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Quite frequently it happens that while the obstetri- cian is busy in checking a postpartum hemorrhage, or in repairing a lacerated perineum, it falls to the lot of the attending nurse to look after the needs of the neonatus. In cases of asphyxia, she even as- sumes the role of a goddess in actually "blowing into his nostrils the breath of life." Under the guidance of the attending physician, many a nurse has resuscitated an apparently dead child by the var- ious methods, mechanical, medicinal, etc., known trazodone cost without insurance to the modern practitioner. At the maternity department of St. Luke's Hos- pital, Denver, in desperate cases of asphy.xia neona- torum, a novel method has been adopted at the inde- pendent suggestion of two nurses, each unknown to the other. In one case, after having exhausted all his skill, resources, and strength, the attending phy- sician concluded that the child was beyond human aid, and left the hospital in despair. The attending nurse cast her eye on the tank of oxygen which was standing in the corner of the room, and tlecided to make an experiment of her own, even at the risk of incurring the displeasure of her superior. She turned on a stream of oxygen into the nostrils of the baby, and was overawed to see the infant take its first breath. On the following day the attending physician was amazed to find a live baby in the arms of its mother. The other nurse, in a similar case, timidly sug- gested to another attending physician, after he had thrown up the sponge, to use a few whiffs of oxygen. He did not protest against her audacity to express an opinion in his august presence, but grasped at the opportunity of trying a novel pro- cedure. He was repaid by having saved a human life, and by the gratitude which shone in the eyes of the parturient and nurse. Having obtained the permission of the physicians and nurses to nublish buy trazodone online no prescription the above, and after consult- how much do trazodone cost ing the recent text-books on obstetrics, the available current literature, and several prominent obstetri- cians without finding any record of the use of oxy- gen in asphyxia neonatorum in this country, I con- cluded that the subject buy trazodone deserved to be brought to the attention of the medical profession for the pur- pose buy trazodone 50 mg of further research, discussion, and experi- ment. I hoDe I shall not be accused of mere gallantry if I mention the names of the two nurses who sug- gested the new method — Miss Marguerite Rullene. dav head-nurse, and Mrs. Oca Cushman. night head- Obstruction of the Biliary Passages. — Delbet does not think that the hypotheses which have been offered to explain the lesions of the gall-bladder are sufficiently convincing, for this is a very complex subject. The causes which must be investigated are buy trazodone generic the nature of the obstruction, the condition of inflammation of the biliary passages, and the location of the obstruction. The last factor plays a very important role. Supporting his point of view, Delbet refers to a case of cancer of the pan- creas which, by compressing the ductus communis choledochus, brought about atrophy of the gall-bladder. The nature and the seat of the obstruction, however, are not the only conditions to be considered; account must be taken of the bladder wall. Not only does in- flammation cause retraction of the gall-bladder, but it also brings about distention. Inflammation of the mu- cosa may bring about a hypersecretion and lead to that condition which is wrongly called dropsy of the gall- bladder. Inflammation of the other layers bring about more easily a sclerosis. A complicating factor is that in many of these cases there are two buy trazodone uk successive stag«s, a temporary period of dilatation and another period of definite retraction. — La Tribune Midicale. Inflammation and Peritonitis Considered as Physio- logical Processes. — John D. Malcolm, in the conclusion ■ ji his paper on this subject, says that it seems prob- able that an obvious and definite aseptic peritonitis is a not uncommon condition; that aseptic inflammation may be described as consisting of the local physiologi- cal changes in and around damaged tissues which are brought about by an injury, and which increase in activity for not more than three days after the injuri- ous action ceases — the object of this increased physio- logical activity being the removal by absorption, with- out obvious loss of tissue, or the demarcation, with a view to separation, of those parts generic trazodone online which have been so dainaged that their period of usefulness to the animal economy has ended. The result in some cases, how- ever, is a revival of tissues which have been deprived of their blood supply. Septic inflammation generic trazodone hcl may be described as consisting of the local physiological changes in and around damaged parts which are brought buy trazodone online uk about by an injury and by the presence of cheap trazodone no prescription irritating microorganisms acting on the damaged and adjacent tissues, or which are brought about by the action of such microorganisms on undamaged tissues — these changes continuing and varying in activity in proportion to the duration and intensity of the irrita- tion. The objects, which are not always attained, are the removal by absorption or by extrusion of the nox- ious microorganisms, and the removal by absorption, without obvious loss of tissue, or the demarcation, buy trazodone sleep with a view to separation and extrusion, of those parts which have been so altered that neither their absorption nor their recovery is possible. The idea that a destructive or an impaired action is a part of the process of in- flammation must be carefully excluded. Briefly, in- flammation, whether aseptic or septic, consists of the series of phenomena necessary for the removal, or for attempting the removal, of effete and irritating matter from a damaged area by the physiological processes of absorption, of extrusion, of demarcation and of re- vival, or by one or more of these. — The Scottish Medical and Surgical Journal. 742 MEDICAL RECORD. [Nov. 10, 1906 Medical Record. A Weekly 'Journal of Medicine and Surgery. THOMAS L. SIEDMAN, AM., M.D, Editor. PUBLISHERS WM. WOOD & CO., 51 FIFTH AVENUE. New York, November 10, 1906. ANTHRACOSIS AND PULMONARY TUBER- CULOSIS. The opinion that tuberculosis of the lungs is in the majority of cases the sequel of a primary infection, occurring how much does trazodone cost — often many years previously — via the in- testine and the mesenteric lymph nodes, has gained many notable adherents of late. Without going as far as Behring, who looks upon phthisis in the adult as the closing act of a drama beginning in the cra- dle, there is much that is rational in the conception of this mode of invasion of the tubercle bacillus, and experimental corroboration is not lacking. To buy trazodone hcl men- tion only two of the most recent of the published observations relating to this subject, reference may be made to the work of Bartel and of Schlossmann. The former of these trazodone discount coupon placed guinea pigs under ap- propriate conditions in the homes of consumptives, and found that those of the animals that became tuberculous in nearly every instance gave evidence of a primary intestinal infection. Schlossmann (see cheap trazodone Medical Record, August 4, 1906, p. 191) endeav- ored to demonstrate the route by which the germs probably make their way from the gas- trointestinal tract to the lung by selecting animals so young that all likelihood of already existing tuberculous disease could be excluded, and under the proper precautions injecting tubercle bacilli into their stomachs. It was found that buy trazodone hydrochloride in some instances, after the lapse of only a few hours, tubercle bacilli had already penetrated to the lung. The experimenter expresses the conviction that the organisms passed through the intestinal wall and gained the mesenteric lymph nodes ; from there they entered the thoracic duct, and thence through the venous blood stream found lodgment in the lung. Ribbert, an authority whose opinion is worthy of the utmost respect, declines to accept this assump- tion. For him, now as before, the respiratory chan- nel represents the chief portal of entry of the tubercle bacillus in pulmonary tuberculosis, though, of course, he is far from denying that the other mode of invasion does not frequently take place. In a recent generic trazodone cost communication (Deiitscher medisinische Wochenschrift, October 4, 1906) he considers the bearing of anthracosis in the present problem and finds in the conditions thus produced a weighty ar- gument in favor of his view. Contrary to those who assume that the deposit of coal dust is per se a dele- terious process, capable of leading to damage to the pulmonary tissue, he believes that when harm re- sults it is in consequence of a preexisting tubercu- losis. In support of this he points out the scattered occurrence of the small — often only pinhead sized — calcareous anthracotic subpleural nodules that by a careful examination can very often be discovered in the lungs of those dying from nonpulmonary dis- eases. Although it is usually impossible, owing to their lack of all structure, to demonstrate by micro- scopic examination the tuberculous character of these nodules, the fact that whereas lesions due to the deposition of coal dust alone would be uniformly distributed, they are found fortuitously scattered in small numbers here and there, makes it evident that there must have been some localized inflammatory process to encourage the carbon particles to collect. Under these conditions the pigment grains would be prevented from being disposed of in the manner usual to healthy lung tissue and would become en- tangled in the connective tissue network. Of the various possible sources for these inflammatory foci, such as syphilis, abscesses, or infarcts, tuberculosis is the most probable. That it does play a role in this connection is shown by those calcareous nodules, black at the periphery and cheesy at the center, or possibly presenting giant cells and tuberculous gran- ulation tissue, which are sometimes found. These and a number of other considerations, the discussion of which, owing to limitation of space, cannot profitably be entered upon here, lead Rib- bert to conclude that most anthracotic foci rep- resent the late stages of healed tuberculous lesions. By a similar process of reasoning, the same con- clusion is reached regarding the anthracotic bron- chial glands. It would seem far-fetched indeed for any one to ascribe the subpleural nodules to bacilli that had entered the body through the ali- mentary tract, and Ribbert considers that their ex- istence affords striking evidence of the aerogenous infection of the lung, and of the bronchial glands as well. Tubercle bacilli can, of course, readily pene- trate the respiratory epithelium without leaving any traces, just as they can and do penetrate the in- testinal mucosa. -Acceptance of this doctrine of the tuberculous na- ture of these very frequent anthracotic nodules has an interesting bearing on the generic trazodone 50 mg statistics of latent tuberculosis. As our knowledge of the pathology of tuberculosis is broadened^ the sweeping assertion that most of humanity is tuberculous, in the sense of harboring in one tissue or another demonstrable tuberculous lesions, seems more and more worthy of credence. Granted this wholesale infection of the human race, there follows the somewhat re- assuring corollary that in view of the relatively small proportion of individuals who actually become diseased most of the population must be compara-

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