sure. The foot and toes were red in color, but
presented no alteration upon change of posture.
Cutaneous sensibilities to temperature and pain
were normal. Medicines, hot-air treatment, and
baths were without avail, under which regimen
he remained for two years.
At the end of this time a gangrenous ulceration
appeared upon the great toe, and was soon fol-
lowed by a similar area upon the toe adjacent.
The symptoms enumerated above persisted. It
was noted that at this time there was no dorsalis
pedis pulse to be felt upon tljat side. No note
was made of other pulses in that extremity. _ The
foot was amputated through the ankle. During a
period of nine months subsequently the wound
refused to heal. The leg was then amputated
above the knee, and from the proximal stump of
the popliteal artery was drawn a long, white,
[Nov. 10, 1906
canalized thrombus three inches in length. The
wound was closed, and healing ensued.
At the present time, five years after the ampu-
tation through the thigh, he again complains of
great pain in the stump, together with a deep
•cyanosis. He was free from pain until a year ago.
There is Is Toprol A Beta Blocker no pulsation in the femoral artery of that
side. An attempt was made to feel the external
iliac pulse per rectum, but the vessel could not be
The patient now, and for the past year, has had
pains of similar character in the right foot and
toes. There is little or no change of color, and
no change with foot dependent. The dorsalis
pedis pulse on the right side is absent. The fem-
oral pulse is palpable, and apparently not dimin-
ished. There is no other determinable vascular
disease. There is neither albumin nor sugar in
the urine, nor has there at any time been hema-
turia. Generic Name For Toprol Unfortunately, there was no further exam-
ination made of the amputated extremity.
Case II. — A. G. Tall, slender male. Russian
Jew, age twenty-eight years. Peddler by occupa-
tion since landing in this country two years ago.
Previous to that time had been a farmer.
Parents living and healthy, as are also four
brothers and Generic Name For Toprol Xl three sisters. Smokes moderately,
and has never used alcohol. Has never had syph-
ilis. Has always been well in recent years until
onset of present complaint. About one and a half
years ago began to have anginal attacks in calf
of left leg; the pain would extend to the foot and
toes, and sometimes would last Toprol Xl Vs Metoprolol Tartrate for several days
without cessation. There was nothing to be seen
upon the leg or foot to account for the pain, which
was deep-seated, and difficult to locate exactly.
It was described as of a boring and burning char-
acter. Various salves and baths were prescribed
for the pain without avail.
For seven or eight months the pain has dimin-
ished in the leg, but persists, and is worse in the
foot and toes. During the past four months the
pain has been extreme and constant in the large
toe and toe adjacent. An ulceration has devel-
oped upon the great toe, and the distal three-
quarters of the foot has assumed a dull red color.
This color persists in horizontal and pendant posi- Toprol Xl Generic Name
tions. The ulceration Toprol Xl 50 Mg Recall upon the great toe is upon
the under inner surface, and towards the tip. It
refuses to granulate. There is no pulsation in the
dorsalis pedis artery on this side, nor can pulsa-
tion be felt in the popliteal with leg flexed at
right angles. The femoral pulse is good.
The reflexes are normal, as are also the cu-
taneous sensibilities to pain, touch, and tempera-
ture. No blood pressure estimation could be
made, owing to the absence of a pulse at the
periphery. Otherwise the patient's general con-
•dition is good. There is no further evidence of
The patient was told the serious nature of his
apparently slight affection, and Toprol Xl Vs Metoprolol was advised to
remain in the horizontal position. He was given
nitorglycerin and iodide of potassium. In the
course of ten days of care in hospital his pain was
very severe, and had to be controlled by opiates.
Meanwhile, the ulceration upon the great toe
extended and became foul, and the adjacent toe
became first cyanosed, and then black. Both toes
were amputated. During the course of the suc-
ceeding two and a half weeks the wound sloughed.
the edges became black for a considerable dis-
tance, Toprol Xl Beta Blocker and a foul, yellowish discharge exuded
from the wound. The leg was amputated above
the knee. The wound healed by primary union.
Examination of the amputated extremity re-
vealed the dorsalis pedis artery Is Toprol Xl A Beta Blocker entirely obliter-
ated, represented by a fibrous strand. No canal
was demonstrable. The posterior tibial contained
almost throughout its length a canalized lamel-
lated thrombus. With the artery laid open this
thrombus was found not particularly adherent,
and could be raised from the vessel wall at any
point. The vessel wall itself was not much
altered. The popliteal artery itself, up to the
level of the amputation, was also occupied by Toprol Xl Generic Equivalent
thrombus, but dififering materially from that in
the posterior tibial artery. This thrombus was
evidently formed by blood clot. It was reddish
in color, it was not canalized, and was also only
lightly adherent to vessel wall. The thrombus
was partly organized.
The symptomatology of this condition is so
well demonstrated in the foregoing cases that lit-
tle need be added. The likelihood of error seems
to be to confuse this disease with Raynaud's
disease, but with little care both the symptoms
and Toprol Xl Generic Recall course of the disease will be found to be
entirely different. Michels and Weber have re-
cently reported a case almost identical with my
first. Their report includes a careful study of
the microscopic findings. The cases reported by
Arkwright and Dunlop, if at all instances of this
disease, are complicated. The question of etiology
is still obscure Toprol Xl Coupon and speculative. Friedlander
considers injury and exposure to cold important
factors. Wwedensky believed there was an un-
derlying neuritis, upon which fs imposed an
arteritis. Metoprolol Tartrate Vs Toprol Xl Sternberg assumes injuries applied to
a weakened and depressed vascular system, and
Hollis suggests that by the repeated impact of
foreign particles against the sides of a small artery,
a state of irritation or "molecular unrest" is estab-
lished within certain endothelial cells. None of
these theories quite satisfies the conditions. It
would seem that if the cause were endarterial, Cost Of Toprol Xl
such as a toxin conveyed by the blood stream, its
action would not be selective to a certain arterial
distribution. If there be extravascular agencies
their nature still remains obscure. The two cases
cited above would rather suggest that the disease
in its onset is peripheral, inasmuch as the obliter-
ation was farthest advanced in the distal parts.
The disease is slowly progressive, and is Generic For Toprol Xl not
cured by amputation, as is evidenced by the re-
currence in the amputation stump of Case I. Toprol Xl 100 Mg
Wwedensky believed the condition to occur only
in Russian and Polish Jews. Michels and Weber
also comment upon this fact, the case reported
by them having occurred also in that race. My
two cases are both Russian Jews. A. Pearce
Gould, in The Second Lettsomian Lecture, cites
several cases, but no mention is made of this fact.
I have failed to find anything racial that might
predispose Jews to arterial changes. The ergot
in the use of rye bread seems to play no role. It
is to be hoped that modern research in artery-vein
anastomosis may find a fruitful application in
Jaesche : Laiigcnbcck's Archiv, Vol. VI.
'Burvow -Mrchow's Archiv, Vol. XXXVIII.
Friedlander : Ueber Arteritis Obliterans : Centralblatl fitr
die mrdiciiiischot JVisseiisclmfteit, No. 4. 1876.
Winiwater : Ueber cine ei.a;enthumliche Form von Endar-
teriti!! luid Endopblebitis init Gangran des Fusses; Archiv
fiir klinischc Chirurgic, Vol. XXITI.
Sternberg: Wiener kliitischr Wochenschrift, Nos. 7,7
Nov. lo, 1906]
Wwedensky : Archiv fur klinische Chirurgie, Vol. LVII.
Von Zoege-Manteufftl : Archiv fur klinische Chirurgie,
Vol. XIII; and Deutsche Zcitschrift fiir Chirurgie, Vol.
Bunge: Archiv fiir klinische Chirurgie, Vol. LXIII.
Wulff: Deutsche Zeitschrift fiir Chirurgie, Vol. Metoprolol Vs Toprol Xl LVIII.
Von Toprol Generic Equivalent Wartburg: Beitriige cur klinischen Chirureie, Vol.
A. Pearce Gould: Second Lettsomian Lecture, Lancet,
Vol. I., 1902; Transactions Clinical Society, London, Vol.
XVII. and Vol. XXIV.
Hadden : Transactions Clinical Society, London, Vol.
Spencer : Transactions Clinical Society, London, Vol.
Arkwright: Lancet, Vol. II., 1902.
Dunlop : Lancet, Vol. I., 1903.
Michels and Weber: British Medical Journal, 1905.
18 East Sixtieth Street.
nurse of St. Luke's Hospital. Even should future
research not accord to them the honor of priority,
they deserve credit for having revived an old
method of resuscitating the apparently dead new-
born in the city of Denver, where this method was
Has oxygen ever been used, or its use suggested,
in resuscitation of the drowned?
14a Court Place.
THE I'SE OF OXYGEN IN .ASPHYXIA
ByC. d. spivak, .\i.d., Toprol Xl Vs Generic
Related tags: Toprol Xl Coupons, Toprol Xl 12.5, Toprol Xi, Toprol X, Toprol Coupon, Toprol Xl Recall, Toprol Xl 200, Toprol 12.5 Mg, Toprol 200 Mg, Toprol Xl Cost, Toprol Xl Price, Toprol Xr, Toprol Interactions, Metoprolol Vs Toprol, Toprol Vs Metoprolol, Toprol Generic Name, Toprol Xl 100, Beta Blockers Toprol, Beta Blocker Toprol, Toprol Beta Blocker, Toprol Xl Er, Toprol Er, Order Toprol, Toprol Xl 50mg, Toprol Xl 25, Toprol Xl Metoprolol, Toprol 25mg, Toprol Xl Generic, Generic Toprol Xl, Toprol 25 Mg, Metoprolol Toprol, Toprol 25, Toprol 50, Toprol Generic, Generic Toprol, Generic For Toprol, Toprol Xl Mg, Toprol Mg, Buy Toprol, Toprol Metoprolol, Toprol 50 Mg, Toprol 50mg, Toprol Xl 50, Metoprolol Toprol Xl, Toprol Online, Buy Toprol Xl, Toprol Xl 25mg, Toprol Price, Toprol 100 Mg, Buy Toprol Online, Order Toprol Xl, Toprol Xl 100mg, Lopressor Toprol Xl, Cheap Toprol, Toprol Recall, Toprol Cost, Buy Metoprolol, Buy Metoprolol Online, Buy Cheap Metoprolol, Order Metoprolol, Order Metoprolol Online, Metoprolol Online, Purchase Metoprolol, Purchase Metoprolol Online, Generic Metoprolol, Metoprolol Buy,