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hundred men receiving chest wounds, twenty-five die before reaching a clearing station, fifteen die before reaching a base hospital, and five die before reaching a general hospital. Shrapnel and shell wounds are much more fatal than rifle wounds, because the lung is Cheap Cozaar usually torn at a distance from the passage of the missile through the chest; an in- LEVBARG: RETROPHARYNGEAL ABSCESS. 417 jury by contre-coitp, so to speak, due to the Cozaar Price blow de- livered on the resisting pleura at the moment of entrance of Buy Cozaar Online the shell fragment. These cases are nearly all fatal as shock and hemorrhage Cozaar Mg are ex- cessive. It is in the cases of small penetrating wounds of the lung with retention of missile or missiles within the lung, that the great progress has been made. It must be remembered, that Order Cozaar in most cases, the injury, even thougli only a single bullet has passed, is an injury bv multiple missiles, for as pointed out be- fore, the high power projectile, and especially the rifle bullet, upon impact, converts everything in its path into secondary projectiles. So bits of clothing, paper, buttons, spicula of shattered bone, pieces of tissue, even coins and pipe stems, in fact anything that is in the way of the bullet has imparted to it a terrific motion, and each particle in turn becomes an added mjur\' inflicting projectile. The result is, that a single perforating wound of the pleura and lung is seldom seen, but the usual injury consists Buy Cheap Cozaar of the entering wound, and multiple lacerations of the lung Avith all k'nds and numbers of particles Price Of Cozaar imbedded in the lung tissue itself. The method of treatment is as follows: If the patient is quiet, does not cough, or spit blood, Buy Cozaar he is left alone. If he is restless, has short hacking cough, or spits blood, the following procedure is undertaken : The patient is etherized in the ordinary way, having received Cozaar Online a hypodermic of morphine sulphate, one quarter grain, and atropine, i/ioo grain, half an hour before the operation. An incision along the fourth rib starting at the sternum is made and car- Cozaar 100mg ried to the anterior axillary line, the rib is freed along its entire length, the costal cartilage is cut, and the rib is fractured in the axillary line and either bent up or removed. All bleeding is now stopped. The ribs are Cozaar 25 Mg retracted as widely as pos- sible, Purchase Cozaar and the pleura is dissected from the ribs as far as possible, up and down, inside the chest cavity. The adhesion between pleura and chest wall bleeds freely, but it must be separated or it will be impos- sible to close the pleura. When the bleeding has ceased, the pleura is opened nearly the entire length of the incision, the hand is put into the chest cavity, swept around it, the lung is grasped and all of it is brought up and spread out on the chest. The lung is kept warm and moist by towels and Cozaar 50mg saline. Often adhesions are encountered between the parietal and visceral layers of pleura. These are easily separated. Then the search for the foreign bodies in the lung tissue is made. Even the smallest spicula of bone or foreign matter is easily detected with tiie fingers, by pressure on the lung as it lies on the chest wall. It gives one very much the same sensation, as do the calcareous particles in a new sponge when being squeezed. As each foreign particle is detected, the lung tissue is made tense over it, a small incision is made, and the particle removed. The wound is then sewed up, just as you ivould sew up liver, kidney, or any other tissue. ^Vhell every particle has been removed, the tear made by the bullet is examined, dead tissue removed freely, and the tear is repaired by Online Cozaar suture. The whole lung is then dried, sponged rapidly with ether, and dropped Cozaar 100 Mg back into the chest cavity.' The pleura IS sev/ed up, and the chest wound closed, without drainage. The ether with which the lung is Cost Of Cozaar sponged, vaporizes within the chest and prevents too rapid an expansion of the lung and consequent liernoirhage. If the lung does Discount Cozaar not expand in forty- eight hours, an aspirating needle is introduced and the ether vapor is aspirated. This is the operation tiiat bas reduced the mortality of gunshot wounds of the chest from forty-six per cent, Cozaar Cost to twenty per cent. This paper proves that no matter what emer- gency confronts the doctors in France there will always Losartan Cozaar be some one who will rise to meet the emer- gency and conquer it. And as these men conquered the Flanders' mud in their wounds, so Sir Berkeley Moynihan has conquered that heretofore terra in- cognita — the injured lung. 40 South Street.

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