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consider treatment. In early cases, when the condition may be presumed to be present, though not absolutely demonstrable, hygienic measures are of great service. All mental and physical excesses must be avoided. Causative factors must be eliminated as far as possible. Diet must be regulated for each individual case. In the advanced cases which call for the use of medicinal rem- edies probably the best one at our command is the iodides. When vasodilatation with sedation is required strontium bromide is of great service. Chloral is often satisfactory in this direction. When immediate vaso- dilatation is required amyl nitrite is the choice. When the myocardium begins to degenerate drugs of the dig- italis type are indicated. They must be used cautiously, however, or there may be a danger of fatal arterial spasm. When rapid heart action is present, rest in bed, morphine, and the icebag become imperative. Rest, however, may in some cases be enforced to an injurious degree. Indications for Surgical Intervention in Diseases of the Stomach. — J. A. Blake divides operations on the stomach into three classes: First, repairs of wounds and perforations; second, improvement of drainage; and third, partial excision. In the first class surgical inter- vention is immediately indicated. In the second class the only conditions that can be helped are those which interfere with the normal drainage of the stomach. Such are pyloric obstruction, intermediate obstruction, or hour-glass stomach and ulcer. If there is evidence of pyloric obstruction we should not wait for evidence of a tumor, diminished hydrochloric acid, or dilatation of the organ. Hour-glass contraction always requires surgical intervention. In ulcers we may have acute or chronic conditions. In general the former call for med- ical and the latter for surgical aid, but we must be Vibramycin Antibiotic careful to understand just what is meant by these terms. Perhaps the designations of "early" and "late" would be better. Pyloric ulcers may be excised or treated by gastroenterostomy while cardiac ulcers must be excised. In the third class of Vibramycin For Acne cases the author states that when the pylorus with only the adjacent portions of the stomach and duodenum is removed, the operation is known as pylorectomy, while partial gas- trectomy usually infers the removal of the pylorus with a considerable amount of the stomach. When only a small part of the stomach wall, such as an ulcer, is re- moved the term excision is employed. Carcinoma is the main indication for pylorectbmy and partial gas- trectomy, but not infrequently the Vibramycin Doxycycline Hyclate pylorus, with the adjacent portion of the stomach, should be removed for ulcers, particularly when large or multiple; in fact, as has already been stated, on account of the possibility of malignant degeneration, the excision of ulcers when practicable is always indicated. In cancer of the stom- ach there is no question as to the propriety of operat- ing, unless we feel certain that it has advanced so far that there is no hope of good even from a palliative operation such as gastroenterostomy. The author then discusses points of dififerential diagnosis and shows by collated statistics that the mortality of these extensive operations is steadily lessening. He does not think that we should Vibramycin Mg refuse operation in any case in Vibramycin 50mg which there is a chance for benefit, particularly when stomach drainage is being interfered with. American Medicine, August and September, 1906. Influence of Rest, Exercise, and Sleep on Gastric Digestion. — Julius Friedcnwald, from his observations draws the following conclusions: In persons with nor- mal digestive powers it Vibramycin Indications makes but little difference whether the individuals rest, exercise, or sleep after meals, though after violent exercise or sleep the gastric digestion is very slightly impaired. In patients suffer- ing with superacidity and subacidity it is best to order rest after meals; after violent exercise or during sleep the digestion is impaired in these cases. In patients suffering with motor disturbances of the stomach it is best to prescribe moderate exercise after meals, for rest, violent exercise, or sleep disturbs the digestion under these conditions. Multiple Chancre. — A. F. Biichler states that while the initial lesion of syphilis is generally single, in a goodly proportion of cases it is found to be multiple. The results of the writer's investigations show that in the two hundred and seventy-three cases of initial lesion of syphilis recorded in recent years, thirty-three, or a proportion of more than twelve per cent, were of the multiple form. Of these thirty-three cases, in twenty-five there were two lesions, in six there were three, and in two there were five. The multiple lesion, according to the writer, was either purely genital, purely perigenital, or purely extragenital in location. In the first group there were thirty cases, in the second one, while two lesions were extragenital in position. Numerous well-attested examples of combinations of these groups have been recorded. .As to the mode of evolution of the multiple lesion, the histories here re- ported ^are incomplete. However, the development of the chancres in most of the cases was said to be syn- chronous. In a number of instances the evolution was successive. The interval between the appearance of the first and the successive lesion or lesions, with the ex- ception of one case, never exceeded a week. The writer believes that in the negro the dual chancre is the rule. Treatment of Cancer of the Breast. — Beverly Mac- Monagle presents these conclusions: All tumors of the breast are a threat to the well-being of the patient. Positive diagnosis cannot be made in the early stages without microscopic aid. All tumors of the breast should be removed with Vibramycin Hyclate care to prevent reinoculation. Microscopic diagnosis should be made. This should be followed at once by radical operation if the growth is found to be malignant. This method gives the best chance of improving the results of surgical treatment of cancer of the breast. Pernicious Effects of Alternating Currents of High Voltage. — Frederick H. Millener has recently made careful investigations in twenty-four cases of individ- uals suffering from the pernicious influence of the alter- nating Vibramycin Suspension current, especially Vibramycin Tablets when of high voltage. He calls Purchase Vibramycin Online attention to the well-known fact of the souring of milk immediately after a thunderstorm. In dairies in which separator machines are used the direct current is invariably employed because souring of the milk does not occur when this is used instead of the alternating current. The writer describes a patient who worked in one of the power plants. These plants are kept scrupu- lously clean, but the patient in a short time had lost his appetite, his face and hands had become almost chalky white, and his condition was becoming serious. The writer then asks what this mysterious force is which flows through the atmosphere. The other pa- tients whom he has examined show symptoms similar to those here described. He believes that the condition is due to the effect of the alternating current of high voltage. He presents this problem, the solution of which he cannot predict. If a man thus disturbed should apply for life insurance he would be put in the substandard list. This problem is sufficient to warrant further study and investigation. Scarlet Fever. — Joseph F. Chmelicek Luhan in the last five years has not lost a patient with scarlet fever, nor among his 129 patients has there been a serious complication. He believes that the condition of the blood is the direct cause of cardiac paralysis, to which death is due in so many cases of this disease, especially in children. He isolates the patient in the lightest and best room in the house. A warm bath is given and the bowels are Vibramycin Antibiotics relieved by an enema or magnesium citrate. The patient is kept on a strict diet of milk, with plenty of water and soups. Antipyretics, excepting the tepid bath, are not used. Elixir of sulphocarbolate of iron is pre- scribed up to the fourth day; after this, elixir sulphocitrate of iron is administered for four days. The Making and Dressing of Wounds. — Miles F. Por- ter declares that wounds should be as small as may be compatible with accurate, reasonably rapid work. He concludes his paper with the following statements: Unwise efforts to produce asepsis may cause more harm than the bacteria against which they are directed. The surgeon's attitude toward nature should be that of a modest cup-bearer, not that of a usurper. Sutures, re- dressings, and drains are, at best, necessary surgical evils; hence, all sutures should be discarded in favor of the bandage and adhesive plaster when these can be made to serve the same purpose, but when the use of Nov. lo, 1906] MEDICAL RFXORD. 751 sutures is imperative, then (a) buried absorbable su- tures should be preferred; buried nonabsorbable tem- porary sutures should be the second choice; through- and-through sutures should be used only on compul- sion, and buried permanent sutures should be discarded except in work on the hollow abdominal viscera; (b) the physician's aim should be to do the first dressing so that it will be the only one needed until healing is accomplished, and, when this is impossible, efforts should be directed toward preventing the necessity of frequent dressing; (c) when in doubt, the physician should not drain, but, if drainage is imperative, it should be adequate without being harmful, kept up while it is needed, and discarded so soon as Order Vibramycin it has fulfilled its mis- sion. The Relation Between Tonsillitis and Acute Articular Rheumatism; with Particular Reference to the Prophy- laxis of Postanginal Rheumatism. — Charles F. Kieffer has studied the retained records of Fort Russell for a period of thirty-eight years. These records show 2,275 cases diagnosed as acute tonsillitis. In the same time there were 1,293 cases diagnosed as acute articular rheu- matism. The records seem to Vibramycin Cost indicate that the epi- demic or infectious form of tonsillitis is followed in a large proportion of cases by rheumatism. In these records 276 cases of articular rheumatism were preceded by tonsillitis, a proportion of 21.3 per cent. The ex- .treme incubation period varied between thrVibramycin Acne solution of sodium bicarbonate. Then finely-powdered acetyl-salicylic acid is rather firmly applied to the tonsil with a cotton- tipped wooden probe. Applications are made thrice daily. In the series of patients treated in this way not one case of rheumatism developed. The Use of Nauheim Baths for the Failing Heart of Acute Infectious Diseases, Especially in Pneumonia; with Studies of the Blood-Pressure. — Philip King Brown says that under the immediate influence of Buy Cheap Vibramycin Nau- heim baths for chronic heart troubles there is a slow- ing of the respiration, a slowing in the heart rate, an increase in the volume of blood in the peripheral ar- teries, with a corresponding increase in arterial tension, and in the amount of urine eliminated. The writer has Vibramycin Syrup studied the effects of these baths on patients who were suffering Generic Vibramycin from pneumonia. The pulse, respiration, tem- perature, and blood-pressure were taken before the bath. A full-strength bath was given at once. In practically every instance there was a lessening in the pulse and respiration rate, and a rise in the blood- pressure. In a few cases Order Vibramycin Online the effect of various drugs on the blood-pressure was compared with the effect of the Buy Vibramycin Online baths. In every instance the average blood- pressure was higher and better sustained on the days when baths were given than on the days when drugs were given. The writer believes that the supplemental use of drugs is not to be neglected. Treatment of Pneumonia, — Woodbridge Hall Birch- more declares that after the intestinal tract is emptied and cleansed and carefully maintained in satisfactory condition, nutrition will not be seriously interfered with. The body can then supply the needed strength for the healing process. To combat the cough ammo- nium chloride and the mixtures of the bromides have been found of the utmost use. The control of the cir- culation is best accomplished by the combined use of aconitine and digitaline. The latter causes contraction of the pulmonary arteries, while the former relaxes the systemic blood-vessels. If there is insomnia the writer believes that hyoscine is the best hypnotic. An Unusual Case of Tic. — Alfred Gordon reports this

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