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(1)1 simply ligated and excised the appendix. A small faecal fistula followed, which lasted for four August 8. 1S96] MEDICAL RECORD. 209 weeks and closed spontaneously. Should I have adopted the invagination method under the existing conditions of sepsis and gangrene? (2) I left the gauze drains in until they fairly floated out on pus. I thought it a safe method, and had not the confidence to remove them at an earlier date. Is it necessary for the sinuses to suppurate in these cases? Is there any clear criterion which would per- mit of the gauze being removed at buy prozac online no prescription needed an earlier stage? Are secondary abscesses more likely to occur if purchase generic prozac the drains are removed earlier? MALARIAL H.i;MATURIA, OR HEMOR- RHAGIC FEVER. Bv W". D. BUSH, M.I)., LEESBfRGH, FLA. This disease is getting to be a very common occur- rence in Florida, Georgia, and the Mississippi bot- toms, and as I find verj- little literature on this subject I think every physician in these regions should make himself thoroughly acquainted with the symptoms and treatment of the affection. Hemorrhagic fever attacks those who have previously had some form of malarial fever, as a general rule those who have their systems full of the malarial poison. Now, as to the pathology, the chief manifestation is the alteration of the blood and the organs that are disposed to congestion and inflammation, such as lungs, bowels, and kidneys, due to a defibrinated con- dition of the blood. The symptoms and treatment I will give by refer- ring to some cases that have come under my observa- tion : Case I. — Mr. F , a man of generic prozac about forty years, who has been in Florida some eight or ten years: very dark comple.xion and of a bilious temperament. He had hemorrhagic fever in Georgia and came very near dying. I saw him at i p.m. He had a temperature of 104° F., and was perspiring very^ freely. He was deeply jaundiced over the whole surface; the conjunc- tiva were of the same color as the skin. He had passed bloody urine three times prozac price per pill and a large quantity at each time. He was somewhat nauseated and the tongue had a yellow coat on it. I gave him at once calomel, gr. vi. ; aloin, gr. ss. ; podophyllin, gr. ',3; sodium bi- carbonate, gr. vi. I also left another capsule contain- ing the same, to be taken next morning in case this did not operate well. I also left turpentine, to be given in ten-drop doses every three or four hours till the urine cleared up. I told my patient I would call again before night. So about four or five o'clock I saw my partner. Dr. Green, and told him I had a case of hemorrhagic fe\er and asked him if he would not like to see it. We drove out and on our wav he asked me what I was giving my patient. I told him and also remarked that I intended generic prozac price giving quinine next morning. He said that if I did I would be apt to send my patient to the other world, for he had lost enough to convince him of its uselessness before he stopped the use of quinine and had not lost a patient since. So I decided to prof.t by some older experience in this disease and not give the quinine. Instead I gave the patient Warburg pills, one every three hours, till five were given in one day, using the two-drachm pills with aloes. I saw him next day. The urine was clear. The mercurial had operated well. There was no fever. The skin was clear and the patient was in a good condition. Case II. — Mr. K had the same symptoms, the same treatment was used, and the patient made a good recovery. Case III. — Mrs. B sent for me on Wednesday. I was out of town, so she waited, as she thought she had a case of intermittent fever. She grew worse and sent again next day. I found her perspiring and show- ing all the characteristic symptoms of hemorrhagic fever. She had been passing blood for two days and I found she had been taking quinine all the day before. She was very ner\-ous, nauseated, and vomited black bile. I at once put her on a mercurial, and gave tur- pentine and Warburg pills. She was verj- bilious, but by repeated doses of calomel she soon recovered. Cases IV. and V. — Father and son. Two of the worst cases I ever saw. These, like the rest, had pre- viously had intermittent fever. Their systems were full of malarial poison. These I saw with Dr. Green at 3 P.M. The father had taken the day before thirty to forty buy prozac online no prescription grains of quinine. When generic prozac no prescription we saw him the father was perspiring freely; the skin and eyes were most deeply jaundiced. Both patients were vomiting ever)- few minutes black bile and decomposed food. They were so nauseated that it was a hard matter to get anything to stay on the stomach. We buy generic prozac no prescription at once put them on the mercurial and Warburg-pill treatment. We finally got the medicine to operate. The son was soon convalescent, but to our great surprise as soon as the urine of the father cleared up there was a total suppression. Vomiting was troublesome for some time and there was prozac cost per pill hiccough. There were then in- voluntarj' discharges from the bowels, which were only checked by strong astringents. We tried everj-thing that was ever recommended for suppression of urine, but to no use. We kept off ursemic convulsions by giving pilocarpine, but the patient died from suppres- sion and exhaustion. INTESTINAL OBSTRUCTION ; L.\TERAL ANASTOMOSIS WITH THE MURPHY BUT- TON, INTRODUCED THROUGH THE VA- GINA. Bv JOHN A. PRINXE, M.D., SPRINGFIELD, ILL, Mrs. L , aged thirty-three years, two children. Vaginal hysterectomy was performed October 2, 1895, for chronic ovarian and tubal disease. Hai'P^ostasis was obtained by clamps, which were rem.oved on the second day. On the fourth day several free move- ments of the bowels were obtained. Flatus passed freely from the first day. discount prozac The patient passed flatus on the seventh day, but all efforts to obtain a move- ment buy prozac canada of the bowels after that date failed. Tympanites was present on the eighth day and rapidly increased. On the ninth day, thinking some obstruction might exist within reach of the hand introduced in the rec- tum, I gave an anaesthetic, and after dilating the sphincter, passed my hand as high as possible, but could detect no prozac price ireland trouble. Her condition, bad before the operation, did not encourage the idea of prozac price without insurance a coeliot- omy. On the tenth day I was out of the city and was surprised on returning to find my patient still alive. I suggested to the mother and husband of the patient, who were present, the bare possibility of being able to reach the point of obstruction by breaking up the ad- hesions at the vaginal vault and exploring the pelvic and abdominal cavities with the hand. After consid- erable delay, consent was obtained, and after anas- thetizing and cleaning prozac discount coupons the vagina the fresh adhesions were broken up. The vault was completely closed by omentum, being firmly united to the edges of the va- gina. Whether this is always nature's method of clos- ing the vault or not, I am in ignorance. There was no suppuration present, the wound being as fresh and clean as the day it was made. 2IO MEDICAL RECORD. [August 8, 1896 I could find no obstruction in the pelvis nor as high ;as I could reach in the abdominal cavity. While passing my hand back and forth among the •distended intestines a loop of collapsed gut got be- tween my fingers, and I brought it down into the vagina. I made efforts to trace it to the point of ob- struction, but they were futile. The thought entered my mind that a Murphy but- ton might be inserted between this loop of collapsed gut and one of the many distended loops, and an an- astomosis made which might save this patient's life. The idea was carried into execution at once, though, ow- ing to the limited area in which I had to work, it was only accomplished with much difficulty. A small rent was made above the button, which was closed as well as possible with sutures. Reaction was slow at first, but when it did set in the woman rallied rapidly. Gas and buy prozac uk faeces passed freely through the natural orifice until the second day, when some faical discharge ap- peared in the vagina. This rapidly increased in .amount, and soon, nearly the entire contents of the bowel was discharged through the fistulous opening. As this opening contracted, more and more of the dis- charge passed through the natural opening, purchase prozac until at this writing, December 2d, there is only an occasional discharge from the vagina. The button passed by the anus November 29th. At the present time the pa- tient is entirely well and able to go about as usual. This procedure would not be the operation of elec- tion in cases of obstruction of the bowels, but in the •case reported it was the only thing possible to do, aside from making an artificial anus. PRIMARY CARCINOMA OF INFERIOR TUR- BINATED BODY. Bv BEAMAN DOUGLASS, M.D., ASSIST.\NT SURGEON, MANHATTAN EVE, EAR, ANU THROAT HOSPITAL; IN- STRUCTOR, POST-GRADUATE MEDICAL SCHOOL A.ND HOSi'ITAL. The literature of medicine contains reports of several cases of malignant disease, carcinoma or sarcoma of the nasal passages, but nearly all the reported cases seem deficient either as to the intranasal origin of the growth, or in the diagnosis having been made without the microscope. Data as to the early symptoms of the disease are often wanting also. In looking over the literature ot carcinoma of the nose, I find two cases only in which a careful microscopic diagnosis of carci- noma was made and in prozac cost uk which the neoplasm clearly began intranasally. In both these cases the disease originated upon the septum. There are no recorded cases in which the lesion began in the turbinated tissues. The case which is the subject of the following re- port has a carcinoma beginning with symptoms so few and so slight as hardly to attract serious attention, and \et the history clearly points to the buy prozac online no prescription canada inferior turbinated tissue as the point of origin, and it is only upon this tissue that the disease can be found inside the nose. Tne consideration prozac purchase uk of this patient and her hi.story would lead us to believe :

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