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tuberculosis by alleviating certain symptoms, re- lieving certain complications that may be present, and putting the diseased organs in that condition which is most favorable for a cure. These, then, are the lines upon which we should base a rational therapy for tuberculosis. Not any one of them should be employed to the exclusion of the others, but all should be worked out into one harmonious whole. Of those remedies and measures which have been put forth as "cures" for tuberculosis in the past, nearly all have some merit, although the merit is not always where it is supposed to be. Cod-liver oil certainlv increases nutrition when well borne, although there are more palatable ways of accom- plishing this end. Creosote will often improve nu- trition by its action upon the digestive system. When given in too large doses, however, even in suitable cases it does harm. It also has a beneficial effect upon the mucous membranes of the air pas- sages, but to think that it will kill the bacilli by its antiseptic action is positively absurd. The pneu- matic cabinet is based upon the idea of exercise for the lung ; nitrogen gas, upon rest for the lung. The various culture products find their basis in the nat- ural defenses of the organism. Perhaps none of these measures is wholly bad, but none of them should be put forth as a "cure ;" they are aids to a cure. They, and many more remedies and measures, find a rational basis for employment in the treat- ment of certain cases of tuberculosis, but they are not to be used in a routine manner. The treatment of tuberculosis is a matter of careful individualiza- tion. Recognizing the importance of nutrition, it should be one stromectol 3 mg of our chief aims to maintain this at the highest point. Everything which interferes with it must be eliminated. ' The" hygienic-dietetic-open-air treatment, which is deservedly so popular through- cut the world to-day, has for its basis the betterment of nutrition. One of the most noticeable, and per- stromectol uk haps the most important effect of the open-air treat- ment of tuberculous patients, is its effect upon diges- tion and assimilation. Coincident with the beginning of this treatment stromectol for lice we note a marked improvement in the appetite. When digestion has been previously slow, and attended with more or less unpleasant svmptoms, we not infrequently observe _ a disappearance of all embarrassment. Assimilation improves, and the patient takes on flesh. The effect of the open air is to enable the stromectol purchase patient to digest and assimilate more food and to furnish the appetite which demands it. The best effect of open air can be obtained only by using it discreetly. While in itself harmless, doubtless more lives have been wrecked while try- ing to follow this mode of treatment than by anv other measure. Open air is not a cure for tubercu- losis: it is onlv a measure for the production of a certain end. If used properly, it generic stromectol is one of the great- est aids to nutrition that can be employed ; if used improperly, it will defeat its own purpose. An individual suft'ering from tuberculosis should not be told that open air will cure him, but that proper living in the open air will be one of his great- est aids. Many an individual has eaten good food and remained in the open air all the time, and yet killed himself. The oft-repeated advice of well- meaning eastern physicians to their patients to "go \\ est, live in the open buy cheap ivermectin air or rough it, and keep away from physicians," is responsible for the deaths of hundreds of patients annually. Not open air, but the proper use of open air, is one of the chief aids in the cure of tuberculosis. Open air should be supplemented by proper food and carefully regulated rest and exercise to make it most effective. While we stromectol buy recognize that rest is a wonderful aid to nutrition, and that overexertion decreases the resisting power of the patient, yet there comes a time in the treatment of order stromectol online nearly all cases of tuberculosis when exercise short of tiring will increase nutrition and hasten recovery. The physician must be the judge when this time comes. Beside prescribing open air, a carefully selected diet, and the proper amount of rest and exercise, the physician must control and regulate the entire life of the tuberculous patient. He must guide him even to the minutest detail of his life. Nothing of im- portance should be left to the patient's judgment until he has proven himself competent. Another measure of great value in improving nutrition is hvdrotherapy. The careful and intelli- gent application of water offers us one of our most valuable and most flexible aids to nutrition, and should never be om.itted. Climatic conditions aft'ect the state of nutrition very decidedly. While sunshine is not indispensable to the treatment, as is shown by the results obtained in many places where there is a larp'e percentage of cloudy days, yet those of us who are fortunate enough to be able to give our patients the benefit of almost constant sunshine realize its value. Its cheering and tonic effect is a very potent factor in aiding nutrition. A climate which not only affords an opportunity, but which invites the patient to be out of doors a great portion of the time, and which also affords a large amount of sunshine, is a great aid in the treatment of tuberculosis. stromectol canada Modern buy ivermectin research points to the possibility of the laboratory giving us cures for all bacterial diseases. N'accination of bacterial toxins is assuming an im- portant and rational place in treatment. It is now about fifteen years since the first efforts at specific treatment in tuberculosis began. This first trial of tuberculin marks one of the saddest pages in the history of the treatment of this or any other dis- ease. Never were hopes raised higher, and never were they dashed lower. The misuse of tuberculin in the early nineties not only resulted in the death of many patients, but it so embittered the medical jirofession against it that it will still take time before the remedy can be assigned its proper place. Dur- ing all these years those suffering from this disease have been denied the help which could have been rendered bv this immunizing treatment. The per- sistence of a few men, however, such as Spengler, Petreschky, Turban, Goetch, Trudeau. and von Ruck, who were convinced of the value of tuber- culin, has finally made the profession reconsider and give a more favorable opinion. Laboratorv experiment, as well as clinical evi- dence, shows stromectol online that tuberculin will aid in the cure of tuberculosis. Its effect on local lesions, such as stromectol for scabies can be seen bv the eye, in the laryn.x, for example, proves its value beyond question. The increase in the agglutinating and the opsonic power of the blood Nov. cheap stromectol 10, 1906] MEDICAL RECORD. 727 of those patients who are treated by it, shows that its action is that of a specific immunizer. Tuberculin stimulates the cells of the stromectol price body so that they throw out more specific antibodies into the bloodstream, and should scabies stromectol be employed in the treat- ment of this disease. So we can do more than nour- ish our patient; we can artificially increase his re- sisting power. We can make him more able to destroy the tubercle bacilli and tiie toxins which they form. Since the important researches of Wright and Douglas upon the opsonic power of the blood have shown us that Buchner and Nuttall were right in ascribing an antibacterial action to the serum of the blood, we can see the wisdom of keeping areas which are infected with tubercle bacilli well bathed in serum. The action of the Finsen light is to cause an irritation, with an increased How of blood to the part. Poultices to certain lupus patches have hastened their cure. Bier's method of treating tu- berculous joints, as well as acute inflammations, by passive congestion, can be explained in this same way. In this way we can also e.xplain the action of violet light upon pulmonary tuberculosis. By causing an active hyperemia it is aiding in bathing the parts with serum. Thus, all these measures which tend to divert more blood to the part involved are of value, and should be used in connection with tuberculin, for by so doing we are bathing the dis- eased areas with a blood which is rich in antibodies. .\nother measure which is of value is the giving of raw meat or muscle juice. Experiments of Richet and Hericourt, also of Philip and Galbraith. show definitely that the emnloyment of raw meat and raw meat juice causes a much greater retention of nitrogen than when the meat has been cooked. It is also the belief of these writers that there is something specific against the muscle waste, in the ingestion of the raw muscle. In order to be most successful in the general therapy of tuberculosis, all distressing symptoms and complications should be carefully managed. It is rarely ivermectin stromectol necessary to give medicines for cough, night sweats, shortness of breath, loss of appetite, indigestion, or fever of the early or moderately early cases. The careful management of buy cheap stromectol the patient, put- ting him to rest in the open air, together with the proper hydrotherapeutic measures, will usually relieve all these symptoms very quickly. Organic diseases of the stomach should receive most careful attention, for a good stomach is indispensable. The bowels should also be kept active. In more ad- vanced cases, sometimes these distressing symptom? will have to be relieved by appropriate drugs. Among the most distressing complications are dry pleurisy, which can be best relieved by strap- ping, and pleurisy with effusion, which should be removed if it causes embarrassment of the heart or respiration : tuberculous laryngitis, which will yield most readily to tuberculin, local cleanliness, rest, and wet packs ; and tuberculosis of the bowel, which will require careful regulation of the diet and such harm- less astringents as bismuth in large quantities, or lead and opium in intractable cases. The tubercu- lous patient is also subject to all other "ills that flesh is heir to." and when present they must be treated caiefully. Mixed infection is a very serious complication. Tuberculosis does not long remain a simple process. Germs, other than the tubercle bacilli, soon gain entrance to the diseased areas, thus complicating the condition. Just what part mixed infection plays in the pathology- order stromectol of tuberculosis is as yet uncertain, but the advent of other germs is generally looked u]jun as being a buy stromectol online serious complication. Mixed infec- tion unquestionably hastens destruction of tissue in the local areas and causes the liberation of toxins wliich are responsible for many grave constitutional (.listurbances. Mixed infection is doubtless present early in the infection, long before we are wont to recognize it by the symptoms which are usually ascribed to it, and it is undoubtedly the part of wisdom always to bear this in mind in treatment. When the symp- toms have once become marked the patient should be put to bed in the open air. The temperature should be relieved by sponging, the patient should be encouraged to eat plenty of good food, taking solid food at that time of the day when the tem- perature is low, and relying on milk, eggs, and muscle juice mostly at other times. All distressing symptoms should be relieved, and the patient kept in as cheerful a condition as possible. Every effort should be made to keep up the patient's nutrition. It is not at all uncommon to find patients who are thus carefully treated run a course of fever for weeks, and yet gain in weight.

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