DISORDERS. — In fractures and sprains the solution of the silicate is a valuable dressing, as it rapidly becomes hard and immovable when painted over the bandages and thus forms an immov able splint which is cleaner than plaster of Paris and equally effective.
Morbid growths, warts, etc., may be removed by applications of caustic soda or of London paste.
Foul ulcers, sinuses, etc., may be cleansed by the solution of chlorinated soda diluted to 2 drachms in 4 to S ounces of water).
—As practiced. at the Johns Hopkins, according to J. G. 'Clark (Canadian Practitioner, Aug., '97), graduated, glass infusion-jars of one thousand cubic centimetres' capac ity, made according to Dr. Kelly's de signs, are used as reservoirs for the solution. The bottles are connected by five feet of ruber tubing to a long, slender infusion-needle, the calibre of which is two millimetres in diameter, similar to an needle. The entire apparatus is sterilized and kept in a sterile envelope, and is available for use at any moment. Before giving the infusion the breast. in the case of women, is carefully disinfected, espe cially well in its dependent. area. It is then grasped with one hand and lifted well up from the thorax, while the needle, with the fluid flowing from it, is quietly thrust beneath the gland. 'Usually, simple elevation of the reser voir is sufficient to force the fluid into the loose cellular tissue, and the breast quickly begins to distend until even a flabby and atrophied organ will reach the size of the puerperal breast. The needle is quickly withdrawn and the puncture is closed with rubber tissue or adhesive plaster. If the fluid does not flow by its own pressure it can be effectually forced in by stuffing the tube. The hands and tube are well anointed with vaselin; the upper portion of the tube is tightly pinched, and from this point down the tube is gently stripped between the fingers of the other hand, driving the column of fluid ahead into the tissue. The lower portion is then pinched between the fingers and the upper is released, allowing the water to fill the collapsed intermediary por tion of the tube. Seven hundred cubic
centimetres (1 1/, pints) of solution may be injected under each breast. If care .is observed in the cleansing of the breasts and the injection of the fluid, no untoward results will follow, which certainly cannot be said. of the infusion into the radial artery or vein.
Its use in abdominal operations has become quite general. Clark states that the more extensive one's experience be comes in the use of normal salt solution, as a stimulant in these operations, the more convincing is the evidence of the benefits to be obtained by its use. Dur ing the past four years he has made it a practice to leave at least one litre in the peritoneal cavity, after even the simplest operations. It increases the volume of the blood, lessens its specific gravity, stimulates the cardiac ganglia, and accelerates the circulation. The skin, kidneys, and intestines are stimu lated, and all the organs of the body functionate better under its influence. The number of red blood-corpuscles is distinctly increased. Its special use in abdominal cases is to prevent shock, to lessen the effects of hiemorrhage, and to decrease the virulence of infection. Next to the Trendelenburg posture, the author regards the introduction of the normal salt solution as one of the greatest benefits which have been con ferred upon modern surgery in the last five years. Its most marked advantages are claimed to be a lessening of the thirst and an increase in the urinary ex cretion. Drainage regarded as a prob lematic benefit, because of the rapidity with which absorption takes place by the lymphatics and peritoneum. In these cases an infusion of large quanti ties of normal salt solution combined with the elevated dorsal posture is recommended. In moribund patients Clark has seen a marvelous stimulation from this treatment, which safely tided them over a critical period. Subinam mary infusions are quite as beneficial; they act almost as rapidly as intrav enous transfusions, and are devoid of some of the complications which attend the latter.