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effects of dressing him in lamisil 250 mg clothing saturated with a strong infusion of cof- fee, after the same manner that we use iodide of potassium, sulphur, etc. A strong infusion of coffee was prepared, and a linen shirt and pair of drawers were allowed to remain in this for half an hour, and, being partially dried, were put on him, and then covered with two blankets. In about thirty minutes the patient moved imeasily about in the bed, and again became quiet. Ten minutes after this he turned suddenly to one side, and vomited profusely, and asked for water. During the next hour he vomited frequently and freely. For the purpose of combating the effects of the morphine, I gave him, during the night, one drachm lamisil lotion of bromide of lamisil at spray potassium, in divided doses. When once aroused from the comatose state, he evinced no disposition to return to it, but conversed naturally, and during the rest of the night slept very little. I feared he would lamisil at gel suffer from the irritant effects of the undiluted chloroform, on the coats of the stomach, but up to 9 o'clock next day he made no complaint. I have since heard he recovered without an untoward symptom. SURGERY. 1. — Successful Application of the Trephine over the Right Lateral Sinus of the Brain. By Paul F. Eve, M. D., Professor of Operative and Clinical Surgery in the Uni- versity of Nashville. [Nashville Journal of Medicine and Surgery, December, what is lamisil 1871.] I take leave to report the following unusual operation — the successful removal lamisil tablet of four disks of bone from over and near the right lateral sinifs; this, too, in direct opposition to our best authorities in surgery. lamisil terbinafine Mr. Erichsen declares that " there are certain parts of the skull — over the venous sinuses, for instance, near the base — to which no prudent surgeon would apply the instrument." Prof. Gross, too, says : " There are certain parts of the skull where, if it is possible to avoid it, the trephine is never to be applied ; " and he specifies the lateral sinuses, to which he makes an additional objection to operating over them, due to the inordinate thick- ness of the occipital bone. My patient, Mr. lamisil one D. P. Eubanks, a stout, healthy man, aged forty-two years, while Sheriff of White County, Illinois, was struck from behind with a bludgeon, having a knot or bend in it, and knocked insensible for sixteen hours. This occurred two years and ten months ago; lamisil cream in the mean time ho had lamisil oral sought relief by visiting Evansville, Cincinnati, St. Louis, etc., and found one surgeon who ventured only to cut down on the depressed bone. Finding I had returned from the last-named city to Nashville, he arrived here on the 25th of October, and was put upon treatment preparatory to a tentative operation at trephining. lamisil at cream Precisely midway between the occipital protuberance and the lamisil at external meatus of the right ear, there was a depression in the cranium of about three-quarters of an inch in depth, with the circumference of a silver half- SUEGEEY. 409 dollar. This resulted froiu the blow already referred to ; and, while the patient had not become epileptic, he yet experienced symptoms demanding operative interference. One professional gentleman, as we have men- tioned, had already attempted this, Mr. Eubanks was now habitally cos- tive; walked with difficulty, and only a short distance ; complained of con- stant weight and oppression in his head; of a dull, annoying pain, radiating at irregular intervals fi-om the point Injured; had lost his energy ; was never cheerful, and was losing flesh and strength. Nothing could provoke a smile ; was almost hopeless, and said that he occasionally felt like losing his senses. Dr. Buchanan unexpectedly coming into my lamisil 250 office, ffi'st encouraged an operation, lamisil purchase by stating that his father once saved a patient in whom the lon- gitudinal sinus had been opened ; thus confirming the opinion that wounds of the large venous canals of the brain were not necessarily fatal. On the 28th of October (Dr. Buchanan being indisposed), assisted es- pecially by Drs. Briggs, Van Lindsley, Fitts, and others, and before the class, the usual crucial incision was made over the depression in the skull ; then, by detaching the occipital portion of the occipito-frontalis and the insertion of the trapezius muscles, thus getting below the superior curved line of the os occipitis, the half-inch crown of Gait's trephine was applied, and, working it very cautiously, in about fifteen minutes a button of bone was removed, fortunately, too, without wounding the dura mater. It was our design to cut through the osseous structure, found, happily, quite thin, di- rectly above the right lateral sinus, and now, by sawing out three other cir- cular pieces of bone, it was made evident that our object had been carried out ; for, in the space made by the elevation of these three disks, lay, undisturbed, the lateral sinus, readily recognized by the deeper color of its venous blood. Nothing now remained to complete lamisil gel the operation, which was performed in about forty minutes, but to cut off the angles left by the trephine, round off the bony opening, and secure over it, by silver-wire sutures, the four angular flaps of the scalp. Some five ounces of blood was lost, but only one artery lamisil online Avas tied. Coming from under the influence of ether, the patient expressed himself feeling better, and was soon after conveyed to the hospital. He was put on the most rigid after-treatment— absolute diet and per- fect repose. A slight reaction the next day was met by small doses cost of lamisil of lamisil spray sulphate of magnesia ; and he subsequently experienced not a serious price of lamisil symptom. Of course one so long and so seriously afflicted could not re- cover at once, and had periods of depressions, but nothing more. Locally, cold cloths were applied, then changed to emollient tepid poultices ; a very blunt probe was inserted every day or two, at the most pendant cut, to prevent accumulation under the scalp, which gave exit first to sanies, for some days, when the wire sutures were removed, and gradually the secretion became lessened and converted to laudable pus. The wound was thus kept open to the thirtieth day, when it gradually closed. The case found most similar to the one here presented is recorded b}' my friend Prof. F. II. Hamilton, in his " Treatise on Military Surgery," page 240, where he notices the injury sustained by a lad ten years of age,

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