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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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