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Prescription Cialis
March 9, 1918.] GRAY: WAR WOUNDS OF THE BRAIN. 457 will be making a real sacrifice and nothing can com- pensate you for the valuable time you will spend there except the thanks which the grateful soldiers will give you. No medical officer is, in my opinion, adequately paid as far as monetary consideration Prescription Cialis is concerned, but of course few go for that purpose. It is, though, important that an officer should re- ceive sufficient to take care of his dependents when he is at the front. His time, in a sense, will be lost Prescription Cialis Prescription Cialis ; but nevertheless it is the duty of us all who are able to make the sacrifice, to make it. 470 Tranville Street. TREATMENT OF WAR WOUNDS OF THE BRAIN AND ITS COVERINGS AT CASUALTY CLEARING STATIONS. By H. M. W. Gray, C. B., Aberdeen, Scotland, Temporary Prescription Cialis Colonel. Army Medical Service; Co British Expeditionary Force. ultant Surgeon, {Concluded from page 411.)' TREATMENT. The objects of treatment can now be shortly summed up: Prescription Cialis i, to prevent or remove infection, thereby preventing further destruction of tissue ; 2, to establish diagnosis in Prescription Cialis some cases of doubt; 3, to remove all sources of irritation to the Prescription Cialis brain, if this can be done without causing further serious damage to it. One cannot undo the initial Prescription Cialis surface wound or cerebral lesion, Prescription Cialis but one can try to procure a condition which will allow healing to occur more rapidly, more normally, and with less permanent impairment of function. 4. In any case to procure rapid healing of the superficial parts, provided that the brain is safe. We may be charged with being too zealous in operating on head injuries. I cannot remember death occurring after any operation which was not one of urgency. We have regretted that we have not operated or operated sooner on some patients who have done baclly. Prescription Cialis In all injuries it is held that operation furnishes an additional and usually accurate means of diagnosing the extent of the lesion. In minor injuries it has done no harm so Prescription Cialis far as can be ascertained, and it renders the pa- tient fit to return to duty at a much earlier date than would otherwise be the case. It is better to send a patient home with a healed scalp and healthy skull, inside which are the fewest possible potentialities Prescription Cialis for future brain trouble, than that he Prescription Cialis should go with the prospect of a later opera- tion on an area which is obscured by many abnor- malities. If it can be shown that this is done Prescription Cialis with as great safety as attends more conservative meth- ods, the procedure is more than justified. Sepsis Prescription Cialis and the exigencies of war will always make the pro- portion of failures a relatively high one. Routine of treatment. — On admission, the pa- tient's hair should be shaved off or removed with a depilatory paste, the wound thoroughly examined — the use of a probe is deprecated — two skiagrams taken in planes at right angles to each other, and a neurological examination made. If all the hair is not removed, other wounds, sometimes more im- portant than the most noticeable one, may be over- looked. An aperient should be given and the ad- ministration of urotropine, fifteen to twenty grains every three or four hours, begun. If the brain is injured it is well, if possible, for future guidance, to make a bacteriological examination of the dis- charge. If brain matter is exposed or exuding from the wound, operation should be Prescription Cialis carried out as Prescription Cialis soon as possible. In most other cases in the absence of urgent .symptoms there need be no great haste, but in no case should operation be Prescription Cialis postponed for longer than a couple of days. The superficial wound should meantime be treated as already described. Excision of zvounds. — The majority of wounds of the scalp sliould be excised, and the bone beneath carefully examined. If no further interference is made, the wounds can be sutured, usually w'thout drainage. It may be necessary sometimes to slide flaps in order to make up for defects in the scalp. After disinfection of the wound and surrounding scalp the damaged soft tissues afe excised by a lemon shaped or elliptical incision down to bone about a quarter of an inch from the lacerated mar- gins. The wound itself should be Prescription Cialis cauterized, or desiccated by thorough rubbing with five to ten per cent, picric acid in spirit and drying with a swab. If the Prescription Cialis periosteum is carefully divided, especially at the ends of the incision, it is easy to remove dam- aged scalp and pericranium en bloc with the handle of the scalpel or a periosteum elevator. Sufficient access to the bone and brain can, in almost every instance, Prescription Cialis be got through the incisions recommended. Turning down a U shaped flap introduces a needless complication and frequently prevents suture of the excised original wound. If this wound capnot be closed, healing by granulation must take place di- rectly over the wound in Prescription Cialis the dura and brain — an obvious disadvantage. Covering the exposed brain with pericranial or muscular flaps, which are left exposed in the depth of the wound, is rather a pre-