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duces no tissue uTitation or jircssure necrosis. The use of this simple device also permits the treat- ment to be carried out in the immediate vicinity of large, exposed bloodvessels. The glove finger also seems to have very slight tendency to have its per- forations become blocked by secretion. The method has given Cialis Buy Uk Online almost perfect results in a large mimbci of patients in the author's hands. Nerve Injuries. — H. S. Sounar {British Medi- cal Jintniul, December 22, 1917; points out that in the vast majority of cases the nerve injury is pri- mary and therefore it is possible to make an early diagnosis of its presence and probable extent and to institute suitable treatment at once. The several diagnostic points are outlined and Cialis Buy Uk Online made as simple as possible, so that every one can employ them in all sus])ected cases in order to avoid delay in treatment. The nerve injury outweighs all others from the point of view of ultimate utility of an extremity, and the treatment of the other injuries should be so conducted as to interfere to the least possible extent with that of the nerve injury? Whatever the nature of the injury the treatment should be arranged so that the formation of contractures will be avoided and the paralyzed muscles will not be stretched. The dressings should be arranged so as to permit the maximum of access to the wounded part, so that daily massage can be carried out to maintain the nutrition and suppleness of the skin and muscles and the mobility of the joints. Physi- cal treatment aimed at the restoration of nerve func- tion should be started as soon as jKissible and should include the daily employment of the following meas- ures, each contributing its share in the recovery: mas.sage; active and passive exercises, including the methods of Zander modified to suit the special con- ditions ; hot whirlpool baths ; and electrical stimula- tion by the galvanic and sinusoidal currents. Oper- ative treatment may be undertaken either at the time of first seeing the wounded part, when imme- diate nerve suture can often be performed with success. Otherwise no operation should be under- taken until all risk of septic infection has passed, that is, not before six weeks have elapsed since the sound healing of the wound. Then end to end nerve suture, end to end suture after alteration of the course of the nerve, nerve flap lengthening, or Cialis Buy Uk Online the use of an autogenous nerve graft can be under- taken with excellent hope of success in the majoritv of cases. In these operations the greatest care must be exercised to avoid all handling of the nerve ends except by the bulbous fibrous parts which are to be subsequently amputated. Nephritis. — Martin Fischer {Pennsylvania Midieal Journal. January, 1918) has fomiulated the following rule: Avoid, remove, and combat every condition that favors the abnomial produc- tion or accunnilation of acids and substances acting like acids in the kidney. In threatened or es- tablished cases o^ nephritis give alkali, salts, and water. The alkali is given to neutralize the acid present in abnormal amount in the kidney, the salts are indicated because the various changes induced in the kidney colloids by acids are Cialis Buy Uk Online counteracted by adding lo such acid any salt, even Cialis Buy Uk Online a neutnil salt, and the water is given in order to have more of it present than is necessary to saturate all the lxidy colloids, as otherwise there is no free water left for the secretion of urine. An active administra- tion of sugar either by rectum or intravenouslv is advantageous. The reasons for this are tliat car- bohydrate starvation is a very common cause of acidosis and that sugar is very efficient in reducing hvdration. March 9. !9l8.] MODERN TREATMENT AND PREVENTIVE MEDICINE. 4/1 Surgical Treatment of Varicose Cialis Buy Uk Online Veins of the Lower Extremity. — E. Cialis Buy Uk Online R. Secord [Canada Lancet, ( Cialis Buy Uk Online )ctalx'r, iyi7) enumerates tlie usual methods as, I, the 'I'rendelenburg operation of excision of the upper end of the saphenous veins ; 2, the Mayo strip- ping operation ; 3, the Schede garter or circumcis- ion operation. F'inding that the results in any one of these methods gave not entirely satisfactory re- sults, .Secord has combined several methods with great success, as follows : The Trendelenburg oper- ation is done in all cases ; the main venous channels are removed in one piece from the uppermost point of dilatation down to the internal malleolus; every communicating vein is ligated as it perforates the deep fascia, and finally the veins that have been left are obstructed by a modified Schede incision about two and a half inches below the knee, exce])ting only one inch on either side of the longitudinal in- cision. The only real objection is the time required, which is, about an hour and a half. Healing of the long wound is insured by the "no hand contact" method, even the gloves and instruments being pre- vented from touching the skin by stitching towels to the skin edge. The dressings are not disturbed- until the tenth day, when the sutures are removed, the Cialis Buy Uk Online leg firmly bandaged, and the patient allowed up. (jradual Cialis Buy Uk Online use of the leg is permitted and discharge of the patient occurs in three weeks from the date Cialis Buy Uk Online of operation. Wounds of the Knee Joint. — Sir Berkeley Moynihan (Canada Lancet, January, 1918) sums up the treatment of knee injuries as follows: The leg Cialis Buy Uk Online should be immovably splinted at once, x ray examination should be made in all cases, and the limb prepared for operation. The essential features in all oi>erations are excision of the wounds and of the track of the projectile, free exposure of the joint, removal of all foreign bodies, and closure of the wounds in layers with catgut. Drainage Cialis Buy Uk Online tubes are never put in the joint cavity, in severe infection the wounds must be reopened, the synovial mem- brane stitched to the skin, and the Carrel-Dakin or other method of progressive sterilization practised. In cases of severe comminution of the articular ends with nuicli loss of substance, a resection of the joint is performed, and in cases with heavy infec- tion the method of Fullerton should be practised, which includes wide temporary separation of the