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of the chest will often act advantageously by withdrawing the patient's attention from the heart. On theoretical grounds, the plaster should act beneficially in promoting the absorption of pleuritic fluid and in favoring resolution in phthisis, but I am not prepared to speak of its action in this direction. Dr. Porter has employed the plaster Buy Levitra Best Price for a num- ber of years past and has extended its application to a much wider field than I have. He informs me that he holds it in high estimation. The irritating properties of Buy Levitra Best Price thapsia rather disqualify it for use in children. Regarding its mode of action, thapsia may be classed among the most vigorous counter-irritants or derivatives. Its influence is undoubtedly chiefly exerted by the active determination of blood which it excites from the deeper structures to the surface. Its effects may also be partially produced, in common with those of other counter-irritants, through the trophic nerves, the methodus .medendi of which does not seem to be fully understood as yet. Note. — Since the foregoing was written, I have received from Dr. WiUiam H. Porter a communication, dated June 26, 1886, in which he says : " You asked me some time since to give you my opiniou and experi- ence in the use of the thapsia plasters. In reply, let me say that I have been using them for the past ten years, and have applied them in hun- dreds of instances, first using them as a counter-irritant in cases of phthisis, when they have often been of great service, acting, as they do, as a steady and continuous irritant. In acute pleurisy they are often of great benefit. One case in particular comes to mind, Buy Levitra Best Price that of a physician who had suffered severely in the past Buy Levitra Best Price with pleurisy, and was again threatened with an attack. Physical examination revealed the fine, grazing friction sound common in the first stage of a dry pleurisy. The apphcation of a thapsia plaster to the chest, over the site of the inflammation, caused a total disappearance of all the rational and pliys- ical signs within fortv-eight hours. In acute and clironic lumbago, Buy Levitra Best Price and in all forms of rheumatic and neuralgic pains, especially those located in the muscles, a thapsia plaster will, in the majority of instances, give complete relief. It should be remembered, however, that the plaster of the American makers often proves inert and sadly disappointing. It is only the imported, of French make, that can be relied upon. One thing should always be remembered in their use, and that is, careful cleansing of the hands after handling them, otherwise the application of the hands to the face may, and often does, result in an acute facial erythema, with oedematous swelling, which closely simulates a facial erysipelas. This inflammatory condition, however, subsides in a day or two without treatment, and is not dangerous, Buy Levitra Best Price although it may tempo- rarily frighten the patient." 135 Lexington Avenue. 44 POSTER: DISLOCATION OF THE HUMERUS. [N. Y. Mbd. Jodk.,, DISLOCATION OF THE IIUMERUS FROM MUSCULAE VIOLENCE, WITH METHOD OF REDUCTION. By M. L. foster, M.D., HOUSE BURGEON AT ST. LDKE'8 nOBPITAL, NEW YORK. About the middle of last May I was called to see an Irish laboring woman, Buy Levitra Best Price who, while climbing a step-ladder, carrying a pail of water in her right hand, lost her balance and tlirew out her left arm violently. She did not fall or strike anything, but felt something snap in her .shoulder, followed by pain and disa- bility of the arm. I arrived about ten minutes after the acci- dent and found a distinct siibcoracoid dislocation of the humer- us. The patient was suffering considerable pain, and was thor- oughly frightened. At the suggestion of Dr. P. E. Tieman, who accompanied me, I tried a method of reduction described by Dr. Neil McLeod in the "British Medical Journal" for January 30, 1886. The patient was placed on her back, with the left arm e.xtended at right angles to the body. Pain was iiumediately eased in this position, and, by a moderate traction on the arm, while Dr. Tieman made counter-extension with his arms about the patient's waist, the bone was reduced wdth an audible snap. The patient said that she experienced very little pain, but felt the bone slip into place. The joint was then Buy Levitra Best Price fixed in the usual manner. There was slight pain for two days, but Buy Levitra Best Price none after- ward. Passive motion was commenced at the end of a week, and the patient was allowed to resume work after a month. At present .she is suffering no pain or discomfort in the joint. She stated that she had never before had a dislocation of the joint. The method of reduction employed is based on the re- laxation of the entire muscular s3'Stem as well as of the muscles Buy Levitra Best Price about the joint. Unless the entire muscular sys- tem is relaxed, complete relaxation of any portion can not be obtained. Anesthetics being excluded, this general mus- cular relaxation may be best secured by placing the patient in a recumbent posture. In the common forms of this dis- location, subglenoid and subcoracoid, the pectoralis major Buy Levitra Best Price and latissimus dorsi have their origins and insertions ap- proximated by the displacement, and are thus, immediately after the accident, relaxed, while the remaining muscles about the joint, except the teres major and minor, are, if not lacerated, in a state of tension. By placing the arm at right angles to the body, the deltoid and supra-spinatus have their origins and insertions approximated as nearly as pos- sible and their tension lessened. Pain is also relieved by this position to a greater degree than Buy Levitra Best Price by any other, and the .spasmodic contraction of the muscles dependent on it les- sened. From these considerations it Buy Levitra Best Price would appear that traction on the arm directly outward at right angles to the body, the patient lying on his back, would tend to reduce the dislocation with the least amount of resistance from the muscles, as none of those relaxed would be stretched be- yond their normal limits, while the tension on the other muscles would be diminished as soon as the head of the bone began to move outward. Dr. McLeod quotes two cases treated in this manner, one subcoracoid, one rather subglenoid than subcoracoid, but not typically either. In both cases reduction was ac- complished easily without pain. In one case neither the patient nor the surgeon knew when reduction took place. In the "British Medical Journal" for May 22, 1886, two other cases are mentioned, both successful and without pain^ in one of which the patient was not aware when reduction took place, the amount of traction being about two pounds- This method of reduction, although not new, as stated by Dr. McLeod, is not, I think, well known. It is not de- scribed in any of the surgical treatises to which I have Buy Levitra Best Price had