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Having seen in some sample journal a two or three line item recommending the preparation of aseptic catgut by first treating it with formalin and then boil- ing, I thought it worth while to try it. Being much pleased with the result, it would seem but proper that I should bring it more generally to the notice of the profession. After trying various strengths of the for- malin, I find the twenty per cent, to be the most satis- factory, leaving the gut immersed in it for three and one-half hours. It should then be at once transferred to boiling water for fifteen minutes or longer, if one so desires, when it will be found in excellent condition. Raw gut that bears a weight of thirty pounds will af- ter the formalin treatment lift twenty-six pounds, and boiling it for fifteen minutes does not weaken it. If is curious that the gut which has been prepared for several weeks seems to become nearly as strong as the original raw article. If one wishes to boil it on spools, care should be taken to wind it very loosely, as it swells and con- tracts during boiling and might easily be broken. The better plan is to order cyproheptadine prepare it before winding on spools; then with aseptic hands it can be made read\ for stor- ing away in alcohol for future use. One day I left some gut in the formalin for eight hours and found it rotten. It would lift but six pounds. After boiling for fifteen minutes I was sur- prised to find that it would bear a weight of sixteen pounds before breaking. So far as I can ascertain, twelve minutes is the longest time that bacteriolo- gists consider that anthrax spores can resist boiling water. Surely, then, fifteen minutes' boiling ought in everv buy cheap cyproheptadine instance to render catgut sterile. Intestinal Perforation in Typhoid — There is no complication of enteric fever more dreaded by the physician than perforation. It occurs in about two per cent, of all cases. Its most frequent causes are improp- er diet, distention of the bowel from buy periactin any cau.se. or too early and sudden movements of the patient. — Wicfa.v. DISINFECTION OF THE HANDS DURINa LABOR. Bv HARVEV B. BASHORE, M.D., WEST FAIR\'IEW, PA. There is always a danger that valuable methods ia science and art may be neglected on account of their complexity; and this seems to me to be just about the position of hand disinfection during labor. The elab- orate methods which are advised in certain quarters will perhaps do well purchase periactin enough in a maternity hospital,, but most women are confined at their homes, and what we want is a method for the practitioner which is both effective and at the same time as simple as possible. It is generally conceded, I believe, that the strep- tococci, staphylococci, and Escherich's colon bacilli are about the only germs we have to fear during labor. Staphylococci and streptococci are non-spore-bear- ing, and consequently are easily destroyed. Robert Koch is the authority for the statement that a solution of bichloride, i to 1,000, destroys these organisms in a few moments. Escherich's bacillus likewise does not form spores, and is killed by the same solution in a short time, unless the germs are in fa-ces or an albu- minoid mixture (Sternberg). In the light of these bacteriological facts, we can build a method for protection against these germs. This method, which has been widely used, is practi- cally Fiirbringer's method of hand disinfection for surgical operations; (i) We wash our hands for several minutes in soap and water — bichloride, if you wish. (2) They are then thoroughly rubbed for one minute w ith several ounces of ether. 208 MEDICAL RECORD. [August S, 1896 (3) They are then scrubbed with a nailbrush for three or four minutes in a solution of bichloride, i to 1,000. (4) Finally, and this is very important, the hand is introduced moist with the solution, without using any lubricant and without coming in contact with the bed- clothes or anything else more buy cyproheptadine online than is absolutely nec- essary. After disinfecting the hands in this manner, they are practically sterile, so far as the germs mentioned are concerned, and any extraneous bacteria which should happen to drop on them would very likely be incapacitated for anv further harm by the action of the bichloride. Escherich's bacillus, although a near neighbor in all labor cases, cannot grow nor migrate in the acid secretion of the normal vagina; but if the hand of the attending physician was saturated with faeces and then introduced to the os, the bacillus would probably find very good pasturage in the alkaline lake at the upper part of the vagina. Disinfection of the hands in this manner will not take more than six or seven minutes, and with care during the vaginal examination is ample protection against infection. Of course, the hands must be treated in the same manner for each e.xamination, but then we are told to avoid making more examinations than are absolutely necessary. The last case I at- tended, I think I washed my hands by the method indicated above some six or eight times in the three hours I was present. Perhaps this was rather exces- sive. Kelly's method of disinfecting the hands with permanganate and oxalic periactin online acid has no advantages over Furbringer's method, while it has several disadvan- tages. NEUR.\L(;iA OF THE PFXIS. Hv ROBERT BOVD, M.IJ., GRAND CAVMAN, BRITISH WEST INDIES, After careful perusal of authorities upon venereal diseases, such as Keyes, Otis, and others, and not having met before with a similar case in my private practice, I am of the belief that the subject of this ar- ticle is a new malady and not heretofore order periactin mentioned by any writer. The following is the history of a patient who re- cently consulted me in regard to his complaint: C. B , male, aged twenty-six years, unmarried; occupation, bookkeeper. For the past two days he has been sutTering from severe paroxysmal pain of a lancinating nature, occurring about e\'er)' half-hour, day and night, and which begins at the root of the pe- nis and extends along the shaft on the right side to the glans penis, when it ceases. As the patient ex- presses it, the pain seems to run along to the head, and, having no farther to go, it escapes. The duration of the pain is about one minute, and has been so se- vere as to awake him from sound sleep several times during the nigiit. The patient states cyproheptadine hydrochloride that he suffered from the same pains about a year ago, but that they were less severe than at present, and that cyproheptadine 4mg they gradu- ally disappeared without any treatment. The patient is of sedentary habits, neurotic constitution, and suffers occasionally from severe general headache. There is no history of venereal disease, nor is there any history of traumatism of the penis or perineum. The urethra is in a healthy condition; there is no dis- charge or tendency to stricture (No. 10 .American sound passing easily); micturition is free and non- painful. periactin price There is a constant desire to micturate, which desire is exaggerated during the paroxysms of pain. Examination of urine gives negative results. Bowels are regular. Examination of the prostate gland, per buy cheap periactin rectum, shows it to be normal. The patient was directed to sleep on a hard bed, to avoid too much bed-clothing, a erections increased the neuralgia, and the following medication pre- scribed: Monobromate of camphor, ten grains, and bromide of sodium, twenty grains, every three hours during the day, and one-si.\th grain of morphine at bedtime. The pain gradually subsided, and in four days he was free of it. I have seen the patient lately, two months since the attack, and so far there has been no return of the periactin uk trou- ble. A CASE OF SEPTIC PERITONITIS— OPERA- TION' (PRIMARY AND SECONDARY)— RE- COVERY. Bv H. E. KENDELL, M.D., sr. JOHNS, N. F. E. V cyproheptadine 4 mg , aged fourteen years, suffering from appen- dicitis, was seen in consultation on the fourth day of the disease. The symptoms then were those of grave peritonitis. An operation was advised and accepted. The abdomen periactin 4 mg was opened over the appendix: incision at the right border of the rectus. Sero-pus cheap periactin welled up as soon as the peritoneum was incised. The right flank and pelvis were full of fluid. It extended well up under the liver and among the coils of intestine to the left of the spinal column. There were no adhe- sions. The cavity was mopped out by the dry method and the appendix was removed. It contained an en- terolith, was gangrenous and perforated. The intes- tines were then well sandwiched between strips of gauze put in every direction, according periactin buy online to the Mc- Burney method, and the incision, about five inches long, was left open. The patient did well and on the sixth day the gauze strips were removed, the sinuses being mopped out and gently repacked. On the eighth day, while gently flushing buy cyproheptadine the sinuses, I ob- served that the fluid did not return well from that which led to the left side of the pelvis. It had a pretty sharp angle where it passed the pelvic brim, which caused some pressure with rupture of adhesions. That night my patient became very ill, and in the morning when I saw him he had again developed all the signs of septic peritonitis. The percussion note in the left flank, which the day before had been tym- panitic, was now flat. I accordingly decided to open on the other side, buy periactin uk and did so about eighteen hours after the accident had occurred. The cavity on this side was full of serum. It presented about one-fourth the surface of the general peritoneal cavity, and was limited by the adhesions set up by the former opera- tion. The treatment was the same as in the first case, with the exception that the latter side was flushed with nonnal salt solution. It is, perhaps, worthy of note that this side so treated discharged serum much more ]jrofusely and for a longer time than the first side, treated by the dry method. It would seem, likewise, as though irrigation in the first instance would have caused infection of a portion of the cavity which es- caped by the method adopted. The patient had a slow convalescence, about ten weeks. A secondary abscess formed, which after a tedious watching opened through the old wound. Recovery has, however, been perfect. This case seems to me to be of interest on account of the secondary infection and the happy result of the secondary operation. Apart from order periactin online this, I wish to report it in order to get some light on one or two questions arising therefrom.

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