Many patients are unable to void urine after operations, particularly after those upon the female genitalia, and the use of a catheter is often necessary. This should be used with antiseptic precautions, both as to the patient, the instrument, and the operator’s hands. Much of this difficulty can be avoided by injecting 20 Cc. of a 2 per cent. sterilized boroglycerin solution through a catheter in the evening after the operation. Its action is usually prompt, and in five to ten minutes the patient spontaneously empties the bladder without unpleasant after-effects.

After abdominal and pelvic operations the patient should not be allowed to urinate, but should be systematically catheterized. The bladder should never be allowed to become distended. The amount and character of urine passed should be carefully noted. In serious cases the amount of solids eliminated should be estimated, in order that it may be kept up to the necessary standard. In fact, efficient and sufficient elimination is more necessary after the prolonged administration of an anesthetic than after almost any other event. When sufficient fluid to keep up the standard cannot be administered by the stomach, it should be introduced into the rectum or given beneath the skin. Two or three enemas of salt solution should be administered each day, and in urgent cases the normal solution should be thrown beneath the skin, and this should be repeated as often and as long as may be necessary. When the patient begins to show evidence of what is vaguely described as uremia, i. e., the toxemia of renal insufficiency, not only should warm water be used in these ways, but hot-air bed baths should be given twice a day if necessary, in order that some of the work of the kidneys may be assumed by the skin. Hot-air baths stimulate the kidneys as well, and these measures will prove more effective than most of the diuretics, although digitalis and pilocarpine by the skin may be of assistance.

Patients frequently complain of excessive dryness in the mouth. This may be relieved by occasionally dropping beneath the tongue one-half of an ordinary hypodermic tablet of ¹⁄₁₀ Gr. pilocarpine; also by mouth-washes which contain a little glycerin, and by keeping the lips moistened with glycerin. Excessive sweating can sometimes be relieved by giving a hot-air bed bath or a hot mustard foot bath, as the extra action of the skin thus induced checks the spontaneous drain.

Delirium and acute mania occasionally supervene after operations. It should first be made clear that these are not due to any antiseptic or drug. Iodoform is less frequently used than formerly. Children and aged people become delirious with less provocation than do those in middle life. Such delirium is generally an expression of a toxemia, and, in addition to such other measures as may be necessary, calls for control and restraint and more active elimination, as in so-called uremia. In proportion to the degree of mania must be the restraint prescribed. A restraining sheet or a strait-jacket may be sometimes needed. When these conditions arise in surgical patients more harm will come from the violation of the principle of physiological rest than from the drugs which may be needed to secure it. The milder measures should be first used, abstaining as far as possible from opiates, which are probably the least desirable of all, but which may be occasionally demanded. Chloral, the bromides, cannabis indica, alone or in combination, may be made to render more valuable service. Hyoscine, in doses of ¹⁄₁₀₀ to ¹⁄₅₀ Gr. beneath the skin, will often control when other remedies fail; it may prove invaluable. When delirium tremens complicates a case it may be treated as suggested in the chapter on Various Intoxications.

Part V.
SURGICAL AFFECTIONS OF THE TISSUES AND TISSUE SYSTEMS.

CHAPTER XXVI.
CYSTS AND TUMORS.

GENERAL CONSIDERATIONS.

A tumor is a new formation, not of inflammatory origin, characterized by more or less histological conformity to the tissue in which it has originated, and having no physiological function.

By the above definition it is intended to separate the new-growths from a distinctive class of neoplasms which are of inflammatory (i. e., of infectious) origin, to which the generic term of infectious granulomas has been given. (See [Part II].)