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healing. If the missile is impacted in bone the in- cision may have to be enlarged even by division of the Hganientum jjatellae to give free access. The site of tlie missile is isolated with moist saline gauze and the missile is removed by clean excision of Mirtazapine 15 the bone containing it. At times the original opening is closed and one made on the opposite side to reach the foreign body, which is removed Remeron Cost by excision. Grooved bone injuries are treated by complete ex- cision. In deep bone injuries in the centre of the joint, excision is sometimes not possible but the ap- plication of 15 Mg Mirtazapine the Carrel treatment will often save Mirtazapine 30 the joint, or the wound can be curetted and the joint closed after free irrigation. In some cases of com- minution the patella may have to be excised, which should be done in one piece with the primary ex- cision. Small injuries to the patella should be re- moved cii masse with a metacarpal saw. The irri- gation fluid for the joint should be normal saline. In clean cases fat can profitably be transplanted into holes in the articular surfaces. In closing the joint the most important step is the complete closure of the synovial membrane Generic Remeron without tension, which may require the loosening of its lateral reflection, or the use of the suprapatellar pouch. The remainder of the wound is then sutured in layers and the leg is put up in a Thomas splint. Treatment of Empyema at Camp Lee. — The Empvema Commission, headed by Major Edward K. Dunham { Journal A. M. A., August 3, 1918), has investigated 140 cases of empyema due to hemo- lytic streptococcic infection and has found the fol- lowing general plan of treatment to be the most rational and to give the best results, both with reference to life and to restoration of lung function. During the acute stage of the illness the patient should be confined to bed and treated and nursed carefully with the object of maintaining his strength and enabling him to combat the Order Remeron Online infection. The chest should not be opened at this stage because of the poor general condition and the danger of caus- ing septicemia. If necessary the chest may be as- pirated through Remeron Mg a needle from time to time to re- lieve mechanical embarrassment. When Order Remeron the fluid has changed from a serofibrinous one to frank pus and the patient's Buy Remeron general condition has improved, as shown by drop in temperature and respiration and disappearance of cyanosis and air hunger, opera- tion may be undertaken. In a few cases it will not be necessary because of the total disappearance of the fluid after one or more aspirations. The opera- tion should be done Remeron Price under local anesthesia by infiltra- tion or Allocking or both. The site of Purchase Remeron the incision should be chosen with reference to drainage in both the recumbent and sitting positions. The incision must be long enough to give good access Mirtazapine Mg to the underlying structures, which are divided as ex- posed, the pleura usually being incised in an inter- costal space. A double drainage tube of large cali- bre may be used, permitting both drainage and irrigation through the insertion of Carrel tubes, or a single tube may be inserted and connected with a series of water bottles and a reservoir for Dakin's solution to permit of continuous suction and the in- stillation of Dakin's solution. The cavity should be irrigated with Dakin's solution every day until the washings return clear, and the tubes and dressings should be changed daily, the strictest asepsis being observed. After the cavitv has become sterile and the discharge Buy Remeron Online has almost disappeared its diminution in size usually goes forward with remarkable rapid- ity and it is seldom necessary to perform secondary operations for Mirtazapine 15 Mg its obliteration. This is especially the case when the interval has not been too long be- tween the operation and the beginning of the use of Dakin's solution. Oil of Chenopodium in Amebic Dysentery. — Mil ford Edwin Barnes and Edwin Charles Cort {Journal A. M. A., August 3, 1918) record a num- ber of cases of amebic dysentery, or of carriers of cysts, which were treated with oil of chenopodium as the result of a casual observation that the oil had promptly relieved dysentery when given for hookworm disease. In most of the cases in which it was tried there Remeron Tablets was very rapid relief of the clinical symptoms, the cases having been subacute or Remeron Online chronic. The drug was proved to be a Purchase Remeron Online powerful amebicide when given either by mouth or per rec- tum, as shown by the prompt disappearance of the amaeb;e from the stools. The tendency to relapse Cheap Remeron was not greater in the series studied than under the use of emetine. Oil of chenopodium would seem to be of distinct value for dysentery, since it can be given with safety when combined in a single dose with castor oil. Emetine has been shown Buy Cheap Remeron to be somewhat dangerous in doses sufficient to cure amebic dysentery and has also not proved entirely satisfactory as a specific in any of its forms. The oil of chenopodium should be given in doses of one to two mils in forty-five mils of castor oil, in one dose, or it can be given by rectum in an emulsion with acacia. In the latter case the enema should be given slowly with the buttocks raised ; should be re- tained for at least an hour, and the anal mucosa and skin should be protected from irritation by

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