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did, however, obtain by the saturation method a substance which coupon for proventil reacted with peptone just as plasmine did. I have obtained from blood serum, by means of the saturation method with magnesium sulphate, a substance possessing a light brown color which was soluble in water and coagulable by heat. proventil price A solution of this substance gave the same reactions with a solution of peptone that were obtained with a solution of plasmine, viz., con- verted it into albumin. Owing to the impracticability of separating the fibrin factors in the pure state, it is impossible to state which one proventil nebulizer of them is responsible for the change. There are very many difficulties attending the separation of these ele- ments from the blood : for instance, the difficulty of keeping the blood liquid for a sufficient length of time, and the almost impossibility of washing the precipitate thoroughly on account of its great solubility in water ; and last, but not least, the fact of the absence of any means within the range of our knowledge by which we can determine the purity of either one and its freedom from contamination by the others. While I am strongly of the proventil coupons opinion that some one of what we call the fibrin factors is responsible for or plays a very important part in the conversion of peptone into albumin, I am conscious of the fact that my experiments were exposed to many sources of error. To prove this fact positively it would be necessary to make a quanti- tative estimation of the peptone and also of the coagu- lable constituents of the plasmine solution, and proventil hfa coupon at the end of the reaction a quantitative determination of the coagu- lated albumin would then be necessary for an absolute verification of this theory. These determinations I have not been able to make, owing to the uncertain composi- tion of these bodies and the present state of our knowl- ©liiiical department. A CASE OF HOMICIDAL MANIA. By ERNEST HELM, M.D.. BELOIT, WIS. Physicians are often called upon to listen buy proventil to strange, humorous, pathetic, or horrible stories ; but seldom has it been my lot to hear a more frightful one than a patient related to me last night. He told it so simply and graphically* that I can do no better than give it in his own words. He is a carpenter, of powerful physique, while his wife is a delicate, slender woman. The events occurred about three years ago and are strictly true, and illustrate to a remarkaWe degree the wonderful cunning of some insane patients. He said : " My wife had often acted strange before, but had never attempted violence, so I was totally unprepared for what happened. We had retired as usual, proventil inhaler when between 1 1 and 12 P.M. I was suddenly aroused from sound slumber by violent and repeated blows on the head. " Frightened, confused, bleeding, I sprang from my bed, and in that hideous darkness I grappled with my unknown assailant. We had a fearful struggle for the mastery, when at last I wrenched a stout club from my opponent's hands and was about to use it with all my force, when my wife laughed and said in her proventil mdi usual tone of voice, ' Ben, I had to do it.' " Until she spoke I had no doubt but that I was assailed by a burglar or a midnight assassin. ,0n lighting the lamp I found the club was a heavy hickory mallet-handle. "A physician was called who treated my wounds, though I will bear long scars proventil hfa inhaler to my grave. " Nothing new happened proventil inhaler coupon during the rest of the night, and the next night she went to bed as usual, while I kept watch. My head pained so that I could not sleep, and anyway I dared not sleep. " Early the next night she said, ' I want a drink,' and when I volunteered to get it for her, she savagely told me ' to mind my own business, she would get it herself I said, 'All right, suit yourself,' for I made it a point never to cross her, except when absolutely necessary, and then to be firm and unyielding. July 8, 1893] MEDICAL RECORD. 45 " She arose, went to the water-pail in the next room, in plain sight of me, stood there rigidly for a brief time, and then suddenly went out of sight into the pantry. I at once arose to follow, when she laughed and returned to bed. Wondering what her object could be in going to the pantry I determined to investigate when she went to sleep. Soon she became quiet, her breathing deep, and regular, proventil cost so I feigned sleep by nodding in my chair, closing my eyes, and ventolin proventil allowing my paper to fall to the floor. Through my half-closed eyes I watched her : she soon half arose, her eyes gleaming like a snake's, and eyed me intently. When I aroused she dropped back in bed in her former position so quietly and suddenly that I doubted my senses as to whether she had ever stirred. After a while, feeling sure she was asleep, I went out through the kitchen into the pantry, and my blood ran cold when I found two large butcher knives laid out for me. Returning to see if she still slept, I found her ap- parently as I left her, so I went again to the pantry and took the knives out of doors and threw them away in the grass. " All this time I heard no sound, and it was impossible for her to see me from the bed or the room where she was. " Her brother soon came, and as she still slept and I was very tired and in great pain, I arranged for him to watch her, cautioning him not to close his eyes for one instant. I then went upstairs, but the floor had settled so I could not quite shut the door. I dared not go to sleep with an unlocked door, so I took a large stove zinc and noiselessly placed it against the door in such a position that the door could not be opened without knocking the zinc over and thus arousing me. I slept little, but toward morning I fell into a light sleep, but soon awoke, feeling that some- one was climbing the stairs. I listened intently and soon knew she was coming. She approached the door, and though it was opened only two inches (and from the in- side, so a person on the outside could not see the zinc at all) her slender hand and arm crowded in, grasped the zinc, and noiselessly removed it. I then said, ' What do you want ? ' She laughed and said she wanted me ' to get up for breakfast.' She then descended the stairs. and forgot to take the large carving-knife she had carried up to use on me. She had laid it down when opening the door. I found her brother had gone to bed and was sound asleep. " It was now 4 a.m. and quite light. She had had him build the fire and go to bed, while she busied herself getting breakfast. I then went out to secure the knives in the grass. She proair proventil came to the door, so I pre- tended to be out to view the beauties of the early morning sky ; but she said : ' Oh I brought those knives in an hour ago.' This startled me greatly ! How did she know those knives were there ? The grass was too long to find them by accident. She could not have seen me from her room or bed when I threw, them out, and I am sure she remained in bed. " Then how did she know the zinc was against my bed- room door ? I placed it there noiselessly, and it could not be seen from the outside. She was soon adjudged insane and sent to the hospital for the insane. " I see her often now, and while sane on many points, and often asking me to take her home, she will never promise not to assault me. " She only says that she ' cannot bear to have me buried alive, and if she does not kill me I will surely be buried alive. ' " Oh I it was a terrible experience, and her first mid- night a.ssault was so deadly and hideous that I shudder whenever I think of it." This experience is worse than many of the terrible things in fiction, but I can personally vouch for every word of it. Oastric Ulcer. — (live neither food nor medicine by the mouth, but rely upon rectal alimentation. — Donkin. progress 0f |]£Ccdical Science. The Treatment of Gangrenous Intestine. — In a cer- tain proportion of cases of strangulated hernia the bowel is found in a gangrenous condition, and the treatment of such cases in the past has practically been limited to re- lieving the constriction and to the creation of an artificial anus. The mortality under these circumstances is proventil 90 mcg very considerable, in fact, the discovery of gangrenous intes- tine has hitherto been buy proventil online looked upon as an indication of the hopeless nature of the case. Judging from a paper read by Dr. Kendal Franks before the Medical and Chi- rurgical Society, these cases order proventil are not as hopeless as statis- tics would lead one to infer (^Medical Press). He urges with some show of reason, basing his conclusion on a tolerably extensive array of statistics, that resection of the gangrenous gut with immediate suture affords the pa- tient a much better chance of recovery. Nor was this conclusion seriously questioned by the experienced sur- geons who had assembled to hear what the author had to say on behalf of a procedure that certainly strikes one as severe, considering the usually very depressed condition of such patients. The discussion turned mainly on the question as to whether the operation should be completed on the site of the original wound made for the relief of the femoral or inguinal hernia, or whether, after the jire- liminary palliative measure, it should be performed through a median abdominal incision made for the express pur- pose. Opinion on the whole was in favor of the resort to abdominal incision, and this is probably the view that will commend itself to most unprejudiced surgeons. It is evident that the thoroughness of the examination of the gut and the freedom of manipulation could never be the same through such a small aperture as that afforded by the inguinal or the crural canal — apertures, moreover, which cannot be safely enlarged. By this procedure the mortality has been reduced from something like ninety- five to about fifty-six per cent., a brilliant enough achievement considering the very unfavorable circum- stances under which it is necessarily undertaken. One proventil albuterol point that came out very clearly in the discussion was the impunity with which relatively considerable lengths of gut can be removed. One case was mentioned in which over a yard had been removed, and this without interfering with the recovery of the patient. It is in- deed all- important to remove every inch of damaged tis- sue, otherwise no suture, however perfect, can be relied upon to hold. A very large proportion of the failures after enterectomy are attributable to non-compliance with this salutary rule, and it cannot be too strongly im- pressed on surgeons that the kind of suture is of far less importance than the fact of its being applied to healthy tissue. There must, of course, always be proventil inhalers cases which come under treatment at such a late period that nothing can be done. These " proventil coupon too late " cases are the operator's horror, for they weigh down the statistics with an unduly large proportion of fatalities, although death has really nothing to do with the operation /('r se. Dr. Franks has called attention to a means of rescuing a certain propor- tion of patients otherwise condemned to inevitable death, and he has succeeded in divesting gangrenous intestine of half its terror. Catarrhal Fever in Children. — According to Laine (Mi'dical A^i-ws) the diagnosis from the symptomatic fevers is made : i . From the simple continued fever, or febricula, by the higher range of temperature, its epidemic character, and longer duration. 2. From thermic fever,

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