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cleanliness ; and, if on the anterior or lateral, the pus is apt to
burrow — whereas, if the patient has the power amoxil 250 mg of changing
his position, the matter can be made to gravitate, and dis-
charge at a 500mg amoxil dependent point, l^o matter how many openings
there may be, amoxil 250 cheap amoxil the splint is still apj^licable ; for, after it has
hardened, fenestrcB may be amoxil 400 cut of any required size, in any
part of the splint, amoxil buy online witliout materially inipairing its strength.
If, however, the fenestrm are to be near each other, wires of
sufficient amoxil 875mg size should be laid between them amoxil 250mg during the applica-
tion of the roller, to insure requisite solidity. Every time a
fresh dressing is applied amoxil price to the openings for the absorption of
the pus, the edges of the fenestrce should be well " calked "
with " patent oakum " or some such absorbent, to prevent the
pus insinuating itself between the splint and the limb. In the
case of a compound fracture of the humerus, the treatment of
which I have just completed, although there were three sinuses
communicating with the bone, necessitating three large open-
ings in the splint above its middle, with the soft parts in a
very unfavorable condition from a protracted attack of phleg-
monous erysipelas, the splint remained perfectly firm for six
weeks, during which it was kept on without once being re-
moved, with the result of perfect consolidation ; and perfect
cleanliness was maintained throughout, the dressings being
all managed purchase amoxil by the patient and his wife. Dr. Burnett, house-
surgeon of Bellevue Hospital, assisted me in the management
of the case.
This apparatus finds another valuable application in the
management of severe sprains and strains in and about the
PEOLONGED EXPIEATION. 231
large joints. The firm and methodical application of strips
of diachylon-plaster in at least three layers, immediately after
the injury, and, if necessary, the subsequent application of the
light plaster-splint, save more pain, and effect a much more
rapid cure, than any other method. Even in those severe
cases of articular rheumatism in the knee, ankle, or elbow,
where the mere idea of movement, or the touch of the couch
by an attendant, produces a cry of pain, and where it is im-
possible, by any position of the body or arrangement of the
couch, to obviate movement of the joints, a light plaster-splint
would effectually relieve all distress from this cause, and thus
tend to expedite the cure ; just as a plaster or muslin amoxil 500 bandage
around the thorax in pleuritis gives more relief even than an
anodyne, and favorably influences the treatment. I have used
it, on the recommendation of other surgeons, also with great
satisfaction in the treatment of club-foot in the youngest in-
ftxnt ; here it is the safest and most effective of all appliances.
Art. II. — Prolonged JExjoiratiooi : its Physical Cause, and
its JRelation to the Pretubercular Stage of Consumjption.^
By Samuel G. Aemoe, M. D.
Ii^^ the study of physical science we constantly encounter
facts of observation, and have only hypotheses to explain them.
Now, it may be that, in attempting an explanation of a fre-
quently-observed clinical amoxil generic fact, I shall be charged amoxil tablets with indulg-
ing in mere speculation ; not, I online amoxil hope, as to the fact itself — for
I cannot doubt that, in a certain proportion of cases, and that
more than has been generally supposed, prolonged expiratory
murmur is an early and prominent feature in the forming stage
of phthisis. And I am equally certain that the sign may be
recognized, both in tracheal and vesicular respiration, inde-
pendently of any very marked variation in intensity, quality,
or pitch. This general statement brings the subject-matter
of discussion at once before the mind.
It will amoxil 500 mg be remembered that prolonged vesicular breathing,
in the absence of vesicular emphysema, has been generally in-
* Bead before the Kings County Medical Society, Brooklyn, N. Y.
232 PEOLONGED EXPIRATION.
terpreted as indicating the " jDresence of tubercle," and that it
does so, in many instances, cannot be doubted. amoxil 875 mg To Dr. James
Jackson, Jr., of amoxil order Boston, is due the honor of having first at-
tracted the amoxil buy attention of the profession to this subject. He
published a communication in 1833, on the subject of a pro-
longed expiratory sound as frequently constituting an impor-
tant physical sign of the first stage of phthisis, and now, so far
as I know, the sign is recognized, with varied degrees of amoxil 875 value
attached to it, in all the standard text-books of Europe and
America.
" The expiratory murmur," says Skoda, " is constantly in-
creased in duration from the normal standard of two to eight
or upward."
Niemeyer speaks of different degrees of value attached to
the sound, and adds, " "When prolonged and altered in quality,
it is very significant."
Flint says : " The earliest and most obvious of the auscul-
tatory evidences of tubercle, in a certain proportion of cases,
undoubtedly, are incident to expiration."
And this observation is fully confirmed by Dr. Theophilus
Thompson, in his " Clinical Lectures on Pulmonary Consump-
tion." From the analysis of a large number of cases, he was
led to conclude that " a prolonged expiratory murmur fre-
quently takes precedence of other characteristic signs."
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