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part. The treatment was empirical, but was based upon common sense. The knife was resorted to when abscesses were pointing. When a joint was pretty well disintegrated, some of the bolder surgeons per- formed resections, which frequently were unsuccessful and were followed by amputations. Operations for bone inflammation when abscesses had not formed must have been rare. Following the wonderful discovery of Koch, numer- ous investigators found that a large percentage of lymph-node joint and bone disease was in reality local tuberculosis, while there was scarcely any tissue of the body which might not be the seat of the infec- tion. The clinical recognition of the trouble became more and more a draw poker slot strategy matter of certainty, and our efforts to eradicate the morbid process grew more effective, because they were undertaken with a fuller knowledge of what was to be achieved. At the present time it is safe to say that tuberculosis is amenable to treatment in direct ratio to our ability to attack it locally. Thus, tuberculosis of the lungs is much more difficult to cure than tuberculosis of texas holdem poker 3d deluxe edition full version free download the knee-joint, download game governor of poker 2 for android while tuberculous meningitis free poker sites for real money is an almost hopeless condition. In this respect the disease differs widely from another disorder, the lesions of which often resemble it. I refer to syphilis, the manifesta- tions of which, though often favorably influenced by local treatment, are almost uniformly helped by sys- temic medication. The local treatment of tuberculosis must depend largely upon the tissue involved and its accessibility. The methods advocated in this paper are those which in my own experience have led to success. For the most part they are not original, though their applica- tion in some cases may be so called. I standard casino poker table dimensions shall say a few- words on the treatment of tuberculosis of skin, bone, joint, kidney, and pleura. In tuberculous skin disease, whether it be lupus or some other form of ulceration, we have the malady in an easily accessible region. Unless a deforming scar is feared, a wide excision or a thorough and, if neces- sary, repeated burning with the thermo-cautery will usually stamp out the trouble. Should the disease show itself in the skin of the face, it is well to test non-deforming measures for a short time before resort- list of poker players net worth ing to such radical treatment. I have found that it is possible to broke professional poker players 2010 secure perfect healing with minimal cica- trization, when the ulcers are not too large by the fol- lowing means : The diseased parts are to be enveloped for twenty-four hours in a soaking wet dressing of some bland fluid, a weak aluminium acetate lotion be- ing my favorite. At the end of this period the skin is carefully cleansed with ether, and then a solution of iodoform in contractile collodion is painted upon the diseased area. More collodion mixture should be applied daily for several days, according to the prog- ress of the case. If improvement ceases or retention of discharge under a crust is present, then another wet 1 Reai.1 November 23, iSo,6, before the Howard Medical Society of New York. MEDICAL RECORD. [January 2, 1897 dressing must be applied for a day, when the iodo- formized-collodion treatment is to be continued. I Look online free poker sites no downloads upon it as very important that the collodion should be unmixed with castor oil, and that its con- tractile qualities should be most pronounced, so as to blanch the skin. The treatment succeeds partly by reason of the iodoform, and partly because the minute crypts and tracts of ulceration are closed by free poker sites for usa players their own walls, which are pressed together by the contractile film and no longer invite retention. Tuberculosis of bone must be differentiated princi- pally from neoplasm and from syphilis. The evening temperature and the existence of marked pain and tenderness, besides the history of the case, will usually exclude neoplasm: but it is not always possible before operation to exclude syphilitic osteitis with suppura- tion at the centre. To read an exhaustive download game texas holdem poker for java paper on the treatment of bone and joint tuberculosis would occupy the time of many meetings of our society. I shall therefore con- fine myself to a few points. Just as in consumption of the lungs there is first a period of hyperemia, then consolidation, and, finally, necrosis and ulceration, so in tuberculous osteomye- litis we have an analogous process terminating in ne- crosis and abscess. Again, as in lung tissue, so also in bone tissue, the process may be checked before pus formation. The disease then will exist as an inactive focus, free poker network fpn online which may for a poker slots app long time cause no pain and no inconvenience. This spot of disease may, how- ever, become active upon slight provocation, and tis- sue destruction may then progress with great rapidity. Our treatment must, therefore, be carried out accord- ing to the location of the trouble do pro poker players go broke with regard to sur- rounding important structures. Tuberculosis in the shaft of a bone may often be treated for a long time by rest and the local application of cold, in the hope that the process may become dormant; while if we know- that there is active bone disease near a joint which is as yet unaffected, the indication is for surgical inter- ference before the joint becomes diseased. youdagames governor of poker 2 free download When the process in such instances is confined accurately to iso- lated foci, they may be removed entire, only healthy tissue remaining. It has repeatedly been my fortune to prevent by operations of this kind the danger of joint involvement, just as one may prevent peritonitis by the early removal of an inflamed but non-perforated vermiform appendix. Indeed, I have operated in such cases when the focus was in such a location as to make an accidental opening of the joint during the opepation unavoidable. An iodoformized gauze plug sealed this opening, however, and was kept in place till granulation of the wound was well established, the articulation escaping involvement. When infection commences in the synovial mem- brane of a joint, there is first a pouring out of fluid, which fills the sac more or less tensely. If this fluid is non-purulent, a speedy cure, which may remain per- manent, may sometimes be effected by antiseptic irri- gation with a live-per-cent. carbolic solution, afterward poker players on instagram in its turn washed away with normal salt solution. lis purpose two --terile cannula are Inserted into the joint, the liquid running in at one and out at the other. The little operation must be performed with scrupulous care, however, because of danger from sep- sis, and also because carbolic acid left pro poker players who went broke in the may, particularly in children, give rise to constitu- tional sympti 'ins. When a joint is destroyed so that it function is manentlv gone, resection of the bones, with tli clearing away of diseased capsule, usually gives prom- ise of a useful limb. This is more necessary when there is evidence that tuberculous bone cavities are in direct connection with the joint. I poker players broke 2010 do not mean to be too sweeping in advising the excision of joints, because it is well known that me- chanical treatment, which usually means local rest by means of apparatus, will often accomplish much. 1 would like, however, to say a word in particular on excision of the knee for tuberculosis in adults, because I believe that 50k poker players championship 2012 this operation is not performed often enough. Frequently it happens that the patient himself, pre- ferring free online strip poker games no download anything to a surgical operation, will for years nurse a limb which is a constant menace to his life. Such a knee will be partly serviceable for a few weeks

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