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ferred principally to gunshot fractures of the knee joint. As a matter of fact, it may be safely assumed than an ex- amination by probing or digital exploration, performed on the filthv floor of a railroad-station or on the street pave- ment, even by the most experienced surgl can not be, and is not, abilify mg size cleanly or aseptic. It is extremely dangerous, unnecessary, and hence culpable. Even in most cases of profuse arterial haemorrhage, mesial constriction with an extemporized tourniquet, as, for instance, the "Spanish windlass," or digital compression of the afferent arterial trunk, can be successfully can you buy abilify online employed while the patient is transferred into a suitable locality, where permanent relief can be safely afforded by deligation. The collected ami business-like manner id' the surgeon will at once allay confusion, prevent can i buy abilify online hasty and injurious interference, inspire the patient and those present with hope and confidence, and facilitate well-considered and rational action. As a rule, the fate of a flesh-wound order abilify online canada is determined bj the views and training of the physician who firsl attends to ft. If the patient is so fortunate as to fall in with a man t'ulU inil 1 with the spirit and familiar with the practice of aseptic surgery, he is truly to hi ngratulated, because his chances of avoiding suppuration are excellent. If his first attendant is one of the still numerous band of Bur- geons to whom wound infection b\ dust oi tilth adherent to hands or a probe is a myth, woe unto him ! Without previous cleansing, immediate probing of the gunshot wound, of a vertebra, tor instance, accompanied by digital exploration, is pel formed on the patient extended on a mattress laid on the dirty floor of a railroad-station. iH 398 GERSTER: ANTISEPTICS IN PRIVATE PRACTICE buy 2mg abilify online AND EMERGENCIES. [N. T. Med. Joi-e., course, the bullet is not found, and nothing beyond the in- fection of the wound is accomplished. A dressing is applied, any way, and the patient is taken home. Suppuration, that otherwise might have been avoid- ed, is sure to set in, and the patient is doomed. No amount of abilify prescription coupon consulting can devise a way for, no surgical skill can establish, efficient drainage of the inaccessible parts of the wound. Here the chances for recovery were thrown away from the outset. On taking charge of a fresh wound, the fearful and often irremediable consequences of a first false step should always be present abilify mg to buy 20 mg abilify online the mind of the surgeon, and his attention should be directed chiefly to the avoidance of septic infec- tion. A temporary aseptic dressing having been order abilify no prescription applied, the general condition and comfort of the patient should be looked to by the administration of stimulants or sedatives. After transfer home or to a hospital, the no prescription abilify necessary measures for permanent buy abilify online relief should be carried out buy abilify online canada as soon as the patient's general condition will permit. 2. Definitive Relief. — Preparations comprehensive and thorough, as required for an aseptic operation, should now be made. The patient is well stimulated if necessary, is anesthet- ized if the case requires it, and, his clothing being removed by cutting or in some proper manner, he is placed on the operating-table. After this should come a careful cleansing and sterilization of the surgeon's and his assistants' hands by scrubbing with soap and brush and immersion in a germicide lotion, followed by a likewise thorough cleansing of the integument in abilify order online the vicinity of the wound. Plenty of soap-lather with the use of the razor, scrub- bine; with soap and brush, rubbing and washing off with a solution of corrosive sublimate, will soon accomplish this. a. Contaminated Wounds. — The character of further procedures will have to be decided by the answer to the question, Is the icound clean or is it contaminated f (ttoss evidence of contamination, such, for instance, as street dirt imbedded in the wound or the blood-clots, or the knowledge that the wounding was done with a filthy instru- buy generic abilify online ment, as, for instance, the foul and foetid butcher's cleaver, will answer the question in the affirmative. In these cases the leading object should be thorough cleansing and disinfec- tion, followed by very comprehensive measures at drainage. If the external wound is small, it should be well enlarged so as to afford good insight. Every nook and corner of the wound abilify prescription program should be systematically gone through, cleansed of clots and dirt, thoroughly irrigated, and well drained. Great care must be taken not to overlook recesses, as one particle of filth left behind unawares may vitiate the whole undertaking. Drainage of the more remote recesses should be made as direct as possible ; that is, a rubber tube carried to the surface from a distant corner of the wound through a prop- erly placed counter-incision will effect more direct, therefore better, drainage than a long tube bent or twisted and brought out through a distant opening. Haemorrhage must also be, of abilify order canada course, well stanched by ligature or otherwise. Divided tendons, nerves, muscles, or fractured bones are next united by suture, and, if the edges of the wound are buy abilify online no prescription viable, they are also approximated by sutures. Where ex- tensive loss of substance order generic abilify precludes uniting of the edges, or where uncontrollable oozing prevails, the wound should be packed. This is best done by first lining the entire wound with one layer of iodoformized gauze, within which is packed a suitable number of loose balls of sublimated gauze. After a final irrigation and buy abilify 5mg online cleaning of the drainage-tubes the wound and its vicinity are enveloped in a moist dressing, that should be protected from evaporation by a large piece of rubber tissue or Macintosh. In case of fracture, the

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