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91 per cent, and typhlitis in only 9 per cent. We must distinguish, between cases of typhlitis, those due to simple impaction (fecal or otherwise) and those due to peritoneal twists. The appendix has a mesentery of its own, and the caecum twists in a manner pecuHar to itself We have therefrom inflammations of simple congestion Mobic Price with pain, tympany fever. These cases are often called typhlitis, and recover under the use of opium, though calo- mel and a saline are preferable. They are not cases of true appendicitis. Cases with obstruction or impaction may get well without operation, just as a bullet may be- come encysted and do no harm. An accumulation of pus here may burst open in the loin or groin or (as he knew to occur in Order Mobic one instance) be spat out. The origin of the appendix from the gut is constant, but the revolu- tions and twists of the latter may place it in various po- sitions. If the exhibition of a saline, by clearing out the bowel, does not relieve the pain, the accumulation of pus is strongly suggested. Dr. L. S. McMurtrv, of Louisville, believes that cases of appendicitis are far more common than is gen- erally supposed. Many of the fatal cases are recorded as peritonitis on the mortality reports of large cities. In males ninety per cent, of all cases of peritonitis are, he believes, cases of appendicitis. More has been learned about the pathology of the ab- dominal contents by operation during life than by post- mortem examination. Many cases of peritoneal inflam- mation of all kinds are the results of appendicitis. Ot course, he does not advise operation on all cases, but it is a fact that a majority of them come either to an operation or die without. The majority of cases do not eventuate in recovery by expectant treatment. Dr. H. a. Hare, of Philadelphia, believed that opium was not to be commended in this class of maladies. It masks the pain, tenderness, and fever, so that the collection of pus proceeds unnoticed. Patients should be kept on a pre-operative diet, so that, if operation is hurriedly called for, it can be undertaken without at all disturbing the bowels. Ice, hot and cold injections, may be used to combat the inflammatory process. All purgatives should be avoided Meloxicam 15mg before operation. Dr. Hare does not believe that all cases of peritonitis in the male are of appendix origin. He quoted the statistics, published some years ago by Dr. Fitz, of Boston, showing that the death-rate after operation was greater than when the cases were treated by medical means. Dr. Charles A. L. Reed, of Cincinnati, quoted cases to show that all physicians do not recognize these cases early enough to give the surgeon a fair chance if he is called upon to operate. Recurrent cases ought to be operated upon without reference to the existence of Meloxicam Mg pus, so that a procedure of election may be undertaken at the proper time, and not when the patient is in a hopeless condition. He believes that there is no such thing as " idiopathic " peritonitis, and that future years will show, on account of the early recognition of the gravity of cases, a marked improvement over Dr. Fitz's old figures. Diphtheria. — Dr. J. B. Murfree, of Murfreesboro, Tenn., read a paper on this subject. He gave a general survey of the history of the disease, with special reference to its introduction into the United States. Dr. Jenkins, of Iowa, in discussing the treatment of this disease, stated that he prefers the local application of carbolic acid or persulphate of iron solutions. The lat- ter coagulates the albuminous exudates, contracts the ves- sels, and shrinks the membrane off. If the larynx is af- fected, he places much value on calomel. Aspiration in Acute Pleuritis. — Dr. E. J. C. Minard, of Brooklyn, read a paper on " Early Aspiration in Acute Pleuritis. ' ' While calomel, opium, veratrum, and ])Oultices all have their value in the therapy of this affection, she believes that early aspiration has more than a merely pal- liative effect. She finds the diagnosis sometimes difficult, as accompanying congestion elsewhere Buy Mobic may cause far more pain than that of the initial malady. Thus she has seen a case of pleurisy with intestinal engorgement where the pain attendant on the latter was so great as to suggest ap- pendicitis. She has seen aspiration of ten ounces of fluid reduced the temperature from 104° to 98.3° F. in three hours. The general practitioner should be prepared to do the operation. Dr. J. M. Anders, of Philadelphia, thought that in MEDICAL RECORD. [July 1, 1893 these cases the initial exudation of fluid filled the chest about one-half. Then in twenty-four to forty-eight hours there was a sudden filling of the cavity to its maxi- mum. As regards the indications for operation, urgent dyspnoea (even orthopncea), especially at night, is a most important feature. When it occurs, aspiration should at once be made, even though there is some fever and em- barrassed circulation. The relief, however, is apt to be but temporary, as the fluid reaccumulates. Fever means an active inflammatory process and progressing fluid leak- age, not a mere transudation, but a true inflammatory exu- dation. If there is no fever, how long shall we wait be- fore tapping? He thought not over ten days. Now, we must remove only a portion of the fluid at once, and repeat the tapping until the tendency to recurrence seems to be overcome. The effect of suddenly taking away too much pressure from the displaced heart may lead to syn- cope. Dr. Scott, Meloxicam 15 of Cleveland, thought that large exudations were more apt to occur in subacute rather than in acute cases. The Detection and Significance of Carbohydrates in the Urine. — Dr. Charles W. Purdv, of Chicago, read a paper with this title. He discussed the various chemical tests for glucose, and pointed out the fallacies of each. Sugar is always present in minute amount in healthy urine, but does not react to our ordinary chemical Mobic Mg tests. Hence its significance is physiological, and not clinical. Many causes will produce glycosuria. His fa- vorite test-fluid is made as follows : Sulphate of copper (purej 48 grains. Caustic potash (pure) .... 144 grains. Strong ammonia, U. S. P 9 ounces. Glycerine (pure) 6 drachms. Distilled water to 20 ounces. The solution should be prepared by dissolving the cop- per sulphate in part of the water and adding the glyce- rine. In another portion of the water dissolve the caustic potash. Mix the two solutions and add the ammonia. Finally, with distilled water bring the volume of the whole to twenty ounces. Keep well corked, and filter in two or three months if the solution becomes in any way cloudy. The principle upon which the application of this test depends is the fact that a definite quantity of the solution is reduced upon boiling by a definite quantity of grape sugar, causing complete disappearance of the blue color, and leaving at the exact Meloxicam Meloxicam point of Purchase Mobic Online reduction a brightly transparent and colorless fluid. Thus ten drachms of this solution are reduced upon boiling by exactly one third grain of grape sugar. Dr. N. S. Buy Mobic Online Davis, Jr-, of Chicago, corroborated the value of this test-fluid." He thought, however, that the Fehling solution made and kept in diff"erent bottles for each ingredient perfectly reliable. Brandt Method of Treating Typhoid Fever.— A dis- cussion on this subject was opened by a paper by Dr. Chr. SiHLER, of Cleveland. He believed that this meth- od ought to be, can be, and will be used in private prac- tice as well as in hospital. In three years and a half he has given over five thousand baths in ninety- five cases, without accident or incident. Most of his cases have been among laborers and artisans, who have carried out the method just as well as those in better circumstances. As to objections, the patient at first rebels, but sleeps so much better after the bath that he comes to like it. The method seems complicated to some and to others danger- ous, but it is found that a patient so treated comes through the disease with his nervous system in a much better con- dition and is spared much of the usual tedium of convales- cence. The bath-tub can be portable and sent by the Order Mobic Online Purchase Mobic physician to the house. The latter should have one or two nurses trained in the special technique, who can give the necessary instructions to the family, who can then take charge of the case themselves. A bath at 68° F. for fif- teen minutes is better than one at 70° F. for twenty min- utes, for it is in the last five minutes in which the shiver- ing is especially noticeable. The first bath should be given as early as possible and Brandt's original Cheap Mobic instruc- tions should be followed to the letter. Don't counteract the good effects of the baths by giving too much whis- key. A paper on the same topic, by Dr. W. Oilman Thomp- son, of New York, was read by the Secretary. He gave the records of ninety-five cases, treated in the New York and Presbyterian Hospitals. He prefers to give half an ounce of whiskey fifteen minutes before each bath, and lays much stress on the accompanying cold affusions on the head. The bath is followed by a Generic Mobic glass of hot milk containing malt extract, and What Is Meloxicam a cold compress may remain laid on the abdomen. In nervous patients the first bath may be begim at 90° F. Menstruation, and even preg- nancy, need not contraindicate this method. Out of the 95 cases there were 7 deaths, 4 from intestinal perfo- ration and peritonitis, 2 from hemorrhage, and i from pneumonia. Tubbing has not shortened the entire dura- tion of the disease nor lessened the frequency of relapses, but complications have been far less numerous. In one case there were pains in the hands and feet, suggesting the lesions of peripheral neuritis ; but the same pains oc- curred in typhoid cases not bathed, and could in nowise be attributed to bathing. Typhoid Fever. — Dr. James B. Mobic Online Herrick, of Chicago, read a paper giving an analysis of " One Thousand Cases of Typhoid Fever," going especially into symptomatol- ogy. As to treatment : rest, diet, sponging, ice pack and coil were used, also antipyretics. The mortality of the cases was about seventeen per cent.; but of Buy Cheap Mobic seventy-six cases from private practice only one had died. The general topic suggested by the last two papers was discussed by Dr. Joseph Eichberg, of Cincinnati. He was not prepared to give up everything for the Brandt method. In his hospital practice antifebrine had given better results than the bathing. Dr. Loughran, of Indiana, preferred intestinal anti- sepsis, which he claims to secure by naphthalin. Dr. J. M. Anders, of Philadelphia, thought that, if shivering came on early in the bath, the patient should be at once removed. He advocates the Brandt method and condemns the coal-tar preparations. Dr. Quine, of Chicago, does not believe that we should tamper with the natural course of temperature. He believes that tubbing lengthens out the disease and makes relapses more common. He has seen death occur in the bath, and also one case of catarrhal pneumonia develop. Also he thinks that the coal-tar series predispose to Mobic Tablets re- lapses and intestinal hemorrhages. The paper was also discussed by Drs. Scott and Her- rick, of Cleveland, Jenkins, of Iowa, and by the Chair- man. The opinions of the Section seemed to be about evenly divided as to the advisability Mobic Cost of bathing. Fourth Day, Friday, June 9TH. The Association of Diseases and Morbid Processes. — A paper with this title, by Dr. H. A. West, of Oalveston, Tex. , was read by the Secretary. The paper discussed the histories of various cases where an autopsy revealed the ex- istence of processes to the existence of which no clue was given by the clinical features of the case. Special stress was laid upon the fact that many diseases, from which re-

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