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posture during sleep among low-grade patients. Many of them are curled up — that is, the legs are flexed on the thighs, while the arms are in a semi-flexed position back of the knees when the latter are flexed. The topamax generic brand head is bent forward until it rests on the knees, and often this grade of patients entirely cover their heads with blankets, ex- posing them topamax generic weight loss to the danger of asphyxia in attacks during sleep. Others of this grade sleep in a sitting posture night after night the year round ; others simply brace the head against the pillow as it st^inds on edge at the head of the bed, while still others sleep with their arms above their heads topamax generic price with the fingers clasped, thus supporting the head. Some sleep with their heads resting upon elbows and hands, while others sleep in a posture in which the head is flexed until it touches the breast, without giving any support whatever to the head. A few lay outstretched upon the back with heads greatly extended, doing so by means of a pillow rolled up and arranged to conform order topamax canada to the scapular and interscapular region of the back. A great number of these patients prefer to sleep curled up on a mattress upon the floor, for the reason that they fear attacks during the night. They would rather thus sleep than occupy a bed of ordinary height, from which they might fall. Some ex- cellent photographs illustrate the paper. The Relation of Gastric Ulcer to need prescription topamax Gastric Cancer. — M. R. Barker relates the case of a man of thirty-seven years in whom all the symptoms pointed unmistakably to peptic ulcer. Under a long-continued treatment he im- proved, when topamax 100 mg weight loss the hydrochloric acid in the gastric secretion began steadily to diminish. Gradually there developed all the symptoms of gastric cancer, which was confirmed get prescription topamax by autopsy, a large open ulcer being found in the pylorus, the edges of which were elevated and infiltrated with cancer cells. The author believes that in such ulcer cases the acid diminution points unmistakably toward malignant invasion and should be regarded with the gravest suspicion, although the patient seems to topamax order online be doing well. This cancerous inva- sion may occur in an open buying topamax online ulcer or in the scar tissue left by a preceding healed ulcer. Trauma of some kind may be the initial factor leading to the malignant invasion. The morbific cancer agent, whatever it may be, may enter the tissues at the time of injury and remain dormant for a long time. When an ulcerating area is thus infected it never heals, though the outbreaking evidences of malig- nancy may be long deferred. In regard to the disappear- ance of the acid, the author ventures the suggestion that in the evolution of the malignant process, a to.xin is pro- duced which, acting upon the nerve centers which control the gastric topamax generic availability cells, paralyzes them, thus rendering these cells inactive, and that this toxin is produced as quickly as the cancer invades the tissues, and increases as the cancer increases, and as the toxin increases the hydrochloric acid decreases, until it has totally disappeared. Journal of the American Medical Association, October 13, 1906. Hemorrhage in the Newborn. — H. McClanahan re- ports six cases of hemorrhage occurring spontaneously in the newborn, with histories; several cases of topamax generic vs brand trau- matic hemorrhage are also briefly reported. One of the spontaneous cases was a fatal hemorrhage from the lungs, which apparently is rather rare. He gives the principal facts in regard to hemorrhage of the newborn, its occurrence within the first few days after birth, its serious character in most forms, its apparent lack of any relation to hemophilia, and the obscurity of its etiology. He thinks that it is probably due to some unknown specific cause producing a change in the blood-vessels. In hemorrhages occurring later than the first ten days of life, he considers septic infection as the most likely factor. His experience, apparently, does not aflford any special support to the theory of hereditary syphilis in these cases, though it is consid- ered an important predisposing cause. Benign Cystic Epithelioma. — J. V. Shoemaker and L. Napoleon Boston report a case of this comparatively rare condition, of which they have been able to find records of twenty-four other cases in the literature. The growths occupied the right arm; the general condition was that of moderate secondary anemia, which im- proved under treatment. Microscopic examination made it evident that the neoplasms originated in the hair follicles and were examples of what has been described as trichoepithelioma. Few cysts were pres- ent owing to the slight age of the turnors, they having existed but a few months. These benign turnors of the skin, the authors remark, have received but little atten- tion from pathologists. Banti's Disease. — W. L. Bierring and E. Egdahl re- port a case of Banti's disease in which splenectomy was performed and discuss the blood findings. The notable facts are summarized as follows: i. Before the opera- tion the blood condition was that of the secondary type of anemia, low percentage of hemoglobin and leucope- nia. 2. After splenectomy there was a slight fall in red cells, then a rise, a leucocytosis at its maximum twelve days after the operation and characterized by a relative increase in the mononuclear leucocytes, especially the large mononuclears. 3. The absence of myelocytes and the scarcity of nucleated reds, both before and after splenectomy. Discussing these findings in connection with those of others in this disease, the authors remark as to the significance of these blood changes, in hyper- trophy of the spleen from any cause, that a decrease in hemoglobin, in erythrocytes, and in many cases also in the white corpuscles, is very likely to follow. How this leucopenia occurs is hard to explain with our pres- ent ideas of the hematopoetic function of the spleen, while the cause of the general secondary anemia with splenic hyperplasia is as yet hypothetical. The good re- sults from splenectomy in both splenic anemia and Banti's disease seem to faror the view that the spleen is in some way responsible for the poor blood condi- tions. The lymphocytosis after splenectomy must be regarded as an effort at compensation. The authors 626 MEDICAL RECORD. [Oct. 20, 1906 conclude that in considering the blood findings in ^he two diseases, Banti's disease and splenic anemia, before and after splenectomy, one is led to the opinion that, whatev.er the nature of the disease process or the causa- tive influence, the blood-forming organs are not particu- larly concerned. The more likely points of attack are the vascular channels, the tissues of the spleen, and in time also those of the liver. The Open-Air Treatment of Pneumonia. — W. P. Northrup for over eleven years has been using free ventila- tion and fresh air treatment in pneumonia. The patients most favorably affected by open-air treatment are those with severe poisoning, with delirium, partial cyanosis, or deep stupor. In Northrup's experience all patients do 'bet- ter in cool fresh air, which can be secured in private prac- tise by screening off a portion of a room by an open window. None have been harmed, in his observation, and some have been greatly benefited and possibly saved by the cold fresh-air treatment. If pneumonia, due to an infecting agent, is thus benefited, the value of the treatment for other infectious diseases is suggested, and, in fact, he has tried it m many others, including typhoid fever with severe bronchitis, whooping-cough with bronchitis and convul- sions, with excellent results. He considers it, in fact, the ideal treatment for septic fevers. The only regulation is to keep the patient comfortable and especially to keep the feet warm. Gangosa.— O. J. Mink and N. T. McLean describe the disease known as gangosa, a form of ulcerated rhinopharyn- gitis which seems to be endemic in the Ladrone and Caroline Islands, but has been reported also from some other tropical regions. It has evidently e.xisted there for at least 150 years, is confined to the natives, and does not seem to be hereditary or due to diet. The evidence is also against its being a luetic manifestation or a sequel to yaws. The authors' opinion is that it is due to some specific infec- tion, possibly carried by flies or by direct contact, over- crowding, etc. The disease seldom being fatal, few chances for autopsy occur, and other than local svmptoms and lesions have not been observed. Fordvce'says that the lesion is a granuloma of undetermined 'nature, the histo- logical picture somewhat resembling tuberculosis. It com- mences non prescription topamax with an ulceration of the pharvngeal mucosa, becoming rapidly progressive and involving sometimes the hard palate, nose, eyes, and face. The tongue and muscles of deglutition are spared, and hearing is rarely affected. In the quiescent stage, scar tissue remains, but the active stage may continue indefinitely or may be arrested at any time. A fulminating type occurs in voung children, usually proving fatal in forty-eight hours and closely resembling diphtheria. If the patient topamax order survives beyond that period the disease follows the usual course. The diagnosis is simple. The sudden onset distinguishes it from lepra and lupus, and the characteristic bacteria are absent. The symptoms differ from do i need a prescription for topamax syphilis and specific treatment is a failure. The ful- minating type is diagnosed from diphtheria by the absence of the Klebs-Loefl3er bacillus and the characteristic mutila- tion. The contagiousness of the disease is evident, and iso- lation, which was discontinued at the time of the American occupation, has again been 100 mg topamax made compulsory. In the ful- minating type rigid quarantine should be enforced. In the early stages treatment clearly limits the progress of the disease. It is essentially local and aims to destroy the affected area. Tincture of iodin, employed freely, is ap- parently the best agent, though in some cases the actual cautery may be more effective. Antiseptic mouth washes should also be used and tonic treatment when necessary. As a deodorant, potassium permanganate, i per cent, solu- tion, has proved most advantageous. The authors suggest the possible utility buy topamax online without script of .r-ray or light treatment. In the fulminating type the treatment should be svmptomatic, combined with thorough local disinfection. The Bacteria in Scarlatinal and Normal Throats. — From a study of 154 throat cultures, 51 from normal throats. 75 from cases of scarlatina, 14 of measles, ■; of ton- sillitis, 5 of pneumonia, and 4 of pharyngitis, G. F. Ruediger sums up his findings as follows: Strc/'fococcus pyogenes is constantly and abundantly migraine prescription topamax found on the tonsils in cases of tonsillitis and scarlatina before the subsidence of the in- flammation in the throat. The organisms rapidlv decrease in numbers after subsidence of the throat inflammation. Streptococcus pyogenes cannot be considered a normal resident of all healthy throats, though it was found in small numbers in 60 per cent, of the cases examined. Pneumo- cocci of low virulence were found in 64 out of 71 throats. A large group of organisms lying between the typical Streptococcus pyogenes and pneumococcus were found in all normal throats and in nearly all diseased throats. Thev have very little virulence for rabbits, and as they are found in nearly all cases they may be considered as normal in- habitants of the throat. Streptococcus pyogenes from nor- mal throats appears to have a slightly greater virulence than these organisms from scarlatinal throats. The Lancet, September 29, 1906. Arterial Blood Pressure in Heart Disease. — H. J. Starling details the results of personal experiments and observations. He considers it of great importance to note this condition of pressure in all cases of failing heart. It enables us to classify a given case under one of two head- ings. In the first the heart muscle is at fault. If we bleed, it is to relieve temporarily the distended right heart. If we give oxygen, it is to improve the nutrition of the heart and to relieve it in cases of malo.xygenation 'by relaxation of arterial pressure. In the second instance we should reduce the high pressure, which has worn down the work- ing power of the heart muscle. Bleeding in such cases would not alone give temporary relief to the heart. It would also, by affording a stimulus to building up of the tissue, enable the organism to apply its nitrogenous waste prod- ucts to this purpose, and so tend to the purification of the circulating fluid. On the assumption that there topamax mg for weight loss is a plethora in the widest sense of the term, and that it is primarily due to an excess of income over expenditure, the treatment which would seem to be indicated would run on the old-fashioned lines of bleeding and purging. At the same time there must be a complete reformation of mode of life. The income must be topamax 50mg and weight loss diminished by limitation of food; the output must be increased where necessary by regulated exercise. It is probably in cases such as these that Oertel's methods of treatment of heart disease have been most successful. Whether, however, limitation of fluids in the diet is desirable, the author is inclined to doubt. Although increased fluids tend to the perpetuation

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