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vis a tergOy resulting in stercoraceous vomiting, and whenever that occurs, we know we have reverse peristaltic action, together with an obstruction of some kind, prohibiting the onward lasix for movement of the intestinal contents through the natural channel. This being the case, what reason is there, either from a physiologic or pathologic standpoint, for in- buy lasix online creasing this peristalsis by administering drugs in- tended for that very purpose? The use of opiates may allay the pain, but will surely mask the symptoms, and thus lasix and potassium not only lead the patient and his friends astray, but the physician as well. Again, false hope may be iv lasix engendered when the obstruction has continued sufficiently long to produce paralysis or gangrene ; in either case, the pain subsiding, the patient imagines he is better, and not infrequently the attending physician is similarly misled by these very serious and usually fatal symp- toms. I am sure there is not a general surgeon who has not repeatedly operated for intestinal obstruction and found the bowel lasix order congested or possibly necrotic and distended with secretions. This, of course, may occur in cases in which lasix cheap there has been no online lasix irritation of the mucous membrane by medication, but in my experience, I have found less congestion, less secre- tion, and less dilation when cathartics have not been used. If this is true in the experience of others, we should be guarded in the use of laxatives, and es- pecially in the use of drastic cathartics in all cases of intestinal obstruction. I recall three cases of fecal impaction, in one of which the intestinal tract was obstructed by cherry stones to such an extent that nothing but mechanical interference could give relief. In the other case the obstruction was caused by hardened feces, necessi- tating operative interference, and in a third case there was an obstruction lasix to buy by lasix 40mg a lasix buy large enterolith which had lodged at the ileocecal valve and produced complete obstruction. According to potassium lasix text-book teaching and "custom," in the cases referred to, patients were all given cathartics irrespective of stercoraceous vomiting and intense lasix with potassium intestinal pain. From irritation by these drugs the bowels were dis- tended with secretions and were congested to such an extent as to produce profuse transudations, in several instances exudations, placing each patient in a perilous condition without in the least relieving the obstruction. The argument against the use of cathartics also holds Digitized by Google 554 RHINITIS FIBRINOSA. [Medical News true in circular constriction of the bowel, whether of malignant or cicatricial origin. It also holds true where there is an obstruction by adhesive bands, vol- vulus, or invagination, and I wish to enter my protest against the persistent use of cathartics in any and all of these conditions: (i) for the reason that as a rule they fail to relieve intestinal obstruction ; (2) be- cause they produce unnecessary congestion and irri- tation of the intestinal tract and thus place the patient in still greater peril, and (3) for the reason that operative interference becomes more dangerous, because of the irritation produced by their use. There are lasik lasix exceptions to all rules, but these exceptions only tend to prove the rule, and, while I believe that the persistent use lasix furosemide of cathartics is usually injurious to the patient and as a rule fails to relieve the obstruction, it is true that occasionally there are cases of severe obstruction in which recov- ery follows their use. Among these exceptions, I might mention two cases in which the obstruction was caused by invagination and in which, after from fourteen to twenty days of absolute obstruction, the invaginated portion of the gut became necrotic, sloughed out, and escaped with a gush of feces, the patients ultimately recovering. Notwithstanding occasional exceptions, I am still of the opinion that it is not to lasix mg the advantage of the patient with ob- struction to continue the use of laxatives, and much less the use of drastic cathartics. The fact that when given continuously cathartics produce irritation and oftentimes inflammation of the intestinal lasix renal tract, even in patients who are not suffer- ing from obstruction, is to my mind sufficient evi- dence that tablet lasix they should not lasix purchase be so employed, espe- cially in the affection under consideration. Such a course adds a serious complication to the existing pathologic condition, which we, as physicians and surgeons, should strive to avoid. It must be conceded by every operator that the less the lasix 40 mg irritation of the intestinal tract, as well as of the intestinal and parietal peritoneum, the more favorable the prognosis. This being true, it is quite evident that a patient who must submit to an opera- tion for the relief of intestinal obstruction is placed in a position of greater danger when the entire intes- tinal tract above the obstruction is irritated by laxa- tives and especially by drastic cathartics. Under these circumstances, the surgeon must contend not only with inflammation, but also with the increased amount of material in the intestines which has re- sulted from the use of cathartics, to say nothing of the increased peristaltic action, which, of course, must interfere with any operation that necessitates in-

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