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Journal of the American Medical Association, September 29, 1906. Cirrhotic Changes from Injury to the Liver. — W. G. MacCallum notes the fact that the circulation of vari- ous poisons in the blood may cause focal or diffuse destruction of the liver cells. If limited in extent there may be no definite symptoms and the injured portion is replaced by scar tissue, the other portions being hyper- trophied to compensate. If the cau.se persists, these changes may be continuous and finally result in one or other of the forms of cirrhosis of the liver. If the in- jury is very extensive, symptoms at once arise and a condition commonly classed as yellow atrophy of the liver may doxycycline tetracycline be brought about and quickly cause death, with great distortion of the liver. Such a case is here referred to. The object of the present paper, however, is to show that there is a scarred condition of the liver intermediate between the ordinary cirrhosis and the ex- treme distortion above mentioned, a condition, in other words, in which some single attack of infectious disease or some single intoxication has produced a single, non- progressive, though widespread, injury from which complete and permanent recovery has occurred. Gen- erally such livers show a smooth, even surface, iriter- rupted only by a network of fine linear grooves indicat- ing where the destruction of liver cells occurred. Else- where the lobules are normal, except for being a little larger than usual. These cases, when observed at autopsy, are commonly recognized as cases of incipient cirrhosis, but MacCallum holds that there is no evi- dence that the condition is part of a progressive proc- ess. It seems more probable that there is here a sta- tionary condition differing from ordinary cirrhosis merely in not being progressive and representing only the scars of an old injury. Cancer of the Lips and Tongue. — D. N, Eisendrath remarks that cancers of the lips, tongue, car, etc., all belong to the squatnous-celled type that extends almost where to buy tetracycline exclusively by continuity of tissue or along the lymph spaces or vessels, and very rarely gives rise to metas- tases in distant organs. Hence the better chance of a permanent cure by early radical operation. For the less advanced cases as well as in the severer ones Eisen- drath removes the lymphatic nodes and surrounding tissues in the submaxillary triangle and along the inter- nal jugular vein as a routine procedure. At least a half inch of healthy tissue, or even more, on each side of the growth should be cut away, and in cancer of the tongue, if it extends beyond the median line, it is bettei to remove the entire organ, as the lymphatics on both sides of the neck are probably involved. Eisendrath insists on the importance of thorough removal of the deep cervical nodes along the internal jugular and on the necessity of avoiding infection of the field of opera- tion, either from the primary growth or from the can- cerous lymph nodes. The primary focus should be cauterized, if possible, and great care be taken to avoid opening the nodes. Eisendrath operates in can- cer of the lips. face, and ear at one sitting, and he has done the same in cancer of the tongue in fairly robust patients without too much glandular involvement. If the latter is extensive it is better to follow Butlin's plan buy tetracycline of operation in two stages. Value of the X-Rays in Ocular Therapeutics.— G. O. Ring concludes that x-ray therapy is generic version of tetracycline very promising in malignant disease of the eye. In superficial epithelioma and rodent ulcer of the eyelids it can usuallv be relied on, he believes, to effect a cure. He states that it is be- lieved that good results obtained in certain cases of malignant disease of the cornea, conjunctiva, and car- uncle will become general under more improved tech- nique, and that the ;r-ray has proved of much value in the more extensive orbital carcinomata, though the results are less favorable the deeper the growth. Enough cures have been reported tetracycline hydrochloride capsules usp 500mg of lid and orbit buying tetracycline online sarcomata to warrant an exhaustive trial of the x-ray in this disease, more radical operative measures with subsequent .r-ray treatment being indicated in case of primary failure. Ordinarily the rays have an anodyne effect in malignant disease of the eyelids and tetracycline mail order orbit, but in some cases exacerbations of pain have been reported from their use. X-ray treatment has been of beiiefit in trachoma, and there is testimony as to its value in ver- nal and chronic conjunctivitis, scleritis, episcleritis, traumatic uveitis, conjunctival tuberculosis, corrieal ulceration, gloma, and gummata. Ring cautions against submitting cases to any but experts in j-ray treatment. Temperature Taking in the Groin in Children. — A. H. Parks points out the advantages of taking the tempera- 546 MEDICAL RECORD. [Oct. 6, 1906 lure of infants in the closed groin. The oral method is hardly practicable, and there are some dangers in the rectal method in the exposure and possibility of break- age of the instrument, as well as some other incon- veniences and objections. He has made comparisons of temperatures taken by the different_methods, rectal and inguinal, in 175 cheap tetracycline children, ranging between four months and five j^ears in age, under identical conditions, tetracycline 500mg capsules for acne and found that the average difference between the tempera- ture of the closed inguinal fold and the rectum is 0.34° F. (0.18° C), while the normal temperature buy tetracycline 500mg in the former in the child is 98.5° F. The great facility of the inguinal method was very noticeable, as the natural close apposition of the thigh to the body retained the instrument in place and the retention of the thermome- ter in the groin was accomplished without any crying or uneasiness on the part of the child. In e.xtremely emaciated cases it may be better to use the internal method, but when it is possible to use the external method the groin possesses decided advantages over the axilla. Tlie Lancet, September 15, 1906. The Prophylactic Use of Antidiphtheritic Serum. — VV. W. Sha,ckelton records his personal experience in an epidemic occurring in a large school for boys. The usual dose employed where can i buy tetracycline was 2,000 units. Seven cases had occurred in a house holding 45 boys. No case occurred in this house after the first inoculation for five weeks except one, and that on the day after inoculation. One other case occurred in this house, but that was in the case of a boy (the only one who had not been injected). In another house in which three cases had occurred, inoculation stopped all further spread of the disease. All the cases (14) recovered. The article is a convinc- ing exposition of the benefits of immunizing treatment. Some Observations on Convulsions in Children and Their Relation to Epilepsy. — According to R. O. Moon, convulsions in early life may shade off indefinitely into epilepsy so that it is impossible to say where the one ends and the other begins. In an analysis of 100 cases fully one-half are shown to be without obvious cause. To such cases the name of idiopathic epilepsy is given. In the other half the first convulsion arose in connec- tion with rickets, teething, trauma, specific fevers, indi- gestion, or indefinite ill health. A history of alcohol- ism was found in one or both parents in 10 per cent, of all cases, equally divided between the two varieties. The prognosis does not appear to be better in the cases originating in connection with some peripheral aflfec- tion than with the others. There is an important ele- ment in all these cases other than the mere number of attacks. It is the mental and moral impairment of the patient. The starting point of some form of insanity tetracycline 250 mg acne may easily lie in uncared-for cases of convulsive tenden- cies. Frequently there are manifestations of nervous instability which indicate a radical unsoundness of the central nervous system as a more important factor in the production of infantile convulsions than is an ex- trinsic cause. Of drugs used in treatment special men- tion is made of urcthane and chloral. It is tetracycline 250mg tablets possible that a convulsion may, regardless of its cause, have some effect upon the brain in the direction of setting up a bad habit, and render further attacks probable. The Rash in Cerebrospinal Meningitis. — W. Wright says in commenting on some features of recent cases in Glasgow that in two instances a decided purpuric rash, purple in color and hemorrhagic in character as to the spots, with well-marked edges, was seen on the dorsum of the feet, but in no other area. In another case punctate hemorrhages appeared all over the trunk and limbs in scattered patches of six or seven spots. In still another case the rash appeared in crops at tetracycline mgd in- tervals of about seven days. On examination on the twenty-first day of the illness, purple and maroon spots, circular, with regular 500 mg tetracycline rosacea edges all the same size — i.e. tliat of a lentil — were seen on the dorsum of the feet, on the arms, the legs, the trunk (back and front), four below the chin, and one behind each ear. They were scat- tered over the body with areas of three to four inches of normal skin between each. These spots were defi- nitely hemorrhagic in character and so well defined as to be seen from a considerable distance, the picture presenting quite the aspect of "spotted fever." Two days later these had almost disappeared, but others took their place. The Pulse in Aortic Disease; the Relation of Pulse Curves to Blood Pressure. — T. Lewis analyzes 20 cases, giving a tabulated list of symptomological findings and reproducing a number of sphygmographic tracings. These must be examined in the original paper by those interested. Some of the most slriking facts brought out in the study are the following: In 14 cases of an aver- age age of thirty-six and one-half years there was an average systolic blood pressure of 132 mm. tetracycline 500mg capsules Hg. These cases were not associated with granular kidney; in 4 cases with chronic interstitial nephritis, average age 46 years, 500 mg tetracycline acne pressure was 136 mm. There was no definite relation between the pressure and the amount of arteriosclerosis and none between the pressure and amount of cardiac compensation. A pulsus bisferi- ens was palpable in 13 out of the 20. A definite rela- tion existed between the height of the first secondary wave and the amount of arteriosclerosis; the greater the sclerosis the higher the wave, but there was no relation between the wave-height and pressure or compensation. A dicrotic notch was observable in all. It showed no definite relationship to the amount of regurgi- tation, arteriosclerosis, or compensation. The author com- ments on the diflficulty of estimating blood pressure by pal- pation, and even by some of the sphygmographs, and states that many errors are current in the text-books regarding the interpretation of the curves produced on these instru- ments. Suture of Perforating Heart Wound; Death on the Eleventh Day. — .\ patient of F. T. Travers fell and was impaled on the large spike of an iron fence. He man- aged to free himself, but fell and lay for some time without aid. Seen three hours after, he presented a transverse wound about two inches long over the lower end of the sternum, through which a vertical fissure in the bone could be seen. In addition there was the usual picture of collapse from hemorrhage. The wound was enlarged, exposing the lower half of the sternum on the left side; the vertical fissure extended upward to the second right costal cartilage, and there were fractures through the left half between tetracycline hcl bp 250 mg the fourth and fifth and fifth and sixth costal cartilages; online tetracycline the portion between the second and fifth costal cartilages was miss- ing. The third, fourth, and fifth cartilages were divided at their attachment to the ribs, and the lower fragment of the sternum was turned downward. In freeing the third cartilage the pleura was wounded. The rent, about half an inch in length, was at once clipped with artery forceps and closed by two sutures. A rent in the pericardium about two and a half inches in length was now exposed, through which blood was slowly escaping. The pericardium was full of blood-clot, which was gently sponged away; a piece of bone one inch by half an inch was removed, and a small spicule of bone was felt imbedded in the heart and extracted. On further e.xamination a wound was felt in the right ventricle, and on following this along another piece of bone was felt. This was seized with forceps and re- moved, and its removal was followed immediately by a terrific gush of dark blood. The wound in the heart was at once plugged by the operator thrusting his fin- fiers in. The insertion of three fingers practically stopped the hemorrhage. He also found that his fin- gers were within the cavity of the heart, the index being

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