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nal glands are similarly affected. The author notes that we have as yet no absolutely positive means of detecting minute glandular lesions of the mediasti- num, so frequently the cause Vytorin Cost of a general infection, and suggests that the presence of visible veins on the Vytorin Cholesterol chest, dilated jugular veins which do not col- lapse on inspiration, visible veins under the chin or on the temples, together with the other suggestive facts (enumerated above) in the history and state of the pa- tient, may lead to an increase in the number of these cases diagnosed during life. It is hardly necessary to mention how quickly these children improve under a liberal diet and ordinary attention to health, and therefore what a valuable weapon for prophylaxis the knowledge of the presence of mediastinal tuberculosis may become. A Method of Taking Impressions of the Weight- bearing Surface of the Foot. — W. D. Lawrie refers to a method recently suggested by Schiiman of Leipsic. Two Cost Of Vytorin solutions are used, one of ferric chloride and the other a 5 per cent, solution of ferrocyanide of potash. It is found that it is difficult to handle the iron paper on which the Vytorin Generic Equivalent foot rests and to distribute the ferro- cyanide solution evenly over the foot. The author has therefore substituted the following method: The ma- terials required are a glass slab, say 16 Vytorin 10 Mg inches by 13 inches, a roller, and a tube of specially prepared printer's ink. Vytorin Gel A thin film is pressed out on the glass plate by the roller, and after standing on this the pa- tient transfers his Generic For Vytorin 10 40 blackened sole to a sheet of paper. It is important to see that the patient puts his weight on the foot during both parts of the process. The re- sult is an accurate and permanent impression of the weight-bearing portions of the foot. The foot can be easily cleaned with soap and water. The impressions mav be photographed and reduced in this way to a size suitable for the notebook. Illustrations are shown from photographs of such impressions. A normal im- pression is by no means the rule. One picture shows the result nf wearing high-heeled boots, viz., pes cavus with crowded toes. .Another picture illustrates a case of flat foot. The method is inexpensive and easy of application. Oral Sepsis in Operation on the Throat. — W. Win- grave makes a plea for putting the mouth in as favor- able condition as possible before throat operations are undertaken and for the maintenance of this condition during the period of healing. Most cases do well under Nov. lo, 1906] MEDICAL RECORD. 753 ordinary circumstances, but there are some patients in whom the tonsil "stump" is very unhealthy looking, disinclined to heal, and complicated with middle-ear in- fection and constitutional symptoms. These Merck Vytorin are almost invariably the subjects of oral sepsis, malnutrition, or neglected sanitary measures — personal and with refer- ence to home surroundings. The nasopharynx is nor- mally sterile, but not so in the ordinary adenoid case. .As a rule the less an infant's nose is irrterfered with, the better. Anterior or posterior nasal douching are not to be recommended. He advises the use, in twelve to twenty-four hours after operation, of a i per cent, solution of Peruvian balsam in albolene blown into the nostrils. Carious teeth should be removed. He men- tions a long list of remedies which may Is Vytorin A Statin be used in the mouth by gargling or with young children by the mouth douche. A New Aspect of the Pathology and Treatment of Leprosy. — R. S. Black calls attention to the condition of Is There A Generic For Vytorin the nr)se and nasopharynx in leprosy. For a long time he was puzzled to account for the marked chemi- cal difference between the maculo anesthetic and nodular forms of the disease. It finally occurred to him that the nodular and mixed forms were simply the maculo-ancsthetic form plus the infiltration and edema of the subcutaneous tissue in various areas caused by the active invasion of the bacillus leora. In practically all cases of nodular leprosy anesthesias and leucoder- mic patches can be found just as in niaculo-anesthetic leprosy. He also noticed that when a nose had fallen in in some cases of nodular or mixed leprosy the type of the disease in the individual seemed to change and he became practically in course of time a niaculo-anes- thetic case, the infiltrations being gradually absorbed. He further noticed that some cases of undoubted mac- ulo-anesthetic leprosy were of an extremely mild char- acter. A patient would have a few anesthetic patches on his body with, perhaps, a contraction of the small and ring fingers of one of his hands and would other- wise be in perfect health — in which condition he would remain for years. He also found that practically all the active cases of mixed and nodular leprosy suffered from rhinitis and were discharging bacilli with the nasal se- cretion in great numbers, whereas except in a few of the early cases he found that the maculo-anesthetic patients had no bacilli in their nasal secretion. The above considerations afforded him what he considered to be a solution of the problem. He thinks that there can be hardly any doubt that leprosy in its early stages begins as a small ulcer on some part of the extensive nasal mucous membrane. We know quite well from our clinical experience of the disease that leprous ulcers in Buy Vytorin favorable circumstances tend to heal. There can therefore be little doubt that a person can suffer from a leprous ulcer in the nose that mav heal and pass en- tirely away. This is the explanation of the maculo- anesthetic cases. They have had nasal ulceration which has passed away, in some cases leaving perhaps a cica- tricial shrinking of the nasal septum, but during the time the ulcer existed leucocytes or white connective tissue corpuscles got detached from the ulcerating spot and along with the bacilli which they were attempting to devour were carried by the blood stream and lodged in various situations in the peripheral nerves, where they got entangled, and the bacilli then proceeded to grow, causing pressure on the fine nerve fibrils and con- sequently setting up nutritive changes in the skin which these axis-cylinders supplied, thus causing the patches of discoloration and anesthesia. The corollary from this theory of etiology Vytorin Statin is that if the disease can be recognized in the nose in its early stages, the treat- ment can be brought into line with that of tuberculosis and diphtheria. We must destroy the local nidus before the system at large becomes infected. He also thinks that the opsonin theory of Wright "may be applicable to the therapy of leprosy. This possibility is made more promising by the fact that the Bacillus lel>ra seems to be a surface growth and that it takes a very considerable time to become established in the body. British Medical Journal. October 20. too6. The Influence of Early Feeding in the Treatment of Typhoid. — F. J. Smith would avoid hard, indigestible, and sharp-edged seeds of such fruits as nuts, grapes, oranges, strawberries, figs. etc.. but does not object to giving the strained juice of such fruits as are juicy enough for the purpose. Moreover, he would avoid giving any food too freely or injudiciously, but he does not interdict a bit of bread and butter or an egg sim- ply because a patient's temperature is not absolutely normal. He has on record a series of 113 cases with twenty-four deaths occurring in hospital practice, but of the deaths but four took place after solid food had been given. The remaining twenty had received no solid food. He compares his own cases with those of the other physicians in the same hospital. His own patients were placed on food Vytorin Discount Card (bread and butter or rusks, fish, and meat) and were fed about two weeks earlier on the average than the cases of his colleagues. His own cases had 2 per cent, of complications (venous throm- bosis, peritonitis, and abscess formation), while the collective cases (1,429) of his colleagues showed 10 per cent, of complications. This remarkable immunity of the "early-fed" cases can only be explained by the better resisting power of the patients. The less fre- quent occurrence of thrombosis (Smith I in 113, col- leagues 59 in 1,429) may be accounted for by the fact that the author's cases had a diet containing less cal- cium than the patients obtained on the ordinary milk diet. Early feeding seems to have but little effect on the occurrence of relapses. Other interesting points of comparison are given. The Treatment of Typhoid Fever. — The paper by W. B. Thistle is an inquiry regarding the effect of purga- tives on the intestinal lesions Vytorin Online of typhoid. He believes that the battle is inostly won or lost in the first week of the disease. If nothing is Generic For Vytorin done to limit infection of the glands or of the body, the result is a matter of chance. He believes that the judicious use of purga- tives greatly limits the number of bacilli gaining Generic Vytorin 10 40 access to the intestinal glands, and thus limits the destructive process in them. He has never encountered during the period in which he has relied on purgation a fatal per- foration or hemorrhage. As soon as a case comes under his care he sweeps the intestines clear as quickly as possible with purgatives, giving usually a few grains of calomel followed by half an ounce of some saline. He repeats this process day after day. the object being twofold. First, to prevent additional infection of the intestinal glands, and, second, to abstract toxins from the body by way of the bile stream and the intestinal secretions. The time to cut off or attack the bacilli is, of course, before they are carried to the glands ; while they are in the drainage area, which in the case of the intestinal glands is the intestinal mucosa and the intes- tinal contents. If purgatives are freely and frequently used, and are efi'icicnt in the earlv period of typhoid infection, it must be that many bacilli are removed from the drainage area that would otherwise go to increase the number already in the glands. If the purgative is repeated day after day and at the same time an anti- septic is given, the effect, in so far as the drainage area of these glands is concerned, is identical with the Vytorin Price surgi- cal procedure of bathing an infected surface with an antiseptic lotion. The good effect upon the glands is due in both cases to the removal of bacilli from the drainage area, and the consequent curtailment of bac- terial infection in the glands. Spirochetes in Yaws and Granuloma Pudendi. — \. MacLennan records the findings in some smear prep- arations from yaws. The smears were fixed in methyl alcohol and were stained in a number of w-ays. In one specimen taken from a papilloma in recurrent yaws numerous spirochetes were Vytorin Generic Name observed. The method of staining was by Giemsa's solution and gentian violet. These spirochetes possessed similar characters to those of the Spiroclueta pallida, but the staining was fainter. Generic Name For Vytorin Loops in the course of the filament were observed, as in the pallida. In two smears from Granuloma pudendi he has found a few spirochetes — most probably the refringens — while in one stained first in fuchsin. then in acetone gentian violet, a number of very long highly refractive spirochetes were observed. These parasites were much longer than the Spirochata pallida, and the waving was finer and closer. In one forty waves were counted. Though the staining was very prolonged, these spirochetes were very faintly stained. There were also a number of other structures present which were less definite. The Management of Advanced Cases of Heart Dis- ease. — This subject is considered by R. Saundby under the headings of exercise, Schott treatment, diet, heart tonics, vasculodepressant remedies, bleeding and leech- ing, tapping, purgation, oxygen inhalations, and hyp- notics. We can refer here to only a few of the many practical points he suggests. He gives a high com- mendation to the baths and exercises of the Schott sys- tem, though attaching no importance to the presence of free carbonic acid gas in the water. Rest is called for in a more or less recumbent position: (l) When 754 MEDICAL RECORD. [Nov. lo, 1906

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