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atomical f)oint at which the nerve was crushed. The lime found necessary for complete regeneration of the nerve when injured in the areas usuallv trau- matized by operation varies between thirty and sixty ilays. Kxploration of the recurrent laryngeal nerves produces an eri'ect on the vocal cords depending on the amount of trauma to which the nerves are sub- jected. Careful dissection will probably not produce any effect : the paralyses noted were probably due lo i)inrhing and other traumatic procedures. Subacromial Bursitis. — Hilbert F. Day (^Bos- ton Mcd'CLil and SiirNon Prescription Cialis Generic countcrtrac- tion. The cure is accomplished in from five to twelve days. Aspiration of the bursa is said to be helpful when there is a large amount of effusion into it causing intense, constant pain, but he has never em])loyed it. \\'hen there has been a partial rupture of the supraspinatus tendon, long weeks of disability may be saved by an operation. A two or three inch incision is made from the acromion process down over the greater tuberosity of the Inimerus, the Non Prescription Cialis Generic fibres of the deltoid .separated, the roof of the bursa exposed and incised. Pulling downward on the ami sometimes allows the bursa to fill with air and make its cavity easier to explore. Villous masses or ad- hesions can now be cut away. The floor of the bursa may be reddened and puffed up with a whitish centre, whicli, when incised, exudes a whitish ma- terial that should be scooped out. but not forcibly curetted. The floor of the bursa is then retracted to bring the tendon of the supraspinatus into view, which is next repaired with vertically placed sutures. The wound is then closed and the arm placed in abduction. Subacute cases, in which adhesions have formed. ref|uire more ingenuity and patience in treatment. Generally speaking, they may be handled in three different ways: By such an operatirn as has been described ; by forcible breaking up of ad- hesions under anesthesia ; by gradual stretching with massage, passive motion. Zander treatment, or ac- 902 MODERN TREATMENT AND PREVENTIVE MEDICINE. [New York Medical Journal. tive exercises. The treatment of chronic cases, in which adhesions have been broken up and motion is possible, Non Prescription Cialis Generic but perhaps painful, needs patience and considerable time. Patients of this type should have baking and massage at regular intervals, generally every other day, and should be given definite ex- ercises to follow up by themselves. These exercises should be graded according to the amount of reac- tion they set up, and are best taken at night. One of the best preliminary exercises is to have the pa- tient put his hand on a wall and slowly abduct the arm, creeping up the wall with his fingers. In all cases any possible focus of Non Prescription Cialis Generic infection should be elimi- nated as a routine procedure, not because subacrom- ial bursitis can be caused by infection, but because, given an injured bursa, secondary infection may keep up its inflammation. Treatment of Painful Neuritis. — J. A. Sicard (Lancet, February 9, 1918) recommends the injec- tion of the proximal portions of injured nerves for the relief of those cases of chronic, intense neuritic pain which not infrequently follow military injuries. Non Prescription Cialis Generic Under a local or general anesthetic the nerve wound is exposed by incision and dissection. The nerve is freed from its adjacent tissues and Non Prescription Cialis Generic one to two mils of sterilized sixty to eighty per Non Prescription Cialis Generic cent, alcohol is in- jected with a fine needle directly into the substance of the nerve in a healthy portion about three to four centimetres above the site of the injury. All the nerve trunks Non Prescription Cialis Generic supplying the painful region must be injected and where there has been Non Prescription Cialis Generic a previous opera- tion to free the nerve or to suture it the injection must be made above the upper limit of the former operation. The treatment should be employed only in the cases of very intense, persistent pain not re- lieved by simple measures. Non Prescription Cialis Generic The injections cause some motor paresis for several weeks or months, but this is always completely recovered from in time. Up to the present there has been only one failure in a series of forty-three cases. Angina Pectoris. — E. Fletcher Ingals and Wil- liam R. Meeker (Journal A. M. A., April 6, 1918) point out, in the course of a discussion of an ex- tensive series of private cases, that the nitrites are among the most valuable remedies for true angina, but that they are not commonly used in sufficiently large doses. Anywhere from ten to twenty or more hundredths of a grain of nitroglycerin may be re- quired in a day, and as many as 100 have been taken in a single day with very good effects. Often following the use of from five to ten hundredths in one day there Non Prescription Cialis Generic will be freedom from attacks during the whole day following. These large doses are frequently needed, and no harm will come from Non Prescription Cialis Generic in- creasing the doses if the way is carefully felt, and so long as they do not cause too much headache. For prompt action the drug should be taken by letting the tablet dissolve in the mouth or under the tongue. This often gives the full eiTects in one to three minutes, while swallowing the tablet may delay the action for ten minutes, and may greatly reduce its intensity. The drug should be reasonably fresh, and should be carried in a tightly stoppered, small bottle. The unpleasant odor is a disadvantage of amyl nitrite, as is the disposal of the glass from the pearls. Sodium nitrite may dis-