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and about one quart of bloody fluid was allowed to escape. The wound was again plugged Order Lotrel and opened on March 8th, and about one pint of fluid again escaped For the first few days the man was very cyanotic, and he improved as soon as the fluid was allowed to escape from the pleural cavity. March Sth he liad a temperature of 100° F., and pulse of 92, respiration 34, and was not very cyanotic. April 5th he was silting up a little each day, respiration 24, teniperature and pulse normal. The opening into the Lotrel Coupon pleural cavity is still patent, and a considerable discharge is secured if Lotrel 10 20 the opening is made dependent. Case VI. — S. L., twenty-one years old, was admitted just before patient in Case V, and inasmuch as his case was thought to be the more urgent was cared for first. He was .somewhat of a noted character in his Polish circle, had been taking some of their wine and eating heartily, and felt the better or the worse for it. He had been fighting with some of his countrymen, and, as the story goes, was getting the better of the argument, but at a critical moment in his fight he was shot through the abdomen, the bullet entering the abdomen at a point two and one half inches below the Lotrel Cost umbilicus and two inches to the left of the median line of the body. He had been given some morphine at the Lotrel 5 time of the shooting, and after he was admitted to the hospital he was given another quarter of a grain of morphine, but he still complained of the severe pain in the region of the wound. He was taken at once to the operating room and with plenty of good assistants given an anaistheiic. After Juir 20, 1907.] KENERSON: GUNSHOT IVOUNDS. 107 the abdominal skin had Been prepared as well as possi- ble the opening in the abdominal wall was enlarged and the course of the bullet sought. As fast as evidence of injur}' to the bowel was found the wound was at once sutured, after cleansing away the partly digested food. I attempted at first to repair the wounds seriati'n with the Discount Lotrel interrupted double row of Lembert sutures, but found that there were so many of the penetrating wounds that I would not be able to make such head- way as to give the man any reasonable chance to get off the table alive. I therefore resorted to the continu- ous Lembert suture, beginning at one end of a particu- lar bullet Lotrel 10 Mg wound and tying the first suture, but leaving the silk long enough so that there would be enough lo tie with when the double row was complete. Thus I sewed rapidly down the length of the wound, then set- ting the stitches back a little, making the row double and bringing the line back to the point at which I started. Then testing the wound and washing away any of the contents of the bowel that had come into the wound, and proceeding to the examination of the length of the intestine again. I did not use Dr. Cush- ing's mattress suture, with which I was familiar, but Lotrel 20 Mg made Lotrel Coupons the point of entrance and exit of the needle for each stiteh in a line vertical to the axis of the intestine. Of course this continuous method Lotrel 10 is many times more rapid than the interrupted Lembert suture, but I do Lotrel Price not consider it so desirable if time and surroundings warrant the longer method. After the intestine had been gone over for the full length and Cheap Lotrel ten bullet wounds of the intestine, all in the small gut, had been found and repaired, a large piece of Lotrel Mg iodoform gauze was inserted into the abdominal wound, and the outside entrance of the bullet trimmed so the edges presented a clean Lotrel 510 surface, the wound was sutured, not tightly but closed appreciably, and the wound dressed. A poor prognosis was given to the waiting police officials. This patient was admitted March 2, 1907, was kept under morphine for three days, allowed to come out, given divided doses of calomel and small doses of salts repeated until a move- ment resulted, which happened with a fall in the tem- perature and with improvement as to the expression of the Lotrel Online patient, which up to this time had been one of anx- iety and pain. The wound was dressed for the first time on March 9th, and all that was done then was Buy Lotrel to examine the wound from the outside, to determine if possible (sim- ply by the odor) if there had been any leakage of gas from the intestine, and then simply loosing the packing of Lotrel 5 Mg iodoform gauze, which had been in now for several days, and then withf>ut completely removing the same cutting off that part that had been .soiled and dressing afresh. Bowels moved March 8th for the second time, and this was accomplished with scarcely any pain. March 20th the patient was allowed to sit ii[) and to walk around after March 28th. On April ^th this man was eating a full hospital diet, walking, sleeping nor- mally, Buy Lotrel Online an(l wanted to go home. His bowels moved regularly without Purchase Lotrel cathartic, Thi wound healed fully, but showed scar and soft spot where packing was finally removed March 15, 1907. The silk Lembert sutures were

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