Pericardotomy.—The incision is made in the fifth left space, and part of the rib resected. The internal mammary artery must be respected. irrigation should never be used.
Puncture of the Heart (PARACENTESIS AURICULI). — This operation has been performed for the relief of congestion of the right heart. It does not com mend itself.
Puncture and injection of stimulants into the wall of the left ventricle is re puted to have revived the heart after it had apparently ceased beating in alco holics. In such a case there is little to be said against it.
Suture of the Heart. — The prime requisites for success in this operation are speed and boldness. As soon as it is determined that without operation the patient will die, no further time should be wasted, even over asepsis. Operate .at once or not at all.
List of 11 instances of suture of car diac wounds collected from different sources. Death resulted in S, and the remaining 3 patients recovered. Death was due in 2 cases to great loss of blood, and in 4 eases decided symptoms of in fection were present. Conclusions as to technique: The best flap for abscess is a thoracic trap-door with the hinge out ward. It is best not to open the peri cardium across the pleura, but to care fully push this aside laterally. Inter rupted sutures are, as a rule, best for the cardiac wound itself. In the ma jority of eases a drain is not needed for either the pericardium or the pleura. F. Terrier and E. Raymond (Revue de Chin, Oct., 1900).
As the right ventricle passes under the sternum at each systole, the best incision is Rydygier's or some modification of it —across the sternum and an inch be yond, just above the third rib. From the (left) end of this incision an oblique cut crosses the third, fourth, fifth, and sixth ribs downward and outward. Sternum and ribs are divided, the flap turned back, the internal mammary arteries se cured, and the pericardium laid open from top to bottom and held open with clamps. The wound in the heart is su tured with a small needle and fine silk. The sutures are passed and tied during systole and must not pierce the endocar dium. If the heart falter or stop, let the operator speed the more. Finally the pericardium is delicately emptied of clots, sutured roughly, and the flap re placed. In the meanwhile stimulation
and infusion are plied.
THYMOL.—Thymol, U. S. P. (Thyme camphor; thymic acid; methyl-normal propyl-phenol), is a phenol from the volatile oil of Thymus vulgaris, L., a garden-herb indigenous to Europe, but cultivated elsewhere. Thymol occurs in colorless, translucent crystals, having a thyme-like odor, and a pung.ent, some what caustic taste. It is soluble in alco hol, ether, chloroform, carbon disul phide, glacial acetic acid, and oils, and in 1200 parts of water.
The oil of thyme (oleum thymi, U. S. P.), often misnamed oil of origanum, is a volatile oil which is soluble in alcohol, ether, chloroform, and in carbon di sulphide, and possesses antiseptic and stimulating properties; it is principally used externally. • Preparations and Doses.—Oleum thymi (11. S. P.), 3 to 15 minims.
Thymol (U. S. P.), 1 to 10 grains.
Physiological Action.—Thymol para lyzes the terminal sensory nerves of the skin and mucous membranes, but is a local irritant. When given internally in doses of 20 to 30 grains, per diem, it causes a sensation of epigastric heat, as sociated sometimes with nausea and vomiting, but more generally with abundant diaphoresis, tinnitus ann um, deafness, a feeling of constriction in the forehead, a lowering of the temperature, and frequently diarrhoea. The urine is increased in quantity and becomes olive or dark- green in color, yellowish brown by transmitted light, and free from al bumin; on the addition of the tincture of the chloride of iron it becomes cloudy and grayish white in color. Violent delirium has occurred several times, marked collapse, and in one case (ty phoid fever) unconsciousness with alarming collapse. The continuous use of thymol in small doses appears to in terfere in some way with nutrition, so that emaciation results. Kiissner has found that thymol has the power of dis solving the red blood-corpuscles. Thy mol is excreted by the kidneys partly as thymol, partly as thymo-hydrochinon united with sulphuric acid, and partly as chromogen, which is probably an oxi dation product of thymol, and partly as some acid of unknown constitution (F. Blum, Deut. med. Woch., xvii, '91).