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and, above all, of the stomach, thus favoring the escape of the germ and preparing the system to succumb to its poisonous products. Idleness is not to be commended : maintain the tone by regular moderate exercise, but don't exhaust the system by working to excess. Loss of sleep and of needed rest impairs all vital func- tions, but none more than the digestive. This comes under the general heading of fatigue, but as it is so often incurred in the pursuit of pleasure it deserves a special note of warning against late hours and night amusements generally. Exposure to cold and wet not only favors indigestion, but also tends to a febrile proscar online no prescription reaction and a general lower- ing of the vitality and resisting power of the tissues and of their protoplasmic nuclei. Many attacks of cholera have been directly traced to the predisposing cause of sleeping on the cold damp ground, and many more to the chills consequent on exposure to the night dews in clothes that were comfortable under the noonday sun. The value of a woollen abdominal bandage, and of extra clothing at night or during a cold period, must not be forgotten. For those with a weak circulation, cold feet should be carefully guarded against Fear and all depressing passions lower the tone of the nervous system and protoplasm, and are particularly liable to impair digestion. The common advice, therefore, to dismiss fear, is no unimportant one, and to-day this can be enjoined with the confidence that there is really proscar prescription drug noth- ing to fear provided the requisite precautions are taken. Cholera is not any longer the " pestilence that stalketh in darkness; " it is but the fruition of a seed that cannot successfully assail proscar 10mg man unless it reaches his duodenum, which cannot reach this viscus except through the stom- ach, which cannot escape destruction in the acidity of a healthy gastric digestion, which cannot survive in the absence of moisture nor in the presence of mineral acids or other disinfectants, which is easily destroyed by heat, even that which is far below the boiling temperature. A few simple precautions directed against the swallowing of contaminated articles will place a man in a position in which he need have no apprehension of an attack of cholera, even though he reside in a cholera district. Bodily cleanliness must proscar cost ireland not be omitted. Theaccumu- 42 MEDICAL RECORD. [July 8, 1893 lation of cutaneous secretions, dust, and bacteria on the skin clothes the person in an envelope in which ptomaines and to.xines hold a prominent place. By the absorption of these the whole system may be deliilitated, and an im- pairment of digestion is too often an important feature of the lowering of tone. .V daily soapy wash is desirable, and, best place to buy proscar online if the weather should be cold, a chill should be care- fully guarded against. The habitual use of alcohol or opium is to be strongly deprecated. This may be safely based for alcohol on the notorious fatality of cholera among heavy drinkers, who always furnish a far greater relative number of victims than do other classes. The government sanitary authori- ties in Hindostan, who have had a greater and longer e.xperience of cholera than anyone else, emphasize this in the following words : "The practice of drinking spirits is believed to be a certain promoter of the disease, and they should not be taken on any account " (Report on Cholera in Europe and India, Shakespeare, p. 857). Now alcohol of ten per cent, and upward retards the growth of the cholera spirillum in artificial cultures : if therefore there were no drawback it ought to be prevent- ive or even curative. But, as statistics show, the disad- vantages far more than counterbalance the advantages. In the first place, the weaker drinks contain too little al- proscar price philippines cohol to inhibit the growth of the germ, and the stronger liquors cannot be safely taken in proscar price compare quantities large enough to maintain such concentration of the gastro-intestinal contents as would secure the requisite inhibition. Beer contains but from two to five per cent, alcohol, ale but eight per cent., claret ten to twelve per cent., port and sherry eighteen to twenty- two per cent., brandy and whiskey, proscar rxlist fifty to fifty-five per cent. It requires the higher strengths to kill the germ, and no one could bring his whole intestinal contents up to fifteen or twenty per cent, and maintain it there with impunity. The rapid absorp- tion of the volatile alcohol would speedily diminish the state of concentration, and at the same time determine a profound and dangerous narcosis. Then such large doses greatly retard the o.\ygenation of the blood, as shown in the experiments of Prout, Vierordt, and Smith, and as seen in the dark, bloated face of the deeply into.xicated. In this connection we must bear in mind that the arrest of hjematosis is one of the most marked and dangerous phenomena resulting from the cholera poison, so that alcohol is increasing the peril. Another consideration is best place buy proscar online that proscar online prescription the habitual free use of alcohol proscar film tablet 5 mg 28 tb lowers the vitality and resisting power of the leucocytes and tissue-cells, and leads them to succumb more readily to the cholera poison. It has long been recognized that alcohol lessened the antagonism to the streptococcus of erysipelas, and a serious surgical 0.5 mg proscar injury to a brewer's man was received almost as a death-warrant. Equally in the case of cholera the prospects of the heavy drinker are at the lowest ebb. Again, alcohol, like opium, tends to lock up the poi- son within the bowel and afford it the best opportimity for a deadly proliferation. In his attempts to convey cholera to guinea-pigs all Koch's efforts failed until he injected tincture of opium into the peritoneum and thereby checked the peristaltic movements. Doyen found that buy proscar online uk the injection of alcohol had precisely the same effect, and the guinea-pig. having taken the cholera germ in a soda solution to neutralize the gastric acidity, usually fell a victim to cholera. Strong alcoholic liquors, like opium, undoubtedly tend to check peristalsis and intestinal secre- tion, and may thus, in certain incipient cases, moderate an attack by preventing the free serous eflusion : but if this fails of accomplishment they both alike introduce the fatal condition of a more prolific intestinal culture and a more abundant production of the toxic elements. But perhaps the gravest objection to the free popular use of spirits as a supposed preventive and cure lies in their tendency to disorder the gastric digestion, the in- tegrity of which we have seen to be such an important factor in prophyla.\is. The nausea, vomiting, and im- paired digestion which result from excess, whether inter- mittent or habitual, opens up the best possible chance for the advance of the germ, if that has gained an en- trance to the stomach. Dr. Fergus, of Glasgow, whose experience in a community who are large consumers of ardent spirits entitles him to speak with authority, says, in his instructions for the prevention of cholera : " Do not take brandy ; it is not a preventive, and it does harm by disordering the action of the stomach and bowels." For the man who habitually drinks wine in modera- tion with his meals it may be unwise to suddenly stop the accustomed stimulant, as the system would temporar- ily suffer : but if he will take the light acid wines in place of the stronger best price proscar beverages, he will at once avoid this danger, and will at the same time secure a safe and valuable protection in the acid taken. Cider which has soured may be used as a proscar 5 mg tabletas substitute. For the non-habitue entire abstinence from alcohol and the maintenance of a vigorous, healthy digestion is the course to pursue. As a refreshing drink for hot weather during a cholera epidemic, acid beverages are to be strongly recommend- ed. Their value was strikingly illustrated by the experi- ence price proscar of Dr. Curtin, in a Pennsylvania Insane Asylum. Two or three cases were occurring daily, but these ceased abruptly when a drink made with sulphuric acid, lemon, and sugar was supplied to the inmates. This beverage having been suspended for several non prescription proscar days, two more cases occurred. It was again furnished, and no further cases appeared. Forty drops dilute sulphuric acid in a pint and a half of boiled, sweetened water, flavored with lem- on, makes a pleasant and refreshing beverage. Sawtschenko, in showing the existence of cholera spi- rillum in the intestinal canal and excrements of flies fed on cultures of this germ,' has made a timely contribution to the jjrophylaxis of the disease. It cannot be doubted that flies carry the germ on their feet as well as in their ingesta, and passing from the dejections to human food and water supplies, are chargeable with unexplained dis- seminations of the virus. It becomes important, there- fore, to exclude flies from the sick chamber by the use of mosquito netting or wire-screens, and to destroy any flies that may gain access by pyrethrum or other insect-poison. The prompt and thorough disinfec- tion of all dejections, vomit, soiled clothing, and leit food or water, and of all articles that have been used in the room is no less urgent. For the same reason, in cholera localities, all food should be kept under cover or screen, in such a way as that no fly nor other insect can gain access to it. Propagation through the intervention of flies is probably a main reason why cholera is so largely a hot-weather disease, and tends to die out in winter in northern latitudes. We have analogous examples of propagation through insects in the case of chicken chol- era, which is easily circumscribed by a fence in winter when no flies exist, but which defies any such barrier in summer, in the fly season ; also in the case of the South- ern cattle fever, which prevails in the hot seaison, when inoculated by the w-ood-tick, but subsides in winter when the ticks are dormant. It has been noticed that flies dis- appeared during certain cholera epidemics, and it may now be questioned whether they themselves suffered from the poison, and how far their disappearance con- tributed to the subsidence of the epidemic. Slight or " walking" cases present a serious danger, as no disinfectant is employed on their dejections, which may thus become the means of unexplained outbreaks. The public should be warned of the extreme danger of neglecting such cases, and it would be an excellent meas- ure to have all cases of diarrhcea which occur during a cholera epidemic secluded in their rooms as suspected persons, and subjected to all the disinfectant precautions which are enjoined for a fully developed lowest price proscar case. There would be considerable unnecessary seclusion, but there would be a far more do need prescription proscar perfect guarantee of the public health. It should be understood that in all such cases, the ' Centralblatt f. Bakteriologie u. Parisitenk. , 893- July 8, 1893] MEDICAL RECORD, 43 same as in those which are pronounced and unequivocal, none but the necessary attendants should be admitted to the sick chamber ; the latter should neither eat nor drink there, and before doing so elsewhere should always wash and disinfect hands and mouth. So, too, with the dishes, forks, knives, and spoons used by the patient or intro- duced in any way into the room. These should be dis- infected before removal. No food should be allowed to leave the room, and all broken victuals should be instantly burned or boiled. A STUDY OF THE FACTORS CONCERNED IN THE RECONVERSION OF PEPTONE INTO ALBUMIN.'

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