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Related post: were kept together during the first few days, a tampon not
being required to control hjemorrhage, primary union of all
the wound, except that portion occupied by the catheter,
generally "occurred, at least of so much of it as could be ex-
amined ; and closure of the remainder quickly followed the
withdrawal of the instiument. While early union of all the
wound, except that of the divided stricture and so much of
the external wound as is required for drainage, is highly de-
sirable, a too rapid complete clo.sure may be objectionable
and a source of danger. In two of these cases a bladder ex-
ceedingly irritable, even while the patient was taking sup-
positories of morphine and belladonna, necessitated the with-
drawal of the catheter in thirty and. forty-eight hours re-
spectively. In both some urine was passed through the
urethra on the third day, and on the fourth day none what-
ever came through the perineal opening. Although in each
of these patients an extensive incision was made — in one, in-
volving an inch of the bulbous and all the membranous ure-
thra — there was no elevation of temperature until some hours
Sept. 12, 1891.J Betamethasone Valerate Ointment Usp 0.1
BLACK: STRYCHNINE NITRATE IN TOXIC AMBLYOPIA. Actavis Clotrimazole And Betamethasone Dipropionate Cream
2(S7
after urine ceased to pass through the perineal wound. Then
marked fever occurred, in one case preceded by a chill.
Separation of the edges of the wound so as to again allow of
perineal drainage, and a few irrigations with a boro-salicylic
solution, brought the temperature down to normal by the
following day, where it remained. These cases are instruct-
ive and serve well to demonstrate the value of perineal drain-
age in operations upon the deep urethra.
STRYCHNINE NITRATE
IN TOXIC AMBLYOPIA FROM ALCOHOL AND TOBACCO.
WITH REPORT OF CASE:s.
By G. MELVILLE BLACK, M. D.,
DEXVER, COL.,
LATE JIODSE SURGEON TO THE MANHATTAN EYE AND Betamethasone Sodium Phosphate Tablets EAR HOSPITAL, NEW YORK.
I DESIRE to place upon record a few cases of tobacco
and alcoholic amblyopia cured by hypodermic injections of
nitrate of strychnine, obtained from the records of the Man-
hattan Eye and Ear Hospital, New York city. Dr. David
Webster's clinic, and referred by him to my morning clinic
for treatment, as will be described. As there is " nothing
new under the sun," we make no pretension of anything
new or original.
Nitrate of strychnine was used, not because the thera-
peutic effects of this preparation were any different from
those of other salts of strychnine, but because it has proved
less irritating for subcutaneous injection. The sulphate I
have found very irritating, producing abscesses, in spite of
the most rigid care, when used in large doses. The nitrate,
on the contrary, I have never had the misfortune to pro-
duce an abscess with, but have seen them produced by oth-
ers. I, however, attribute the fact to carelessness about the
syringe and improper administration. I have not found that
it makes any difference whether the needle is plunged deeply
into the tissues or superficially, if the needle and syringe are
clean, if the site of puncture is clean, and if the solution is
made with distilled water ; and, lastly, which I deem very
important, if the part is thoroughly massaged afterward for
from three to five minutes. I usually choose for my site of
puncture the arm, preferably over the biceps muscle, chang-
ing from one arm to the other. I have never found it
necessary to change to any other location on account of irri-
tation. The temple has not proved a favorable site with
me ; owing to the large doses used, the part would become
sore.
The solution used was made from Merck's nitrate of
strychnine, eight grains to the ounce of distilled water.
This is about as strong a solution as can be kept made up,
and in cold weather the strychnine will crystallize and fall
to the bottom, requiring it to be warmed before using. I
use this strong solution because I have not found it any
more irritating than a weaker one, and because it often be-
comes necessary to run up as high as twenty to twentv-five
minims to get the desired result.
Physiological effect is the limit and the point to be
reached as soon as possible without danger to the patieut.
I have never had any ill effects from adding one minim to
each daily injection, and continuing Betamethasone Valerate Lotion Usp 0.1 this until the physio-
logical limit is reached, which will be obtained under
twenty minims, as a rule. I have given, however, twenty-
eight minims (seven fifteenths of a grain) before obtaining
it. When the physiological limit is reached it is best to
drop back a few minims, say three to five, and go up again,
aiming to get physiological effects about every six to eight

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