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Imperative Surgery for the General Practitioner, the Specialist and the Recent Graduate.

JAMA. 1900;XXXIV(16):1018-1019. doi:10.1001/jama.1900.02460160060024.
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In criticising this work one is somewhat disarmed by the statement in the preface that it "presupposes the absence of a surgeon and the impossibility or inexpediency of removing the patient or of waiting for expert assistance." The number and distribution of good surgeons would make the fulfilment of the above conditions a very rare occurrence in this day. Some of the advice approaches very near the laity, and reperition is common, as the author remarks. The use of the dangerous 4 per cent, solution of cocain subcutaneously as a local anesthetic, when Schleich's solutions are so harmless and efficient, can not be endorsed. Nor can the advice to suture the gall-bladder to the skin in cholecystostomy, owing to the difficulty often experienced in closing such fistulæ. The recommendation to leave the skin unsutured and pack with gauze in the radical operation for hernia shows a lack of confidence in


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