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the use of quinine urea hydrochloride we produce a natural barrier, we can say that we relieved our patient safely. This makes me believe that we come near fulfilling the golden rule of surgery by "re- lieving our patient, pleasantly, quickly and safely" in a class of cases, composed to a large extent of patients who would generally be considered be- generic cymbalta from canada yond generic cymbalta the age for safe surgical intervention. The average age for the development of first degree hemorrhoids is forty years, and the time necessary for the evolution from first generic cymbalta 2013 degree to third degree hemorrhoids is generally ten years, which brings the average age for the beginning of the third de- gree hemorrhoidal period at fifty. As this unre- lieved pathological condition persists during life, cymbalta online pharmacy it necessitates our dealing with a class of patients the majority of whom are in the fifth to the eighth decade of life. 605 HOLLIXGSWORTH BuiLDlNf;. GUNSHOT INJURIES OF THE CHEST IN CIVIL PRACTICE. By George P. Muller, M. D. Philadelphia. The cymbalta discount program treatment of gunshot injuries of the chest constituted one of the most interesting and important chapters in the medical history of the war and in the volume of literature was hardly exceeded by any subject except, of course, that of wounds per se and their treatment by revision, suture, and anti- septics. To the French we are indebted for much that is cymbalta 60 mg discount card new, particularly to Duval for the develop- ment of the method of wide discount generic cymbalta open thoracotomy and to Petit de la Villeon for his method of extraction of late projectiles. Those of us who were unable to participate in the active surgical work of the war must get our ideas from those who did the work, nuist assimilate cymbalta discount card the literature, and be prepared to adopt the plan of procedure in the hospitals with which we are connected, when a gunshot wound is brought under our observation. Let us first glance, superficially of course, over the record of accom- plishment, and the plans of procedure, during the October 23, 1920.] MULLER: GUXSHOT IXJURIES OF generic cymbalta 60 mg CHEST. generic cymbalta available us 615 forty years preceding the war. The oldest book on surgery which I own is that of Agnew who was professor of surgery in the University of Penn- sylvania from 1871 to 1888. Writing in 1878 he devotes considerable space to chest wounds but his buy online cymbalta opinions are entirely colored by the work of Otis who wrote the chapters on thoracic surgery (1). His descriptions, however, of wounds, of hemo- thorax, and other matters, are minute and really worth reading at this day, but he suggests nothing that is discount prescription card cymbalta radical. In speaking of hemothorax he ad- vises enlargement of the wound, it by so doing the outlet for the blood discount cymbalta 60 mg to escape will be increased. Agnew was succeeded by John Ashhurst and at the time I graduated, (1899) we online cymbalta petition were told by him to practice rest, apply cold and give opium. If bleeding from the lung continued he advised re- opening the original wound to allow the blood to escape or the generic cymbalta from india performance of paracentesis to relieve the dyspnea. Gross, professor of surger\- in the Jefferson Medical College, writing in 1882, had a fair idea of the pathological consequences of chest wounds. He classifies them as : Primary — shock, collapse of the lung, hemorrhage and pneumothorax ; cymbalta discount prices and, secondary discount cymbalta — inflammation and accumulation of serum, lymph, and pus in the pleural cavity. He states that in the Russian Army at the siege of Sebastopol the mortality from chest wounds was ninety-eight and five tenths per discount cymbalta coupons cent.; in the British Army it was eighty-one and five tenths per cent. He states that the Russian surgeons relied chiefly upon the use of digitalis ; the British upon copious venesection. In the Civil War, of 1272 cases, seventy-three per cent, were fatal. Gross makes no mention of thoracotomy and he recounts a fatal case where the ball was loose in the pleural cavit\' and was followed by violent inflammation and death in four weeks. Such cases he .says "must necessarily be fatal." Venesection and purgation were his sheet anchors, and the patient was always placed with the wound dependent generic cymbalta online to allow the blood to drain out. In an address before the American Medical Association in 1903 Rodman stated that the treat- ment for gunshot wounds of the chest should, as a rule, be a "masterly inactivity ; absolute rest, cooling drinks, a little opium, and a sterile immobilizing

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