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there is little swelling before the periosteum bursts. Careful examination will always reveal a point of maximum tenderness, which is to be found by pressing gently on the skin with a toothpick or neurontin prices generic some such pointed object. The patient generic neurontin 300mg can often locate this spot very accurately. This tender point exists very early in the disease before neurontin 800mg the infection has spread far or broken through the periosteum. Under the neurontin price comparison tenderest point between the periosteum and the bone is the seat of the trouble. Over this point is the place to open, and the knife point should reach the bone here only. A large incision generic neurontin manufacturers is never needed if one neurontin discount card can get the patient early. Often only a very generic neurontin gabapentin neurontin 600 mg high small drop of pus is found. The process usually lasts two or three days before the periosteum gives way. Knowing the pathology, course, and prognosis of infections, no sane man would counsel any other than surgical treatment ; vet, those who do not know advocate poulticing until the felon — for this is a real felon — is "ripe." The offending organisms in hand infections are usually the staphylococcus and the streptococcus, neurontin 200 mg and the pus is very thick and does not run out easily. Saline in which citrate of soda has been dissolved, two drams to a pint, helps to thin the pus. So does Dakin's solution. Dress with gauze generic neurontin solution moistened in such a solution, change often, and keep the part at rest. Instead of the moist dressing, constant immersion in a hot bath of saline and citrate is often better. We use the latter during the day and the warm, wet pack at night. When neurontin price streets infection following wounds in the skin or subcutaneous tissue spreads, it does so most often by way of the lymphatics. There are lymphatic vessels passing along the sides of the fingers. Their radicles are in the deeper layers of the skin, the sub- cutaneous tissue, and in the periosteum and bone. But in addition there are what are known as lymph spaces ; for example, what are called perifascial lymph spaces exist between the subcutaneous fat and the deep fascia or tendon sheaths, and there are perivascular lymph spaces around the vessels on neurontin 300 mg pain each side of the finger. If now, for any reason, a lymph space becomes infected, the pus can easily spread in any direction until the whole space is involved. This explains how it happens that pus may extend completely around a finger neurontin discounts and not affect the tendon sheaths or periosteum at all. It is a point to remember in opening phlegmons of the fingers ; for if one cut deeper than the plane where he encounters the pus, and if neurontin price the incision is over a tendon sheath, he may cut through the fibrous tendon sheath and unnecessarily open its synovial lining. This, too, may follow the insertion of a drain or pack, the pressure of the same causing necrosis of the tendon sheath. The ordinary lym- phatic vessels passing down the sides of the fingers converge in the web, unite, and crossing the web, enter the palm or pass to the back of the hand. Great numbers of them eventually reach the back of the hand. This, as well as the loose nature of the subcutaneous tissue there, explains why it is that the back of a hand undergoes such great swell- ing in all these infections. It is simple, lymphatic edema. Very seldom does pus so spread, but the web between the fingers is the place to look for generic neurontin available the ■ first metastatic abscess in finger infections. Bac- teria — not pus — get into the lymph channels and 668 COi'uliLIX: neurontin price increase SURGICAL TREATMENT OF HAND INFECTIONS. [New neurontin price without insurance York edical journ^ flowing:; back neurontin 300 mg for nerve pain reach the web. The web is filled with fat. Fat is poorh- suppHcd with blood, its resist- ance being low. This fat is no exception to the rule and the bacteria find a good place to grow, just as they do neurontin mg when crossing the ischiorectal foss_a through the lymphatics there. An abscess develops in the Kic. 5.— Di.ngr , tendons of lur

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