasation of blood in the air cells and lung tissue. This, however, will not occur if the ligature is properly applied. It is necessary to avoid puncturing the lung, as a fatal hsemorrhage may follow the opening of a vessel. To avoid this Order Imigran Online accident, a better way is to throw the ligature around the entire mass and secure it by a proper knot. It

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