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combined with separate suspension of the thigh and leg, and extension of Cialis Costco the thigh by weights and pulleys. The Treatment of Fractures of the Cialis Costco Extremities by Means of Suspension and Traction. — Joseph A. J;;!al;o and Kenneth Ijulkley Cialis Costco {Surgery, Gyne- cology and Obstetrics, March, 1918) state that all wounds and fractures of the leg repair far more quickly if the limb is suspended, and this should be always done. 'I'lic Hodgen's splint bent to an angle of 135° is employed. The leg is suspended in the splint by the usual bands and the splint suspended above the bed by the trolley. Fractures of the fibula alone are of little consequence, being well supported by the tibia. They are suspended because of the improvement in circulation and for the Cialis Costco dressing of v/ounds, but no traction is necessary. Fractures of the tibia alone are splinted by the fibula and are prevented from overriding to any great extent, but incurvation is common. A slight traction of one or two kilos will correct this tendency. Fractures of both Cialis Costco bones demand more Cialis Costco care. Here traction of three or four kilos is necessary. Fractures of the tarsus and metatarsus are also commonly treated by suspension largely for the improvement in circula- tion obtained and the consequent more rapid heal- ing. In fractures involving the ankle joint, traction by means of a Sinclair-Smith "skate" is used. Treatment of Pleuritis and Empyema. — G. P. La Roque {l^'irginia Medical Scmi-Monthly, Jan- uary, 1918), referring to pleuritis after pneumonia, recommends watchful waiting for proper encap- sulation of the pleural exudate until accessible to needle puncture exploration, as a safer procedure than exploratory thoracotomy across a nonsuppu- rating pleural area, with its fifty per cent, mortality. Rest in bed, opiates to Cialis Costco secure rest of breathing, local applications, plenty of fresh air and sunshine, and self restraint on the part of the surgeon will Cialis Costco practi- Cialis Costco cally always lead to walling off of pus, after which puncture can be performed within an area three inches in diameter, with its centre at the seventh interspace just behind the axillary line. In aspi- rating, a large needle attached to a large record syringe, provided with a double stopcock for with- drawing and expelling the fluid, may be appropri- ately employed. In Cialis Costco young children, unless the pus is thick and yellow, Cialis Costco this is frequently all that is necessary. In adults and others, when the pus is thick. La Roque Cialis Costco commonly irrigates through the needle, injecting and evacuating saline solution with the aid Cialis Costco of the double stopcock until the fluid re- turns clear. In the presence of very thick pus he plunges a gallbladder trocar through the interspace, and irrigates with saline solution or a weak solution of Cialis Costco iodine. In such cases, a linear incision through the interspace under local anesthesia will permit of introduction of two small calibre rubber tubes, pinned Cialis Costco together and sutured to the skin. In from one to three weeks the drainage has ceased and the incision healed. By this treatment he has ob- tained 90 per cent, of cures without sinus forma- tion, and had no mortality due to the disease. He deems rib resection unnecessary as well as unsafe, conducive to sinus formation, and a hindrance to healing. In an occasional case the necessity may arise for intercostal incision and rib spreading ac- cording to the technic of Lilienthal as a second operation. MODILUS TKEAJMENT AND I'REVENTIVE MEDICINE. 951 A Cyllin Mixture in Intrathoracic Sepsis. — W. (.iordoii and M. \L. (jates {British Medical Journal, February 9, 1918) add two more cases, and mention a third, in which they have obtained very satisfac- tory results from the use of the following mixture : Iodoform 0.3 (gr. v) ; Cyllin, 0.3 (min. x> ; Olive oil 0.3 (mill, v) ; Their ilrst case, reported some years ago, was one of the apparent cure of pulmonary gangrene by in- Cialis Costco jection into the lung tissue of this mixture. The two now reported are of foul, septic empyema, both of which seemed to respond most favorably to the packing of the cavity with gauze soaked with the mixture. A third case is mentioned in which intra- thoracic sepsis following a gunshot womid re- -^ponded well to the treatment. Telephone Deafness. — George Cott {Buffalo Medical Journal, April, 1918) calls attention to sev- eral cases in which Cialis Costco persons when they put the telephone receiver to the Cialis Costco ear suddenly heard a loud, high pitched sound, and then could hear nothing more, the deafness persisting for a considerable length Cialis Costco of time. His explanation of the cause of this deafness is that any interference with the line while one is listening may jar the auditory nerve suddenly, anil induce a high pitched sound, fol- lowed by jirolongcd tinnitus with immediate deaf- ness, cither partial or total ; the symptoms amelior- ating after some weeks. This accident can be avoided, because it occurs only when the listener Cialis Costco holds the receiver in such contact with the ear that no external sound can enter, a Cialis Costco common way to hold the receiver when there is much noise around. If the user of the telephone ajiplics the receiver in such a way that a space is left for Cialis Costco free circulation of air between it and the ear, a shock cannot be transmitted to the nerve, no matter how much dis- Cialis Costco tuib.uuc there may be on the line. Modified Technic of Caesarean Section with Hysterectomy. — E. A. Schumann {American lournal of Cialis Costco Obstetrics, February, 191 8), in the pres- ence of indications for some form of Cesarean sec- tion, considers hysterectomv the o[ieration of choice where there is infection — as shown by fever and leucocytosis — where there has been marked trau- matism to the lower uterine segment, Cialis Costco or when the pregnancy is associated with salpingitis. After the usual low median incision, he cvcntrates the uterus, covers it with a hot, moist towel, and has it held