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346 SOITHERS MEDICINE & SURGERY September, 1949 It is essential to recognize the existence of the reading problem within the first year or so of schooling and to take steps promptly toward its correction, with special emphasis on ability to recognize at first letters and their phonetic values, and later the details of syllable and word structure. As regards many children, perhaps the great majority. an important mistake has been made, for the past quarter century or more, in departing from the old methods of teaching word-structure and word-recognition. The most practical approach to educational economy in acquirement of the reading skill includes not merely an attempt to correct failures already more-or-less firmly established, but the use of teaching method which will as far as possible prevent creation and fixation of reading failures in each new school generation. Many times has the editor protested against the foolish theory that a child should be taught to recognize words before he is taught the letters of which the word is made up, and cited the poor spelling and poor learning of reading and writing which result from the Xew Deal way. A benison on the Denver gentleman and scholar. May his words gain heed according to their timeliness and wisdom. S(»mk Diktakv Factors ik Cardiovascular Diseases (Siinujcl I'rogcr. Mc.ston, in K. I. Med. JL, July We have heard much of late about the role of salt in cardiovascular disease; more particularly in hypertension and in con^restive heart failure. An increase of salt intake docs not elevate the blood pressure; salt restriction on th -other hand, if extreme, appears to lower b. p. in some cases, but only so long as the extreme sodium restriction is continued. The striking lowering of the high blood ure.i nitrogen and the dramatic clearing of neuro-retinitis, which are more important than the simple lowering of the b. p., may result from some of the restriction of the rice diet other than salt—the low-protein content, for example. .1 low-salt intake is justifiable in hypertension only if there is evidence of cardiac weakness, then not for tk^ louerinfi of b. p., but in order to prevent accurtiuhiion of fluid. The question may be raised whether salt restriction may be prophylactically beneficial in hypertension; that is. whether it may be helpful in preventing cerebral accidents. heart failure, or renal insufficiency. There is no evidence to favor such an assumption. If the occasional b. p.-lowering effect of a low-salt intake could be maintained, it would certainly be desirable: however, the salt restriction must be extreme to be effective and this makes it difficult. The evidence thus far indicates that, if salt restriction is to be employed in the treatment of hypertension, it must be extreme and permanent. It is questionable whether such a program is worth th? deprivation, particularly since most patients with hypertension live a relatively long life with few symptoms ascribable to hypertension. It is not unlikely that the present enthusiasm for the use of salt restriction in hypertension per se will quickly wane. In congestive heart failure one must have excessive fluid retention, and in order to have excessive fluid retention one must have sail retention. In severe congestive heart failure maximal restriction of salt intake is necessary. Patients with heart disease but without recent heart failure often seem to be able to tolerate a normal or moderate salt in- take quite well, just as patients who have been severely dyspneic on slight exertion may after active therapy perform moderate physical exertion with complete comfort. By less stringent salt restriction during relative cardiac competency it may be that some of the deaths being reported from the too enthusiastic and prolonged salt restriction plus frequent mercurial diuretics might have been prevented. SURGERY FLOSS SILK DARX FOR IXGULVAL HERXL\ The floss-silk darn operation for inguinal hernia incorporates all the good technical points of the many time-honored herniorrhaphies. This startling statement is made by Maingot^ who goes on to give details. The all-silk technique is employed throughout; fine silk for ligatures and sutures, and jloss silk for the lattice repair which covers the buttresses the weakened posterior wall of the canal and an area well beyond this. Asepsis must be rigid, hem-ostatsis complete, trauma minimal, and suturing impeccable. The silk, after being boiled in w'ater for 30 min-ute.s, is soaked in 500,000 units of penicillin. Penicillin is given systemicallv in full dosage for the first four post-operative days as a routine measure. This operation is said to be applicable to all types of inguinal hernia—direct, indirect and recurrent—except the small congenital hernia of children and young adults with good muscular and fascial supports, in w^hich simple herniotomy, followed by repair of the internal ring, is the procedure of choice. Maingot sets no age-limit on his cases for hernia surgery, and refuses only those in which there are definite contraindications such as pulmonary tuberculosis. The important steps of the operation are: 1. Crease incision, as it heals well and the scar is flexible and almost invisible. 2. Stripping the cremaster muscle from the cord and removing an indirect sac after transfixion and ligation of the neck. 3. Suturin gthe cremaster and transversalis fascia (from the point where the cord issues from the internal ring to pubic spine) to Poupart's ligament. 4. The insertion of the floss silk darn from the pubic tubercle to the point w^here the cord issues from the internal ring and then back again to the symphysis. The first row is inserted along Pou-part's ligament and the conjoint tendon, whilst the returning layer is introduced with a wider traverse rectus sheath to I'oupart's ligament. 5. Approximation of the cut edges of the external oblique aponeurosis behind the cord. 6. Ensuring that there is no gap or weak spot 1. Rodney Maingot. in Proc. Royal Soc, Med. (Lond.), Julv.
Object Description
Rating | |
Fixed Title * | NCHH-22: Southern Medicine and Surgery [1921-1953] |
Document Title | Southern Medicine and Surgery [1921-1953] |
Subject Topical Other | Medicine -- North Carolina -- Periodicals. |
Publisher | Charlotte, N.C. : Charlotte Medical Press, 1921-1953. |
Repository | University of North Carolina at Chapel Hill. Health Sciences Library. |
Host | University of North Carolina at Chapel Hill |
Date | 1949 |
Identifier | NCHH-22-111 |
Form General | Periodicals |
Language | English |
Rights | This item is part of the North Carolina History of Health Digital Collection. Some materials in the Collection are protected by U.S. copyright law. This item is presented by the Health Sciences Library of the University of North Carolina at Chapel Hill for research and educational purposes. It may not be republished or distributed without permission of the Health Sciences Library. |
Digital Collection | North Carolina History of Health Digital Collection |
Sponsor | The North Carolina History of Health Digital Collection is an open access publishing initiative of the Health Sciences Library of the University of North Carolina at Chapel Hill. Financial support for the initiative was provided in part by a multi-year NC ECHO (Exploring Cultural Heritage Online) digitization grant, awarded by the State Library of North Carolina, and funded through the Library Services and Technology Act (LSTA). |
Volume Number | 111 |
Health Discipline | Medicine |
Digital Format | JPEG 2000 |
Print / Download PDF Version | http://archives.hsl.unc.edu/nchh/nchh-22/nchh-22-111.pdf |
Document Sort | all; group-e; nchh-22 |
Volume Link | http://dc.lib.unc.edu/cdm/search/collection/nchh/field/identi/searchterm/NCHH-22-111 |
Title Link | http://dc.lib.unc.edu/cdm/search/collection/nchh/field/documa/searchterm/NCHH-22 |
Catalog Record link | http://search.lib.unc.edu/search?R=UNCb2542543 |
Revision History | keep |
Description
Fixed Title * | Page 346 |
Document Title | Southern Medicine and Surgery [1921-1953] |
Subject Topical Other | Medicine -- North Carolina -- Periodicals. |
Publisher | Charlotte, N.C. : Charlotte Medical Press, 1921-1953. |
Repository | University of North Carolina at Chapel Hill. Health Sciences Library. |
Host | University of North Carolina at Chapel Hill |
Date | 1949 |
Identifier | NCHH-22-111-0324 |
Form General | Periodicals |
Page Type | all; report/review |
Language | English |
Rights | This item is part of the North Carolina History of Health Digital Collection. Some materials in the Collection are protected by U.S. copyright law. This item is presented by the Health Sciences Library of the University of North Carolina at Chapel Hill for research and educational purposes. It may not be republished or distributed without permission of the Health Sciences Library. |
Filename | southernmed1111949char_0324.jp2 |
Digital Collection | North Carolina History of Health Digital Collection |
Sponsor | The North Carolina History of Health Digital Collection is an open access publishing initiative of the Health Sciences Library of the University of North Carolina at Chapel Hill. Financial support for the initiative was provided in part by a multi-year NC ECHO (Exploring Cultural Heritage Online) digitization grant, awarded by the State Library of North Carolina, and funded through the Library Services and Technology Act (LSTA). |
Volume Number | 111 |
Issue Number | 11 |
Page Number | 346 |
Health Discipline | Medicine |
Full Text | 346 SOITHERS MEDICINE & SURGERY September, 1949 It is essential to recognize the existence of the reading problem within the first year or so of schooling and to take steps promptly toward its correction, with special emphasis on ability to recognize at first letters and their phonetic values, and later the details of syllable and word structure. As regards many children, perhaps the great majority. an important mistake has been made, for the past quarter century or more, in departing from the old methods of teaching word-structure and word-recognition. The most practical approach to educational economy in acquirement of the reading skill includes not merely an attempt to correct failures already more-or-less firmly established, but the use of teaching method which will as far as possible prevent creation and fixation of reading failures in each new school generation. Many times has the editor protested against the foolish theory that a child should be taught to recognize words before he is taught the letters of which the word is made up, and cited the poor spelling and poor learning of reading and writing which result from the Xew Deal way. A benison on the Denver gentleman and scholar. May his words gain heed according to their timeliness and wisdom. S(»mk Diktakv Factors ik Cardiovascular Diseases (Siinujcl I'rogcr. Mc.ston, in K. I. Med. JL, July We have heard much of late about the role of salt in cardiovascular disease; more particularly in hypertension and in con^restive heart failure. An increase of salt intake docs not elevate the blood pressure; salt restriction on th -other hand, if extreme, appears to lower b. p. in some cases, but only so long as the extreme sodium restriction is continued. The striking lowering of the high blood ure.i nitrogen and the dramatic clearing of neuro-retinitis, which are more important than the simple lowering of the b. p., may result from some of the restriction of the rice diet other than salt—the low-protein content, for example. .1 low-salt intake is justifiable in hypertension only if there is evidence of cardiac weakness, then not for tk^ louerinfi of b. p., but in order to prevent accurtiuhiion of fluid. The question may be raised whether salt restriction may be prophylactically beneficial in hypertension; that is. whether it may be helpful in preventing cerebral accidents. heart failure, or renal insufficiency. There is no evidence to favor such an assumption. If the occasional b. p.-lowering effect of a low-salt intake could be maintained, it would certainly be desirable: however, the salt restriction must be extreme to be effective and this makes it difficult. The evidence thus far indicates that, if salt restriction is to be employed in the treatment of hypertension, it must be extreme and permanent. It is questionable whether such a program is worth th? deprivation, particularly since most patients with hypertension live a relatively long life with few symptoms ascribable to hypertension. It is not unlikely that the present enthusiasm for the use of salt restriction in hypertension per se will quickly wane. In congestive heart failure one must have excessive fluid retention, and in order to have excessive fluid retention one must have sail retention. In severe congestive heart failure maximal restriction of salt intake is necessary. Patients with heart disease but without recent heart failure often seem to be able to tolerate a normal or moderate salt in- take quite well, just as patients who have been severely dyspneic on slight exertion may after active therapy perform moderate physical exertion with complete comfort. By less stringent salt restriction during relative cardiac competency it may be that some of the deaths being reported from the too enthusiastic and prolonged salt restriction plus frequent mercurial diuretics might have been prevented. SURGERY FLOSS SILK DARX FOR IXGULVAL HERXL\ The floss-silk darn operation for inguinal hernia incorporates all the good technical points of the many time-honored herniorrhaphies. This startling statement is made by Maingot^ who goes on to give details. The all-silk technique is employed throughout; fine silk for ligatures and sutures, and jloss silk for the lattice repair which covers the buttresses the weakened posterior wall of the canal and an area well beyond this. Asepsis must be rigid, hem-ostatsis complete, trauma minimal, and suturing impeccable. The silk, after being boiled in w'ater for 30 min-ute.s, is soaked in 500,000 units of penicillin. Penicillin is given systemicallv in full dosage for the first four post-operative days as a routine measure. This operation is said to be applicable to all types of inguinal hernia—direct, indirect and recurrent—except the small congenital hernia of children and young adults with good muscular and fascial supports, in w^hich simple herniotomy, followed by repair of the internal ring, is the procedure of choice. Maingot sets no age-limit on his cases for hernia surgery, and refuses only those in which there are definite contraindications such as pulmonary tuberculosis. The important steps of the operation are: 1. Crease incision, as it heals well and the scar is flexible and almost invisible. 2. Stripping the cremaster muscle from the cord and removing an indirect sac after transfixion and ligation of the neck. 3. Suturin gthe cremaster and transversalis fascia (from the point where the cord issues from the internal ring to pubic spine) to Poupart's ligament. 4. The insertion of the floss silk darn from the pubic tubercle to the point w^here the cord issues from the internal ring and then back again to the symphysis. The first row is inserted along Pou-part's ligament and the conjoint tendon, whilst the returning layer is introduced with a wider traverse rectus sheath to I'oupart's ligament. 5. Approximation of the cut edges of the external oblique aponeurosis behind the cord. 6. Ensuring that there is no gap or weak spot 1. Rodney Maingot. in Proc. Royal Soc, Med. (Lond.), Julv. |
Digital Format | JPEG 2000 |
Print / Download PDF Version | http://archives.hsl.unc.edu/nchh/nchh-22/nchh-22-111.pdf |
Document Sort | all; group-e; nchh-22 |
Volume Link | http://dc.lib.unc.edu/cdm/search/collection/nchh/field/identi/searchterm/NCHH-22-111 |
Title Link | http://dc.lib.unc.edu/cdm/search/collection/nchh/field/documa/searchterm/NCHH-22 |
Catalog Record link | http://search.lib.unc.edu/search?R=UNCb2542543 |
Revision History | keep |
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