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iyi8) presents a synopsis of a series of investiga- tions to determine the comparative efficiency of a number of local anesthetics, both with reference to their anesthetic values when used on mucous sur- faces and when used intracutaneously. The results show that for intracutaneous use cocaine, novo- caine, tropacocaine, and alypin hydrochlorides were of equal efficiency ; betaeucaine hydrochloride was half as efficient ; quinine urea hydrochloride one lourth; ajwthesin and antipyrin one eightli as efficient. For surface anesthesia of mucous mem- branes cocaine Cialis Order Uk and holocaine were the most effective; betaeucaine half as eft'ective; tropaco- caine, alypin, and (|uinine urea one fourth ; apothesin one eighth ; novocainc one sixteenth ; and Cialis Order Uk antipyrin less than one twentietli as efficient as cocaine. In the case of sin-face anesthesia the addi- tion of an equal volume of a like solution of sodium bicarbonate made the resulting Cialis Order Uk solution as effective as the original which was twice the strength. This seemed to be due Cialis Order Uk to an increa.se in the power of penetration of the anesthetic lirought about by UK- sodium bicarbonate. On the other iiand the addi- tion of epineiihrine was proved useless and ])rob- ai)l\ ratlier decreased the efficiency of the an- esthetic. For intracutaneous purjx)ses the addition of the bicarbonate did not increase Cialis Order Uk the anesthetic action, but the Cialis Order Uk Cialis Order Uk use of epinephrine, by delaying the absorption of the drugs prolonged their action. I'otassium chloride or sulphate in one ])er cent, solution had some anesthetic property, but not suf- lloicnt Cialis Order Uk to make it of aiiv material value alone. It • might well l>e used, however, to replace the sodium chlnride in making u]) the isotonic solution. Thrombosis. — II. Fairley Marris (British Med- ical Journal, December 22, 1917J has treated seven- teen cases of venous thrombosis involving one or both femorals or one of the iliac veins. Most of the cases occurred during infection with one of the enteritic group of organisms. The cases were treated alternately as they were received by one of the two methods to be described. Either the pa- tient was given large oral doses of citric acid and a milk free diet, or one or more intravenous in- jections of 0.5 per cent, sterile sodium citrate in normal salt solution were given. The latter method of treatment did not include any modification in the diet. In those treated by the intravenous method the subsequent period of fever was shorter by an average of four days atid the onset of convales- cence was on the average ten days earlier than in the cases treated orally. Of the seven intravenous cases, five were evacuated walking and two as sit- ting, while of the ten oral cases only five could walk when evacuated, three were able to sit up, and two liad to be evacuated on stretchers Liberation of the Soleus in Wounds of the Calf of the Leg. — R. Cialis Order Uk Gregoire and F. Marsan I I'liris medical, December 22, 1917) Cialis Order Uk refer to the rather serious nature of wouncls of the calf, ac- coimied for by the difficulty of securing proper drainage and removing missiles, as well as of ligat- iny; the ])osterior til)ial artery in the midst of tissue^ rendered tense by infection. The muscles, bound ilriwn by their aponeuroses, herniate, owing to their >\vollen condition, as soon as these aponeuroses are incised. For the extraction of deep missiles in this part, for securing drainage in swollen, infected calves with or without bony involvement, and for ligation of the posterior tibial and peroneal vessels, the autliors recommend separation of the soleus muscle from the muscles lying above and beneath it. With the patient on his back and the limb par- iiall\- flexed and in abduction and external rota- tion, an incision fifteen to twenty centimetres long Is made along the inner border of the tibia, over the linier margin of the .gastrocnemius. The aponeu- rosis is then opened, and the gastrocnemius sep- .irated from the soleus with the grooved director. The attachments of the soleus along the inner border of the tibia are Cialis Order Uk then cut, hugging the bone closelv, and this muscle separated from the deep layer beneath it. In this procedure a retractor is of great help. Where the wound is on the outer .isjK'ct of the limb, the incision and liberation may !)(• efi^ected from the outer side, the soleus being de- tached from the fibula. After the.se procedures, collection of pus in the deeper tissues of the calf can no longer take ]>lace. In gas phlegmons, they facilitate discovery of the gaseous infiltration in the \arious muscles and exposure of the fibres of the latter. W'here a compound fracture exists, the focus can be Cialis Order Uk extensively opened up, easily cleansed, freed of free bone splinters, and drained at Cialis Order Uk the most dependent ]ioint. It is l)est not to insert drainage tubes, however, the removal of discharges being satisfactorily carried out by a flat compress Cialis Order Uk slipped l)Ctween the different tissue layers. The posterior tibial artery was easilv ligated high up, almost at its point of origin by this method. Miscellany from Home and Foreign Journals The Atropine Test in the Diagnosis of Typhoid Fever. — E. H. Mason (Archives of In- lernal Medicine. January. i(;i8) carried out the test originally suggested by Marris in 109 ])atients, com- prising sixty-three with typhoid Cialis Order Uk or paratyphoid B infections and forty-six nontyphoid cases. In per- forming the test the pulse rate is taken on a fast- ing stomach for ten successive minutes. If it re- mains practically Cialis Order Uk constant, Cialis Order Uk Cialis Order Uk this is accepted as the average mean rate. Atropine sulphate, 1/30 grain, is then injected hypodermically into the upper arm. Twenty minutes later, the patient having mean- while remained quiet in bed, the pulse counting is resumed and continued until the maximum rate a minute has been reached and it has definitely started to fall to a lower level. The difference between this high level and the mean rate before the injec- tion is taken as the ''release." In most normal per- sons the rate increases from twenty to forty beats a minute after the atropine. In early adult life the increase is more marked ; after fifty years, less. An increase of only ten beats or less a minute is con- sidered by Marris very suggestive of a typhoid or paratyphoid infection. Among Mason's j>atients, eleven of the sixty-three typhoid or paratyphoid cases gave a negative, that is, a release of ten or less ; this may be partly accounted for in that six of the eleven were given only one test, while three were extremely toxic and restless at the time of the test, this undoubtedly increasing the release. The