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concluded that in certain cases the con- stitution of the blood may be a predis- posing cause Buy Aerovent of hgemorrhage following the least vascular injury. That singu- lar malady known as haemophilia is per- haps precisely the consequence of a particular state of the ha^raatoblasts. In conclusion, the author gives a practical exemplification of tlie impor- tance of this \'iew. Ue was called in consultation with Gosselin, Perier, and Dieulafoy, in a case of extreme epis- taxis, in which the patient was at the point of death from anasmia. For thirty years the patient had been subject to similar attacks. On examining the blood, the author was struck by the fact of the relative rarity of the haemato- blasts, and of their feeble vulnerability, the changes which they undergo out of the organism occurring much more slowly than natural. He believed that the persistence of the hfemorrhage, which had lasted for three weeks, and was renewed whenever the tampon was removed for a few hours, was due to these changes; and thought that, by transfusing into this patient a certain quantity of normal human blood con- taining active heematoblasts, the condi- tion might be modified to advantage. One hundred and twenty grammes of venous blood were injected, and, in spite of the Purchase Atrovent Online feeble dose, the epistaxis was im- mediately and definitively arrested. Af- ter the operation the tampons were re- moved, all ha3mostatic agents were laid aside, and the patient lost not a drop of blood. It seemed evident to himself and his colleagues that the transfusion had acted as a htemostatic of remark- able power, and that the cure of the patient should be attributed to it. 9. Mr. Sydney's method of applying ligatures to veins consists in the use ot a catgut ligature subcutaneously. The form of phlebitis required is the healthy aseptic variety, with its limiting zone of plastic formation passing across the lu- men of the vein and its solidified con- tents, and preventing purulent matter, or tlie results of disintegration, from Buy Cheap Atrovent entering the circulation. The variety to be dreaded is the septic, where phlogo- genous matter, Cheap Atrovent Order Atrovent zymotic or chemical, pen- etrates the tissues before the defenses of the limiting zone can be formed, and diffuse suppuration is the result. If septic inflammation were due only to germs introduced from without, it might be hoped that strict antiseptic precau- tions would prevent it ; but there is every reason to suppose that it can arise from the formation and absorption of a material not of a zymotic but of a chemi- cal nature, due to decomposition, or ret- rograde metamorphosis of Buy Atrovent Online tissue, or wound products. In the ordinary mode of occluding veins by acupressure or sub- cutaneous ligature, there is, in addition to the vein, a large amount of skin and other tissue seized, compressed, and more or less Atrovent Online devitalized ; and, conse- quently, conditions are produced favor- Generic Atrovent able to unhealthy tissue metamorphosis and absorption. From whatever point it is viewed, the principle of inclosing within Order Atrovent Online a ligature or by acupressure tis- SURGERY. 547 sues other than the vessel to be occluded, the author believes to be wrong; and whatever proceeding tends to limit the action of the ligature to the vessel only, he believes excludes an element of dan- ger. Whether the dangers of operations Purchase Atrovent on veins are exaggerated or not, results are apt to follow which will be grave in proportion to the ease with which, ceasing to be local, they become gener- al, and therefore an essential precaution in operations is antiseptic procedure. This the author does not follow to its extremes. He uses either the Buy Atrovent spray or the irrigator, and has had equally good results from each. He has also had per- fect freedom from suppuration and sep-

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