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port. In certain perforations, owing perhaps to the en- feebled or cachetic state of the patient and his dimin- ished reparative powers, the protecting adhesions which ordinarily develop in the region of the ulcer and which are stimulated by the gauze packing, are imperfectly formed so that Lopressor Mg the opening in the stom- ach reopens and communicates with the exterior of the wound. The resulting gastric fistula lopressor 50 is an ex- tremely serious complication. The contents of the stomach flow constantly over the wound and the irritating secretions excoriate and inflame the skin. In addition there is a great loss in nutriment owing to the escape of a large part of the ingested food and fluid. In the case of a duodenal fistula, a rem- edy is at hand in the temporary ligation of the pylorus, supplemented by posterior gastrojejunos- tomy to establish the continuity of the intestinal tract. The foregoing is an epitome of definite notes and records of impressions written immediately follow- ing operations when the actual details lopressor 12.5 were vivid and fresh in the mind. Hence, it is an abridgment of personal views based on observations demon- strable at operation. Admitting that these facts may be nothing more or less than repetition of somewhat trite clinical beliefs they represent, nevertheless, a precise program for the practical treatment of per- forated gastric lopressor 12.5 mg and duodenal ulcer. 328 West Eighty-third Street. 766 JONES: THE OPERATING ROOM. The Operating Room* By JOHN F. X. JONES, M. D., Philadelphia, Surgery at Jefferson Medical College, and Surgeon to St. Joseph's, The Misericordia and St. Agnes's Hospitals. (Concluded from page 606) "The approximate size and weight of bacterial dust particles have been ascertained by different ob- servations and experiments. If, for example, in quiet air (air of a room) dust, containing bacteria, be stirred up; in the beginning there are great quan- tities of bacteria in the air ; soon afterwards — say thirty minutes Order Lopressor — because of the settling of the dust most of the bacteria have disappeared from the air and there remains practically nothing but spores of mould lopressor 25mg fungus. Air currents of a speed up to two tenths mm. cannot maintain in suspension lopressor price or carry away the heavier bacterial dust particles ; the light- est bacterial dust, from clothing and from pocket handkerchiefs (never Buy Lopressor Online from the floor) can be held in suspension and carried away horizontally by air cur- rents of from 0.2 to 2 mm. speed" (35). Until 1897 atmospheric infection was supposed to be due almost exclusively to bacteria carried by par- ticles of dust. In 1897 Fliigge (36) called attention to the possibility of microorganisms being carried in droplets and bubbles. Fliigge (36) and his asso- ciates, with bacillus prodigiosus in their mouths, spoke loudly, sneezed and coughed in a room where agar plates had been exposed. They thus proved that by such acts droplets or minute particles of mucus are ejected from the respiratory tract into the air. They further showed that these minute par- ticles are driven by the ordinary air currents of the average room to all levels and to various distances. Among other things Fliigge (36) says: "Wound in- fection requires a special discussion — particularly the peril of infection from droplets of excretion which are lopressor 50 mg sprayed into the air and which threaten the asep- sis of operations. In spite of every precaution, in recent years operators have been obliged to record inexplicable cases of suppuration and lopressor hct sepsis. The cause of these disagreeable results does not Buy Lopressor admit of ready explanation. We have blamed insufficient disinfection of the hands and have sought to improve this without wholly lopressor 50mg satisfactory results. We also thought of the air which in the original Lister pro- cess was Lopressor Online considered almost as important as the con- tacts. But, then, we only considered the dry germ laden particles of dust in the air and from these only did we fear eventual infection. With this idea in mind we sought principally to minimize the trans- portation of dust to purchase lopressor the air of the operating room ; we made those having business there wear sterilized gowns and overshoes ; we moistened the floor, etc. Moreover, Cheap Lopressor the content of dry, germ laden, dust par- ticles in the air of operating rooms has been deter- mined several times with contradictory results." Fliigge then says that the occurrence of wound infection from the dust particles of the air is very limited and states his reasons for so believing. "It •Read before the Lancaster Citv lopressor 25 and County Medical Society. October 12, 1921. is nuich more apposite," continues Fliigge (36), "to consider air infection of operating wounds as aris- ing from drops of Lopressor Xl secretion ejected from mouth and nose by those present, in the act of speaking, cough- ing or sneezing. In the saliva of the healthy we frequently find Staphylococcus pyogenes lopressor 25 mg aureus; occasionally Diplococcus lanceolatus. When there are the most trivial pathological changes in the mucous membrane of the throat we find masses of strepto- cocci. Carious teeth constitute a mine for all pos- sible more or less suspicious bacteria. Here we are confronted with pathological varieties which are always dangerous ; they are not debilitated by dry- ing, but, as many animal experiments have shown, they are often of the greatest virulence. The opera- tor, Lopressor 100 Mg the assisting personnel or the spectators may be responsible for the dissemination of these droplets.

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