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by the presence of laryngeal cough, and the fact that it occurred both in epidemic form and at all seasons of the year, irrespective of temperature or weather. 3. From typhus or typhoid fever it might be frequently impossible to differentiate, especially during the presence of these diseases in epidemic form. In the typhoid fever of chil- dren both diarrhoea and spots are often wanting. The abdominal symptoms are slight, the fever likely to assume 46 MEDICAL RECORD. [July 8, 1893 a distinctly remittent type, and on the whole, running a shorter course than in adults. The spleen is, however, always enlarged ; the nervous symptoms are prominent ; bronchitis is usually present ; epistaxis rarely occurs ; purchase medroxyprogesterone and the mortality is low. According to Dr. George B. Wood there is provera cost an extraordinary susceptibility to the action of cathartics in the disease under consideration. The pres- ence of herpetic eruptions on the lips and face is also said to exclude its existence in children. 4. Relapsing fever, by the absence of enlarged spleen or liver, of jaundice and articular pains. 5. From tuberculous meningitis it might be quite a difficult matter, since cases are mentioned in which, notwithstanding the presence of extensive cerebral disorganization, there were no convulsions or evidences of paralysis. On the other hand, its abrupt commence- ment, and the absence of strabismus, irregularly in the pupils, arhythmical pulse and respiration, constant and peculiar vomiting, and violent screams, should exclude the existence of meningitis. Only in its more rapid onset and higher range of temperature do the symptoms of acute meningitis differ from those of tuberculous inflammation of the membranes of the brain. 6. From acute general miliary tuberculosis I doubt whether it could be dis- tinguished, except by the usual fatal termination of the latter. 7. From malarial remittent fever, by the absence of chills and sweats, but above all by the careful exami- nation of the blood with a view of provera mg determining the pres- ence or absence of Laveran's plasmodium. 8. From yellow fever it would be a difficult matter, especially in countries in which this disease is prevalent all the year round. In fact, Guiteras is authority for the state- ment that yellow fever in the tropics can only be diag- nosticated from the simple continued fevers of children by the fact of the increased mortality from meningitis, dentition, malarial remittent fever, etc., occurring dur- ing certain seasons of the year. g. From central or abortive pneumonias, there should be no doubt in the diagnosis after the first few hours. 10. From catar- rhal pneumonia, or broncho-pneumonia, by the change in both the character and frequency of respiration, the absence of all abnormal physical signs in the chest denot- ing catarrhal fever, and a dry cough out of all proportion to the local symptoms. The advent of catarrhal pneu- monia is slow and insidious in children, but we should always be able, no matter at what stage of a prolonged fever, to detect its presence by the physical signs, the in- creased temperature, or its greater remissions during the day and changes in the character of the cough, which would become looser and more frequent. Of the treatment of catarrhal continued fever there is little to be said. Antipyretics had little or no effect on the course of the fever, and although quinine was given in large doses, both by the mouth and in suppositories, its effects were, on the whole, disappointing. In fact, more reliance was placed on treating hyperpyrexia in these little patients by tepid baths than on the provera tablets use of internal antipyretics. The baths not only reduced the temperature, but to a certain extent also relieved the great irritability from which the patients all seemed to suffer. Retrograde Changes in Trichinae and their Capstiles. — Dr. Langerhans, of Berlin, reports a case of trichinosis in the person of a woman who died in the wards of the Charite Hospital, aged fifty-one years. The parasites were found in enormous numbers, particularly in the diaphragm, in the intercostal muscles, in the muscles of the neck, of the eyes, the tongue, and in both pectoralis major and deltoid muscles. As nearly as could be ascer- tained, the only time in the life of the patient when the invasion of these parasites could have taken place was in her twentieth year, during the manifestations of a supposed articular rheumatism : from which it may be assumed that they had been present in her person for thirty-one years. A small ])roportion of the organisms were yet living, the duration of their supposed parasitic existence being the longest on record ; but by far the greater number were dead and more or less altered. Inasmuch as the changes of these parasites after their death have received little attention, and references to such changes are infrequent and indefinite, the author has classified the various condi- tions in which he found these parasitic bodies in this case with such an apparently prolonged duration. In many the capsules were unchanged, buy cheap medroxyprogesterone the trichina: dead and cal- cified, some with their forms preserved, others broken into larger or smaller fragments ; about many of the capsules was a variable amount of fat-tissue, especially about the poles, and in some instances there was to be seen, in addi- tion, a round cell deposit, either about the poles or all around the periphery of the capsules. In some cases the unchanged capsules presented an absolutely empty in- terior, while others, unchanged in size and appearance, were filled with connective tissue, here and there being changed into adipose tissue. There were to be seen, too, degenerated capsules containing fragments of calcified trichinse, or entirely empty, or filled with generic provera fibrous adipose tissue. Some provera online of the appearances were to be regarded simply as atrophied, shrunken, empty, or sclerosed cap- sules ; and here and there there were spots in the tissue which seemed to be the former position of parasites and their capsules, but which no longer showed anything save small patches of connective tissue. From these descrip- tions it is cheap provera to be supposed that these parasites, together with their envelopes, are subject to degenerative condi- tions, and that they eventually order medroxyprogesterone and naturally reach a stage of elimination from the body of their host. It is probable that this process of removal is accomplished sometimes, in part, at least, through the agency of a connective- tissue formation : but it is order provera online likely that it may also take place with- out it. The author states that he cannot confirm Miiller's belief that the removal of the parasites occurs by a fatty degeneration, or Leukart's, that they are resorbed without having first been calcified. It is probably correct that the parasites undergo this calcification before the capsules do, the latter undergoing this change soon after the death of the parasite, sometimes before the resorption of the trichina is com])lete, sometimes after its complete removal. The recovery from the invasion of the parasites is not, therefore, complete with the calcification of the trichinae, but with the total elimination of both the animals and their envelopes. — International Medical Magazine. The Functions of the Gastric Mucous Membrane. — At the Twelfth German Congress of Internal Medicine, Wiesbaden, ^'on Mering detailed some interesting experi- ments made to elucidate the absorbent power of the gas- order provera tric mucosa, the results of which investigations were as follows {The Boston Medical and Surgical Jour- nal) : The purchase provera online evacuation of the contents of the stomach takes place at intervals by means of the rhythmical opening of the pylorus. A liquid aliment escapes more quickly from the stomach than a compact aliment such a£ meat or bread, even when strongly impregnated 'with water. The stomach is an organ of excretion much more than an organ of absorption. It does not absorb water. When water charged with carbonic acid is in- gested, the stomach does not absorb the water, but it ab- sorbs largely the CO,. Alcohol is absorbed in large pro- portion by the stomach. Sugar, of whatever kind, is absorbed in moderate quantity when in solution in water, and in greater quantity when in alcoholic solution. Dex- trine and peptone are absorbed by the stomach, but in less proportion than sugar. The (juantity of substances absorbed augments with the degree of concentration of the solution. Chloride of sodium, iodide, and bromide of potassium are absorbed in notable proportion. Con- jointly with the absorption of the aforenamed substances, there is produced in the stomach an aqueous secretion, more or less buy medroxyprogesterone active, whose importance is generally in di- rect relation with the quantity of substances absorbed. There is an abundant secretion of water in the stomach, even when there is no free HCl secreted. Gastric ab- sorption resembles in many respects the physical process of diffusion (endosmosis and exosmosis). Gastric dil- July 8, 1893] MEDICAL RECORD, 47 atation, in cases of pyloric stenosis, is due not only to the pressure and bulk of the aliments introduced and stagnating in the stomach, but also to the augmentation of volume of the contents of the stomach by reason of the quantity of water furnished to the stomach by the or- ganism (endosmosis) in ratio of the proportions of nutri- tive substances which penetrate the blood from the gas- tric cavity (exosmosis). From a therapeutic point of view it is well, then, in cases of gastrectasis to exclude alcoholic beverages, and to advise the ingestion of nutri- tive substances in a state of concentration, as well as con- secutive lavages of the stomach. To combat the thirst. it is better to give lavements of plain water, or salt and water, than to allow the patient to drink water, as the in- dication is to limit as far as possible the excretion of water by the stomach. Dr. Unverrecht, of Magdeburg, in commenting on the paper of Von Mering. said that he had himself observed that in cases of dilatation of the stomach, water is badly absorbed and the urine scanty, and he has deduced therapeutic conclusions similar to those of Von Mering. In such cases a dry diet, lavage of the stomach, and lavements of a weak buy provera solution and com- mon salt, prescribed methodically, not only give real relief, but cause an increase in weight ; for in a case where the dilatation was due to carcinoma, he has seen the weight increase five pounds in eight days under the influ- ence of this treatment. Ewald, who was also present, stated that the clinical observation of diseases of the stomach has enabled him to provera price study the various forms of dilatation and their stages. In gastrectasis patients eliminate more water than they ingest, hence the name gastrosaccorrhcea applied to this condition. His experi- ence was largely corroborative of the conclusions reached by Von Mering. The experiments of the latter were made with healthy adult dogs, in which pyloric fistul;^ were established. Aural Vertigo in Children. — Dr. Lannois maintains that aural vertigo may appear in children either as a tran- sitory epiphenomenon or as a manifestation of an acute lesion of the auditory apparatus : recurring, however, at intervals of varying duration, in association with chronic disease of the ear ; it is much more rare in children than in adults. He reports four cases. One was in a child of seven that had measles and whooping-cough at two, followed by chronic otitis media. The second case was in a child that had, for eighteen months, suffered with vertigo and vomiting, and that presented cicatricial ad- hesion between the tympanic membrane and the handle of the malleus. The third case was in a child of seven that had scarlatina two years pre\nously, and thereafter the symptoms of aural vertigo. The fourth case was in a child of eight that had suffered some impairment of hear- ing after a fall at the age of five, and that presented symptoms of aural buy cheap provera vertigo following an attack of influ- enza. Attention is called to the possibility of mistaking the attacks for those of epilepsy, but the loss of conscious- ness buy medroxyprogesterone online in the one condition and the occurrence of vomiting in the other should be distinctive. Of sixty deaf-mutes, but six presented vertigo and nausea. Children who still heard a little seemed more liable than those that were entirely deaf — Medical News. Surgical Intervention in Tumors of the Dura Mater. . — Dr. buy provera online Delageniere has described a case of sarcoma of the dura mater in which, after trephining, extirpation of the tumor, with resection of the dura mater, the patient made a good recovery. purchase provera He submits the following conclusions : I. Perforating tumors of the cranium, whatever their

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