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capacity of an artery in general may be said to be greater the softer and less easily palpable its wall is. In proportion as the wall is thickened the capacity of the artery dimin- ishes, and in the most extreme cases of rigidity the func- tional efficiency is almost entirely absent. In some cases, however, considerably thickened arteries may yet present normal or even buy trazodone more than normal efficiency. 628 MEDICAL RECORD. [Oct. 20, 1906 The Effect of Cholin on Pregnancy.— Werner and Lichtenberg describe a series of experiments made on rab- bits bv injecting cholin during pregnancy. It was found that by injecting 10 c.c. of a 5 per cent, watery solution of this substance five times at intervals of four days into a preg- nant animal, abortion was produced, and on examining the uterus portions of several atrophic and misshapen embryos were found. The daily injection of small amounts of 0.5 per cent, solution caused animals that had previously been fertile either to become entirely sterile or to become much less fruitful. The authors point out the similarity m effect of these cholin injections to the action of the A'-rays in re- stricting fertility. The Methods of Treating Bladder Wounds After Cystotomy.— Baratynski reviews his own experience and that of others in the closure of bladder wounds, the average time of healing in cases in which primary union occurs is 11.5 days; in cases in which most of the wound heals by first intention but there is slight leakage of urine, the average period of healing is 20.3 days. If the condition of the wound requires sutures to be removed, the period is lengthened to 30.S days, and if the incision is allowed to heal by second intention 66.6 days are required, ihe au- thor concludes that in cases in which the urine is normal and the vesical mucosa is unaltered, the wound should be sutured completelv. The same thing may be done m cases in which the urine does not show marked changes, being neutral or faintly alkaline and there is slight cystitis, under the condition that the latter will be subjected to active treatment. The open treatment of the bladder wound is necessary if there is pronounced cystitis and buy trazodone hydrochloride the urine is alkaline. The American Journal of the Medical Sciences, September, 1906. Toxemic Vomiting of Pregnancy.— J. Whitridge Wil- liams states that present evidence seems to justify the classification of serious cases of vomiting during preg- nancy as reflex, neurotic, or toxemic, according to the etiological factors concerned. He considers toxemic vomiting a very serious disease. It is a manifestation of a profound disturbance of metabolism. Its exact origin is not known. This affection usually ends m death in the last stages of the disease the matter vomited has a coffe-ground appearance. No apparent effort is noted during its expulsion. The urine, though diminished in amount, does not contain albumin or casts until shortly before death. It may also apparently show a normal amount of urea as determined by the Doremus method. There is a greatly increased percentage of nitrogen eliminated as ammonia in the early stages, although the nitrogen excreted as urea is decreased. The proportion of amidoacids is increased. The acetone content is very large in some cases. The writer thinks that if the am- monia coefficient exceeds 10 per cent, the diagnosis of toxemic vomiting should be made and the generic trazodone hcl pregnancy at once terminated. Unexpected lesions are found at autopsy. The writer believes that the only way m which advancement in knowledge in this subject may be hoped for is by grouping the cases together according to their anatomical and chemical characteristics and by waiting for the revelation of the significance of the con- ditions about which little or nothing is now known. Elephantiasis Non-Parasitica, Secondary trazodone cost without insurance to Chronic Cardiac Disease, and Repeated Edema of Pregnancy.— T. W. Hastings describes a case of this nature. The etiological factors he considers a chronic cardiac con- dition and some local lymphatic deficiency in the right leg. The right leg from the knee down was greatly enlarged. The left leg showed a moderate edema. There was entire freedom from attacks of inflammation in or repeated injuries to the right leg, suggesting that the local condition depends upon some defect in the lymphatics of the affected part. Whether this was con- genital or acquired it is difficult to prove. There was persistence without steady increase in size of an edema- tous condition of the left leg which more strongly sug- gested some local lymph-vessel deficiency in the right leg. Edema had repeatedly occurred during four preg- nancies, and this with the cardiac disease with several periods of broken compensation, would account for the edema in the legs; but it would not account for the thick elephantiatic condition of the skin of the right leg. The patient was born in New Jersey and has never been outside of New York, Pennsylvania, New Jersey, and Illinois. She follows the occupation of silk winder. There is a constant discharge of serous fluid from the right leg. Tissue for histological study has not been obtained. There is no history or evidence of infection. The patient has been treated by bandages, rest, eleva- tion of the leg, and massage. The cardiac condition has also received attention. Results of the Biterminal Transplantation of Veins.— Alexis Carrel and C. C. Guthrie from their studies have learned that after the transplantation of a segment of vein between the two cut ends of an artery the wall of the artery is only slightly altered, as revealed by the microscope; the wall of the vein becomes enormously thickened, the muscular and fibrous layers of the middle coat and the inner layer of the outer coat being princi- pally involved; there is no evidence of weakening or breaking down of the wall; the ligatures which have been used are enveloped in a dense coat of fibrous tis- sue. The writers conclude cheap trazodone that a venous segment inter- posed between the cut ends of an artery quickly under- goes anatomical changes; from macroscopic and microscopic standpoints the vein has a strong tendency to assume the character of an artery; from a physiologi- cal standpoint it performs the arterial functions. The trazodone discount coupon Value of Massive Doses of the Salicylates in the Diagnosis and Treatment of Acute Articular Rheuma- tism. — Thomas Wood Clarke presents the following conclusions: Sodium salicylate can buy trazodone uk and should be given in much larger doses than are generally used. Given in massive doses it reduces the fever, relieves buy trazodone generic the pain and swelling, and how much does trazodone cost shortens the course of the disease. It is not injurious to buy trazodone online no prescription the heart and appears, by quickly cutting off the disease, to offer some protection to that organ. The patient's tolerance to the drug and the rapid cessation of symptoms form valuable therapeutic tests for the diagnosis of acute articular rheumatism. Infections of the Biliary Tract, with Special Refer- ence to Latent (or Masked) and Typhoid Infections.— A. O. J. Kelly enumerates the following pathways whereby the biliary tract may become infected: The diverticulum of Vater and the common bile duct; the portal circulation; the systemic circulation; the generic trazodone cost lym- phatic circulation and the pathway directly through the wall of the gall-bladder or the gall-ducts from the peri- toneum. Doubtless these pathways vary with the in- fecting agent. Authorities now generally agree that the typhoid bacillus is regularly present in the gall-bladder, and commonly in pure culture, in practically all cases of typhoid fever, this being the one region of the body from which a pure culture of the organism is most likely to be obtained; the typhoid bacillus may persist in the gall-bladder, as well as within gallstones, weeks, months, and even years after the patient has recovered from an attack of typhoid fever; cholangitis and chole- cystitis (catarrhal, suppurative, and gangrenous) are by no means infrequent complications of typhoid fever; a history of antecedent typhoid fever may be obtained in many cholelithitic and cholecystitic subjects. The ty- phoid bacillus may be present in the gall-bladder with- out exciting pathological lesions, in some cases. There exist also a primary typhoid cholecystitis and cholangi- tis, an infection of the biliary tract without other evi- dence of past or present typhoid infection. This affec- tion has not yet been sufficiently studied. The writer cites the history of a number of cases. He declares that it would be wise in all cases of jaundice to under- take bacteriological studies of the blood and the feces. The Gruber-Widal reaction with the typhoid, paraty- phoid, and other bacilli should not be neglected. Branchiogenous Remains and the New Formations to which they Give Rise. — G. Mioni tells us that tumors derived from the remains of the branchial arches have their origin in epithelial germs included at the time of the obliteration of the sinus ccrvicalis, or to the remains of the second branchial arch left after the formation of the pharyngeal segment. They are not truly congenital, since they may begin to develop only after birth, as a result of some sort of stimulant cheap trazodone no prescription to their growth. They maybedivided into three classes : first, those tumors covered with a sim- ple epithelial covering and containing products of the same epithelium. This epithelium may be ciliated or how much do trazodone cost cylindrical, and the contents be mucous, or epidermoid, or both forms combined. The second class consists of remains of the branchial arches, and may be due to inflammations or mechanical disturbances of the walls, becoming adenoma- tous, carcinomatous, etc. The third class includes terato- mata. The commonest form is that of cysts, with walls covered with some form of epithelium. These are derived from the second and third branchial arches. They are situated generally on the sides of the neck, rarely in front. These cysts may become purulent. There are also rare tumors containing cartilage of the embryonal type. They are common near the ears, and are often bilateral, but are rare in the region of the sternomastoid and very super- ficial. The author describes three tumors operated on by him One of these was a carcinoma, one a cyst, and the third contained cartilage.— .-4 rr/m'i'o generic trazodone online per le Science Mediche. Oct. 20, 1906] MEDICAL RECORD. 629 Medical Jurisprudence, Forensic Medicine, and Toxicol- ogy. By R. A. WiTTHAUS, A.M., M.D., Professor of Chemistry, Physics, and Toxicology in Cornell Univer- sity; and Tracy C. Becker, A.B., LL.B., Counsellor at Law, Professor of Criminal Law and Medical Jurispru- dence in the University of Buffalo. With the collaboration of August Becker, Esq. ; Chas. A. Boston, Esq. ; Hon. Goodwin Brown; W. N. Bullard, M.D. ; G. C. Cam- eron, M.D. ; J. Clifton Edgar, M.D. ; Jas. Ewing, M.D. ; E. D. Fisher, M.D.; J. C. Johnson, M.D.; D. S. Lamb, M.D.; H. P. Loomis, M.D.; W. B. Outten, M.D.; Ros- well Park, M.D. ; J. Parmenter, M.D. ; Irving C. Rosse, M.D. ; E. V. Stoddard, M.D. ; George VVoolsey, M.D. ; J. H. Woodward, M.D. Second buy trazodone 50 mg edition. Volume One. New York : William Wood and Company, igo6. Of the importance to the physician of the topics treated in the present work, there can be no doubt ; of the general excel- lence of the handling of these topics there is, also, no room for two opinions. At present buy trazodone online uk we can only give an outline of the contents of the volume under notice, reserving a general review till the completion of the work. The book begins with an historical introduction of twenty-five pages, into which is compressed a large amount of interesting mat- ter, and which represents considerable research on the part of generic trazodone 50 mg the author. This is followed by a table of buy trazodone sleep the cases cited in the present volume, and this alone is of marked value to the lawyer, and is only one of the many excellent features which differentiate this work from others. buy trazodone hcl The subject of Medical Jurisprudence proper contains chapters on the following subjects: I. The legal relations of physicians and surgeons, including their duties and obligations; their right to practise medicine and surgery; their legal duties and obligations; their right to compensation; their privi- leges and duties when summoned as witnesses in courti of justice, and their liability for malpractice. 2. The law of evidence concerning communications between patient and physician. 3. Synopsis of the laws regulating the practice

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