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if they recovered, it must be because of their own protec- tion. The use of serum in these cases seemed to give encouraging results. The serum he had used was obtained from rabbits, and in this connection it should be borne in mind that rabbit's serum was poisonous to certain people. Injections were given in the back of the arm. Mr. ToRREY reported a series Where To Buy Amoxicillin of cases of gonorrheal rheu- matism treated with the serum during the past year, SS in all. There were 39 acute and subacute, and 16 chronic cases. Of this number, 34 (61 per cent.) were cured by the serum. Of the remaining 21 cases, 12 were improved, and in nine there was no change. Of the acute and subacute cases, 39 in all, Trimox 500mg 31 were cured (79 per cent.) ; of the re- maining 8, 3 were improved and there was no change in 5. The serum was of marked benefit in only a small per- centage of the chronic cases, but of great benefit in the acute and subacute cases. In 28 the condition was mono- articular; in 27 polyarticular. They were of all degrees of severity and 18 had been treated before without any im- provement. When the injections were given there was a rise in temperature of from one to two degrees, with slight pain in the head and back, especially in the chronic cases. Dr. Joseph Collins said that arthropathies accompanied chronic or organic nervous diseases, and that Dr. Mitchell, St., had described the joint changes of tabes seventy-five years ago. All recognized in tabes and syringomyelia that from 8 to 12 per cent, of all cases developed painless en- largements of joints. Oftentimes in organic nervous dis- ease, as of the peripheral nerves, such as a neuritis, there were changes in the joints, especially of the wrist and ankles, giving certain alterations named arthritis deformans, and such arthropathies vi-ere worthy of an adequate descrip- tion in the literature. These arthropathies were not well marked in cerebral diseases. Dr. Collins also discussed arthropathies and hysteria. Of 10,000 cases on record, only two of Amoxicillin 500 hydrops intermittens were recorded which might be classified as chronic enlargement of the joints. Dr. Col- lins was loath to accept the classification as given by the reader of the paper. Dr. Royal Whitman spoke of one minor form Amoxil Trimox of joint affection, the overweighted joints. A patient weighing 200 pounds who should weigh 135 might have a so-called rheu- matoid arthritis of the knees, no other joints being involved. Here the remedy was to reduce the weight. Dr. LovETT, closing the discussion, said that the word rheumatism, as used by the general practitioner, should be avoided. All he asked for in the matter of classification was that they should have a provisional class for the un- identified cases until they were identified. The classifica- tion he presented was merely a provisional one. SECTION ON SURGERY. Stated Meeting, Held May 4, igo6. Dr. John F. Erdmann, Chairman pro tem. Bronchoscopy and Removal of a Foreign Body from the Right Bronchus. — Dr. Charles A. Elsberg presented a child who, thirty hours before admission to Mount Sinai Hospital, had swallowed a pin about one and a half inches long, its head going Trimox Dosage first. She immediately after began to retch, vomited bloody mucus, and complained of pain and discomfort in the chest. These symptoms disappeared after a few hours. She was kept on a fluid diet and the stools were carefully watched for Trimox Indications the pin. There was no pain on swallowing, nor other symptoms. When admitted to the hospital there were some peculiar Amoxicillin 500 Mg bleating sounds over the lower part of the right chest behind. The j.--ray revealed the pin with its head downward in the fifth intercostal Generic Trimox space, a little to the right Trimox Antibiotic of the middle line. Three days after admission Dr. Emil Mayer passed the bronchoscope, but could not find the foreign body. Dr. Elsberg then did a low tracheotomy, passing a moderately sized endoscopic tube through the tracheal opening and into the right bron- chus. The pin was at once seen lying in the right bron- chus. Its shaft could be followed upward for about one- half an inch until it became buried in the wall of the bron- chus. All efforts to free the point of the pin were unsuc- cessful until he did as follows : The shaft of the pin was grasped with slender forceps as far away from the head as possible and the endoscopic tube then pushed down, Where Can I Buy Amoxicillin the pin being firmly held by the forceps. Thus the head of the pin was freed from the wall and the shaft of the pin grad- ually bent Trimox 500 Mg into view, until the point was swept into the left bronchus. By repeating this procedure the pin was bent upon itself and, with the head and the point both pointing downward, could be Order Trimox grasped at the angle and eas- ily extracted. A tracheotomy tube was then inserted; this was removed at the end of a week and the wound healed rapidly. Convalescence was interrupted by an attack of measles. Dr. Elsberg presented another patient who had had a turkey bone in the right bronchus. Coughing persisted for weeks and with a mucopurulent expectoration. Very interesting signs were noted in the chest. Dr. Janeway made a positive diagnosis of foreign body. The .r-ray ex- amination was negative. There was a large amount of peri- bronchial exudation. Expiration began with an amphoric sound and ended by a hissing one. The temperature was irregular. Much flesh and strength was lost. Under chlo- roform anesthesia a low tracheotomy was done and the foreign body, a piece of turkey bone, was Buy Trimox found in the middle one of the three branches of the right bronchus. There was no trouble experienced in grasping it with the forceps and removing it. Pictures were presented showing the position of the bone in the bronchus. Laparotomy and Suture of Bleeding Duodenal Ulcer. — Dr. Elsberg presented this patient, a man, 31 years old, Oct. 20, 1906] MEDICAL RECORD. 633 who had had an operation performed for some gallbladder trouble. He came into the hospital with a long history of intestinal symptoms, tarry stools, etc. The physical exam- ination revealed nothing. He complained of pain in the gastric region and tarry stools. Hemoglobin was 94 per cent, and dropped in four hours to 60 per cent., and by the evening of the same day it was 50 per cent. An operation was done at once for supposed duodenal ulcer. The gall-bladder and mass of intestines were bound together by adhesions and the duodenum was much infiltrated and opened into an ulcer. He attempted to bring the parts of the ulcer together, but the parts were too fragile. Trimox 500 After operation the patient improved rapidly, but later there- occurred a leakage of fecal contents. Two hours later he was again operated upon, but no ulcer was found, only a hole in the duodenum. The duodenum was immobilized ac- cording to Kocher's method and the transverse colon was then implanted upon the duodenum. The wound was closed with drainage. The wound healed well and there was no further leakage. The hemoglobin now was 85 per cent. The great fall of the hemoglobin made the opera- tion justifiable. Dr. John A. Hartwell reported a case of gastric ulcer occurring in a man 35 years old who was admitted to hos- pital the second time. He gave a history of bleeding for three or four months before coming to the hospital the first time. He remained three weeks and went out again much improved under medical treatment. After several severe hemorrhages he again entered and the hemo- globin was then 40 per cent. He was kept under observa- tion for four or five days and was improving. After the sixth or seventh day the hemoglobin was 50 per cent, and no hemorrhages. There was no pain or other gastric symp- tom. That night he died, apparently from acute hemor- rhage. Buy Amoxicillin At autopsy no ulceration or even suggestion of ulceration was found anywhere in the alimentary tract Nothing was discovered to cause either the original bleed- ing or death. Dr. John F. Erdmann said that he had had Amoxicillin Amoxil twelve or thirteen cases of perforating ulcer of the pyloric end of the stomach and in none was there any preliminary hemor- rhage at all, no hemorrhagic evidences whatever. Recurrent Sarcoma of the Outer Table of the Skull; Disappearance under X-Ray Treatment. — Dr. Aspm- Trimox Side Effects WAi.L JuDD presented this patient, a woman, with a re- current sarcoma of the outer and beginning involve- ment of the inner table as well. Forty-two exposures (three a week) were made, using a high tube at a dis- tance of nine inches. There were no burns and there followed a complete disappearance of the tumor. He did not claim a cure, only a disappearance of the sar- coma. Dr. Lewis Gregory Cole discussed this case. Tendon Implantation vvith Restoration of Function in the Hand. — Dr. Judd presented a little girl who had had a suppurating wound involving the tendon of the communis. He cut down upon this tendon and found it retracted so that he could not bring the ends together. He then made an incision in the tendon of the indicis and stitched it to the communis tendon with silk, surrounding Trimox Online the parts with Cargyle membrane. There was complete immobility of the middle fingers of the hand; at present the movements were perfect. Passive motion was resorted to early. Dr. Reginald R. Sayre congratulated the doctor upon the good results obtained. Local Anesthesia in the Operative Treatment of Ano- rectal Diseases. — Dr. S. G. Gant read this paper. He said that since he had advocated local anesthesia in the oper- ative treatment of minor affections of the lower bowel, 1,200 cases had been operated upon at the clinic, office, or home of the patient. Some of the operations were of minor Buy Trimox Online importance, while others were of considerable mag- nitude. The conditions for which operations were per- formed embraced nearly all the diseases encountered about the rectum and anus. While local anesthesia could un- doubtedly be successfully employed in a great many radi- cal operations, he was convinced that it was not for the best interest of the patient to employ it to the exclusion of general anesthesia. The administration of a general anes- thetic was imperative for all operative procedures in the upper rectum, and all extensive operations such as were required to remove large tumors or to relieve complete extensive prolapsus recti, complex, horseshoe, rectovesical, rectourethral, and rectovaginal fistula;, very extensive ab- scesses, necrosis of the coccyx and sacrum, and strictures and congenital malformations above the internal sphincter muscle. General anesthesia was also necessary in opera- tions for fistulx, hemorrhoids, fissure, abscess, etc., com- plicated by other more serious rectal disease, when the lo- cal anesthesia did not permit the diseased tissues to be sufficiently exposed for thorough operation, when the areo- lar tissue was loose and allowed the solution to disseminate rapidly, and when a sufficient amount of the fluid could not be retained to cause pressure and blanching of the tissues. The above-named affections constituted but a small proportion of the total number of cases coming under tlie proctologist's care. The local anesthetics employed by the writer were, in the vast majority of cases, sterile water, eucaine, and cocaine. In the cases operated upon by the aid of water anesthesia, the anesthetization of the parts was produced by the injection of cither a physiological sa- line or a plain sterile water. They were equally effective in producing anesthesia, and the pain caused by the distention was not noticeably more from one than from the other. The temperature of the water played no part so far as the an- esthesia was concerned, but there was less discomfort when it was at the temperature of the body. The distention of the tissues with water had never caused sloughing in his experience. Postoperative pain was more severe and lasted longer with eucaine and cocaine than when sterile water was used. At present he employed eucaiq^ and co- caine in strengths ranging from one-eighth to one-twen- tieth of I per cent. The technique was the same whatever the agent employed. The anesthetic should not be injected too suddenly or in a larger amount than was required, nor should the needle be made to enter one place and then another. When a linear incision was to be made the .incsthetic should be slowly injected between the layers of the skin along the line to be incised, after which the needle should be pushed further in and the deeper tissues anesthetized. In divulsion of the sphincter muscle a one- tenth of one per cent, eucaine or cocaine solution was pref- erable to sterile water. In order to ascertain to what extent sterile water was being employed in operations about the rec- tum and anus, a letter was sent to members of the American

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