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cle with or without injuries to the aorta and other organs are related, death being caused by shock, hemorrhage, traumatic aneurism, or secondary inllam- mations. In only eleven of Tricor 48 Mg eighty-two cases collected by Schuster did the patient survive more than twenty- four hours. Two highly suggestive cases are recorded by Hoch- Tricor Price haus.' The first was that of an adult, forty-three years old, previously healthy, who fell from a wagon, breaking some ribs, though not in a locality involving injury to the heart. His heart later was found to be somewhat dilated, pulse 100-120, small and soft. He became premanently disabled on account of his car- diac malady. The second was a similar though more complicated case resulting from a fall on the back. Both were regarded as cases of chronic myocarditis of traumatic origin. Tricor Coupon It is to this class of cases of injur)' to the heart muscle due to non-penetrating injury that the case above narrated probably belongs. The lesion is sup- posed by Schuster to be caused by concussion or bv the direct crushing of the heart between the sternum and the vertebra-, the latter springing back into place. It seems not impossible that cardiac laceration may be produced by spasmodic contraction excited by the shock of the accident, as occurs not infrequently in the case of the voluntary muscles. In looking over the recent literature of this subject I could find very little about the matter. It is not probable that such cases are extremely rare. It is not improbable that traumatism has a larger share than is generally recognized in chronic diseases of the myo- ' Jacoby: X. Y. Med. Journal, 1S93, 373. ' Prodsting : Deutsch. Archiv f. klin. Med., x.\xi. , p. 349. ' Rev. de Med., i88g, p. 755. * Brain, Vol. 4. ' Langenbeck's .Vrchiv, Bd. ix. ' Zeitschr. fiir Fleilkunde, 18S0-S1. p. 417. ■ Deutsches .\rchiv f. klin. Med., ii., p. i, 1S92. cardium, as exemplified by the two cases related bv Hochhaus above referred to. The effect of trauma- tism on the cardiac valves has long been recognized. I publish this case in the hope that it may attract at- tention to the less readily recognized lesions of the myocardium due to injury and lead to the publication of illustrative cases. 106 West 0.\-e Hlndkeu and Coupons For Tricor Twentv-Second Street. A CASE OF GLOSSITIS. Bv W. WASHBURN, M.D., NEW YORK. J. M. H , aged forty-five, commercial traveller, had generally enjoyed good health, but had been subject to what had been termed malarial attacks, for which he had been treated by quinine. About December I St the patient discovered a small ulcer on the inside of the left cheek, which after washing with witchhazel disappeared. He had not had syphilis. On December 5th the patient presented himself at my office for treatment for sore throat and pain down the left side of the neck. He was well nourished, rather fleshy. The skin was of good color and the eyes were clear. The pulse was 90, temperature 100^ F., respiration 22. The left tonsil was enlarged Tricor Coupons slightly, with marked redness, localized on the an- terior inferior surface. I ordered a gargle of tannic acid and potassium chlorate. Early the following morning I was summoned in haste, the messenger saying that the patient was choking to death. When I reached the patient he was in bed, conscious but unable to speak, and had a feeling as though he could not breathe. The nose was, however, free and with a little encouragement he soon learned that he could not only breathe properly but also swallow without any great difficulty. The mouth was forcibly open and the tongue filled the whole opening, the teeth being embedded in the tongue. Closer exam- ination showed that the left side of the tongue was extremely thickened — nearly three inches thick — and that the right side was very little affected. Cracked ice was immediately applied to that portion of the tongue that could be reached. Diagnosis: Left hemi- glossitis. The sublingual veins were opened as soon as a knife could be procured, some fifteen minutes later. The patient could articulate (very thickly) immediately after liie blood began to flow, and his mental condition improved at once. Ice was ordered now for external application, as the left cheek and left side of the neck were beginning to swell rapidly. An hour later more blood was drawn from under the left side of the tongue, with relief (for the patient had again become unable to articulate. The bleeding was re- peated each hour thereafter until about noon, after which the swelling did not again increase on that side of the tongue, but began on tiie right side and rapidly in- creased, so as to make articulation Tricor 145mg again very difficult. The same treatment was applied on the right side of the tongue that had been given to the left, and in the mean while three leeches were applied to the lower angle of the left jaw. At i p..m. the pulse was 108; temperature, 101 ' F. : respiration 18 and pretty full. The leeches were still on the left side, and the right side of the face and right side of the neck were swelling but under control by blood-letting from the under sur- face of the tongue. Here a different course had to be adopted in bleeding, for the veins could be seen, there having been so mucli rolling over of the tongue to the right side, and longitudinal cuts were therefore made as near the under side as possible. Tricor Online The bleeding was at first not very free, but a little later the veins were Purchase Tricor reached and the improvement was as rapid as it had August I, 1896] MEDICAL RECORD. 173 been on the left side. A catheter was left with the nurse, with instructions how to use it in case of oedema giottidis. Solution of acetanilid in fifteen-drop doses, about one grain, was given every hour. Swelling of the right side of the tongue began to go down rapidly about 2 P.M., but the glands of the neck on that side remained swollen. The mouth was now douched with ice water, as pa- tient could control the water from going down the throat. This was continued for ten minutes and repeated each hour. Mustard leaves were applied to the Tricor 145 feet and removed when these became very red. Hot applica- tions to the abdomen were also made. The subsequent incisions in the tongue showed white lines of tenacious pseudo-membrane Tricor Mg (the knife and hands were thoroughly aseptic). The mouth was sprayed Buy Tricor Online every hour with a solution of the perman- ganate of potassium. Patient left the city on Decem- ber loth and has not been heard from since. The case presents some peculiar features. No cause could be found for the glossitis —there were no sharp edges of any of the teeth. The patient had never had syphilis and no other known poison had been absorbed or injected; recovery took place without the forma- tion of pus. The case is reported as interesting be- cause of these features and the probability, so far as can be seen, of the glossitis being the direct result of cold, as is claimed by some authors, among whom Tricor Cost Cohen, in " Pepper's System of Medicine," may be quoted. One other feature deserves mention — the fact that first one side of the tongue only was affected and then the other, and to this may be attributed the further fact that there was no protrusion of the tongue, as is usually the case, but rather a rolling over and point- ing downward of the tip, which was caught behind the lower teeth and during the time it was swollen could not be dislodged from that position, except partiallv. BIL.\TERAL ORCHIDECTOMV, SUPRAPUBIC CYSTOTOMY. FOLLOWED BY ,\(;;UTE MA- XLV AND DEATH. Bv WILLIAM WARREX TOAVXSENH, M.D., RUTLA-ND, VT., CEKITO-L"RINAi;V SLRL.EON, \ERMONT STATE HOl'SE OF CORRECTION. Re.alizixg that the advisability of bilateral orchidec- tomy Order Tricor for prostatic hypertrophy is still under discus- sion, and believing that it is the duty of every operator to give a full and detailed history of cases that come under his observation, I report the following: S. M. P , aged si.xty-seven, farmer, came to con- sult me in regard to a bladder trouble which he had had for the past five years, and gave the following history: L^p to the beginning of his trouble he had always enjoyed good health, and had been a hard worker. He was always very energetic se.xuallv. He gave a complete history of beginning prostatic hvper- trophy, namely, frequent and nocturnal micturition, lack of force to stream, etc. The use of the catheter began two years before, as voluntary micturition had become impossible, and .since then he had consulted a number of physicians, who advised various internal remedies, vesical irrigations, and suppositories. Since using the catheter he Cheap Tricor had been growing worse; intro- duction of the instrument was getting more painful, and had to be performed every hour, day and night. The urine contained a large quantity of pus and some blood. The prostate was enlarged to about the size of a goose egg. The passage of a searcher through the prostatic urethra excited a severe parox- ysm. The bladder contained 55 c.c. of residual urine whicli was ammoniacal. Stone was suspected but was not made out by the examination, as this was quite painful and the patient would not consent to an anaes- thetic merely for an examination. Cystoscopy was not performed for the same reason. As the case seemed to me to be an ideal one for bilateral orchi- dectomy, and as the patient was in excellent con- dition in other respects, I advised operation, which was assented to. November 3, 1895, I performed the operation in the presence of a number of my associ- ates. The first forty-eight hours after operation the patient was in excellent spirits, Tricor Fenofibrate and other than pain from the wound and that occasioned by catheteriza- tion, which was performed every two or three hours instead of every hour, as had Buy Tricor been done previous to operation, he suffered little. On the third day the dressings were removed and the wound was found to be healed. A collodion and gauze dressing was put on and from the time of operation up to the fifth day all went well. Catheterization was performed every two or three hours and frequently when the beak passed the cut-oft' muscle urine would flow out along side the catheter. Beginning Tricor 145 Mg about the fiftii day the patient, after the bladder had been voided of its contents, experienced severe pain near where the beak passed into the pros- tatic urethra, and after the bladder had been voided of its contents. ?"xamination of the prostate by palpation per rec- tum showed that there had been atrophy. In passing the catheter I detected a distinct grating on with- Tricor Prices drawing the instrument, and with the searcher and various manipulations vesical calculus was made out. Operation was Cost Of Tricor advised and one week from the day of

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