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orchidectomy I did a suprapubic cystotomy, and re- moved three calculi weighing in all forty-eight grams. The patient recovered from the shock of the opera- lion and on the day following was doing well; the urine was draining from the bladder and his condi- tion was good. The second day following the operation the temper- ature ran up to 102° P., whereupon the gauze packing was removed, the bladder washed out, and a drainage tube inserted; the temperature came down to 101° F. following the dressing. Pulse and respiration were of good character up to within a few hours of death. The next morning he had a normal temperature, but was somewhat delirious. Thinking that there might be some septic condition, I removed the tube, irrigated, and repacked with gauze. He grew more delirious, was very restless, and insisted upon getting out of bed. Bromides and suiphonal failed to quiet him, and on the following morning I found him in a maniacal con- dition and requiring the services of several attendants to keep him in bed. I called Dr. L. C. Stillings in consultation, who advised hypodermatic injections of liyoscine and feeding with the cesophageal tube intro- duced through the nares (as the patient refused nour- ishment, thinking that we were trj-ing to poison him). This form of treatment was carried out until death took place from exhaustion, eight days after the supra- pubic operation and fifteen days after the bilateral orchidectomy. What caused this maniacal condition? We can certainly eliminate Order Zestoretic the idea of sepsis, as the wound was perfect in each operation, and so far as urrtmia is concerned I think that also can be eliminated, because a very careful examination, both microscopi- cal and chemical, was made of the urine and no sign of kidney lesion was discovered. Was it possible for the mental condition to be due to the severe strain in undergoing two such serious operations in so short a time when recovery or rather alleviation from the painful symptoms was anticipated as a result of the orchidectom\? This we might expect in an hysterical subject, but hardly in the patient in question. '74 MEDICAL RECORD. [August I, 1896 In reviewing the literature, I find a quotation from the British Medical Journal, May 18, 1S95: "The au- thor reports seven cases in which this operation was performed and in the first hemiplegia occurred, with death four weeks Zestoretic Online after the operation. The second developed signs of acute mania six days after the ope- jation and died ten days after; the third also devel- oped mania and died on the twelfth day; the fourth exhibited the same symptoms with the Zestoretic 20 25 Mg same result, death. The fifth had no appreciable mitigation of the urinary trouble thirty days later. The sixth was one of single orchidectomy, Ijut the patient died in a few days in a state of mental aberration; and finally the seventh, also a single orchidectomy, developed distinct mental weakness, and death followed."' It is well known that when oophorectomy was first teing done, numerous cases of mania were reported following the same. Should the testicle and brain not maintain the same relation to each other as the ovary and brain? I will leave this to the neurologists. In conclusion I will say that as for the operation relieving the prostatic hypertrophy it was a success, as there was a marked decrease in the size of the gland, determined not only by rectal palpation but by palpation and ocular demonstration through the supra- pubic incision. Although unfortunate in not being able to report a favorable case, I will operate again, as the favorable cases that have been reported out- number the unfavorable ones. In the case just re- ported the prostate did decrease in size and I have •every reason to believe that, had the patient lived, the prostate would Zestoretic 20 have been reduced so as to have allowed the urine to be voided voluntarily /<:■/■ vias naturaks. NARCOTINE IN MALARIA. By LOUIS C. AGER, M.D.. ASSISTANT BACTERIOLOGIST TO THE HOAGI-AND LABOKATORV, BROOKLYN. Ix the Buy Zestoretic Online Medical Record for September 21, 1895, the statement was made that the opium alkaloid " narco- tine" or " anarcotine" was being used ver)' successfully in India as a substitute for quinine. The drug was recommended in the acute forms of malaria only, but it occurred to me that it miglit be useful in hemicrania, supraorbital neuralgia, and the other chronic forms of malarial poisoning that are often so difficult to deal with. After considerable difficulty I got some of the Order Zestoretic Online drug from a wholesale house in New York and put it up myself in two-grain capsules. The first case in which I used it was that of a woman about thirty-five years old. She had had acute malarial fever a few years before and had been troubled with neuralgia in various forms ever since. About a month before I saw her she had a severe attack of hemicrania, which had only been controlled by the hypodermic use of morphine. When I saw her she was suffering from a similar at- tack of a severe character. I gave her three two-grain doses of narcotine half an hour apart, then two grains every four hours, till about fourteen grains had been taken. The patient was much relieved after the third dose, and has had little Lisinopril 20 or no return of the Purchase Zestoretic trouble in the last three months. Since that time I have used narcotine in a few simi- lar cases with very good results. In one case there was considerable heart depression about two hours after Zestoretic Price the third dose, but not Zestoretic 20 12.5 Mg so much as sometimes occurs after full doses of the coal-tar analgesics. Although my experience with the drug has been Buy Cheap Zestoretic far too limited to furnish any positive knowledge of its usefulness, I feel encouraged to try it further and to :suggest it to others. The Hot Iron. — Before using it render the skin area ana-sthetic Zestoretic Tablets by applying pure synthetic crystallized guaiacol, in quantity of from twenty to sixty drops. — PiZE. Epitheliomata of slight extent often give way to such mild means as the following solution frequently applied: I? Resorcin 2 gm. Potass, chloral 10 " Aq. dest 300 " — Brocq. Burns of the Second Degree. — I( Carbonate of lime 10 gm. Oxide of zinc 5 " Starch, Zestoretic Generic Linseed oil, Lime water aa 10 Ichthyol 1-3 " M. — Leistikow. Orchitis. — Apply a few drops of guaiacol over the scrotum. — Balzek. Generic Zestoretic Analgesia, without irritation of the skin, is best obtained by adding an equal part of glycerin, or some vehicle which can Cheap Zestoretic be absorbed by the skin, to guaia- col, and covering with tissue to prevent evaporation. — Ferraxd. Tedious Purchase Zestoretic Online Labor After a case of tedious labor, an iodoform pessary is to be Zestoretic Strengths inserted in the vagina. A similar pessary is to be Zestoretic Cost used night and morning for the first three days, and once in twenty-four hours for the next six days. — Clifton Dispensary Rules for Mid- 7vivcs. Dr. Cheever, in the Boston Medical and Surgical Journal, says it is not advisable to operate in glandu- lar infiltrations so extensive as to preclude entire removal ; neither is it w ise to operate when you can- not remove the whole disease, as in a tuberculous or- gan of which you excise a part, nor in a sarcoma of the antrum in which you cannot extirpate the splienoid cells. It is allowable to depart from these rules when the pain is so agonizing that unless the suffering can be palliated the patient had better die than live; and also in a " forlorn hope," so-called, the patient is en- titled to an operation if he assumes the responsibility. Even then it is well not to operate unless there is some slight chance of success. Deaths from Anaesthetics. — The German Surgical Society gives the following statistics for the past five years in regard to mortality from anaesthesia: Chloro- form was administered 201,224 times, with 88 deaths, or in the ratio of i in 2,286; ether, 42,141 times, with 7 deaths, or in the ratio of i in 6,020; chloroform and ether, 10,162 times, with i death; chloroform, alcohol, and ether, 5,744, with i death; ethyl bromide, 8,967, with 2 deaths. Spontaneous Straightening in Rickety Curves of the Legs. — Dr. liruns concludes from observations in Tiibingen (Beitrdge Cliir., vol. xvi., i) that tlie greatest niunber of cases undergoes spontaneous cure in from two to four years. If the curves are unchanged at the sixth year, spontaneous cure does not occur. The chief aim of treatment should be to improve the general health. Of the number of cases under obser- vation 75 percent, were cured, 15.3 per cent, were improved, 9.7 per cent, remained unchanged. He considers that after the acute stage it is not harmful for children to be on their feet. August I, 1896] MEDICAL RECORD. /o Epididymitis. — The testicle should be wrapped in lint Lind moistened frequently with lead water and opium, or the following: K Tincture of aconite. Tincture of opium aa 3 i. Dilute lead water, Water aa ; ij. Osteomyelitis. — Dr. Funkhouser, of St. Louis, Buy Zestoretic says the chief diagnostic point in osteomyelitis is the acutely sensitive spot near the junction of the epi- physes. Fistula in Ano. — Dr. Gibbs, in the JVew York JA-i//u!/ /I'/o/ia/, March 21st, gives two reasons for failure in treating this trouble, i. We are by no means sure of starting with an aseptic wound, though it is a simple matter to lay open a small, superficial, straight tract, and after thorough cleansing obtain im- mediate union. It is a different matter with an old fistula running under the skin and up around the in- testine, with pockets and ramifications difficult to

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