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nature, have a special form of development. 2. In the majority of cases they originate upon the external surface of the dura, dissect it from the bone, perforate the bone, raise the integument, and finish by Buy Remeron perforating it. j?. Anatomically they may be considered as pedunculated, having a base internal, a neck corresponding to the open- ing in the skull, and a subtegumentary intra-cranial por- tion. 4. Surgically they are pediculated tumors origi- nating from the dura, and the removal of that portion of dura and the tumor guarantees their total enucleation. 5. To remove them it is necessary to exsect the external portion and sufficient bone to uncover the base : they should then be removed by morcellement, and finally the dura resected, the entire portion upon which the tumor rested being taken away. — Archives de Chirurgic. Destruction of the Pituitary Gland. — In the Revista sperimentah di Freniatria, vol. xviii., December3i, 1892, may be found the results of thirty experiments upon dogs and cats in reference to the eflect produced by complete destruction of the pituitary body. Complete destruction of the gland proves rapidly fatal. Partial destruction is also fatal. But in this instance the process of dissolution is sufficiently slow in some cases to be carefully followed. There is a marked change in the character of the animal due to the profound prostration that is present. There is muscular weakness, together with clonico-tonic con\-ul- sions. Difficulty of breaj;hing is noted ; anorexia alternat- ing with boulemia : polyuria, urine watery and very alka- line ; polydipsia, low temperature, and emaciation out of all proportion to the anorexia. All these conditions are improved by injections Mirtazapine 15 Mg of extracts of the pituitary gland. The Remeron Tablets inference is that the destruction of this gland is fol- lowed by the formation and the accumulation ^^^thin the organism of some special toxic substance. Haematocele Simulating Appendicitis. — At a recent meeting of the Clinical Society of London ( The Lancet) Mr. Barker described a case of subserous uterine hemato- cele in a girl, aged eleven, simulating acute appendicitis: laparotomy was performed with success. Taking the view that the child was suflering from the latter disease in a most typical form, Mr. Barker opened the abdomen in the right linea semilunaris, over the cscum, but found the latter and the vermiform appendix perfectly normal. Some turbid, brownish serum, without lymph, flowed from the direction of the pelvis, and feeling in this direction the right Fallopian tube and ovary were found to be swollen and twisted, and when brought into view were seen to be quite black from blood effused under their serous coats. Tracing this effusion. inward, it was found to expand into a large subserous hematocele behind the uterus. This tumor nearly filled the pelvis and corresponded with the swelling felt per rectum before the operation. This brown- ish serum in the pelvis had probably transuded from it ; it was quite smooth on the surface and was inflamed. The condition was now recognized, and it was felt that no attempt should be made to remove the blood tumor. The serum was therefore sponged out and the abdomen was closed in the usual manner. The child made an uninter- rupted recovery. On leaving hospital on the thirty-first day after the commencement of the last attack, the Purchase Remeron Online he- matocele, as felt from the rectum and vagina, had dimin- ished in size. The patient was watched for a month or two subsequently, but there was no return of Remeron Price the symp- toms suggesting any attempt at very early menstruation. The case was recorded as possessing pathological, clinical, and surgical interest, and as being probably a rarity : Mr. Barker was unable to find any account of a pelvic hemato- cele in a girl so young as the patient in question. In discussing this case, Mr. Treves dwelt upon the Cheap Remeron diffi- culties referable to the anatomical site in diagnosing ap- pendicitis, and cited two cases illustrating this. One was that of a boy who exhibited all the classical signs and symptoms Remeron Mg of intussusception, but on opening the abdomen to relieve the obstruction, the condition was found to de- pend upon gangrene of the vermiform appendix. This was removed and the patient recovered completely. The other case was diagnosed, after consultation between two medical men. as enteric fever, and was sent to the Fever Hospital, being subsequently transferred from there to the London Hospital, where the abdomen was opened in due course and the appendix found glued by inflammatory ad- hesions to the ileum opposite a Beyer's patch, which may have accoimted in part for the close simulation to typhoid fever. After removal of the append^ this case also re- covered. 48 Purchase Remeron MEDICAL RECORD. [July 8, li Medical Record: A Order Remeron Weekly yournal 15 Mg Mirtazapine of Medicine and Sicrgery. GEORGE F. SHRADY, A.M., M.D., Editor. Publishers WM. WOOD & CO., 43, 45, &. Mirtazapine 30 47 East Tenth Street. New York, July 8, 1893. THE HYPODERMATIC TREATMENT OF .SYPH- ILIS. Dr. J. William White, of Philadelphia, has girded himself to the task of settling the question of the value of the hypodermatic method in the treatment of syphi- lis. He has discharged his work well, and has, we should judge, established the position of this mode of practice very definitely (^University Medical Magazine, May and June, 1893). After describing the various preparations recommended and giving the supposed indications and the alleged results, he proceeds to quote the experience of a large number of authorities upon the subject of hypodermatic injectio.ns. These authorities are almost uniformly against the practice. Some of the Germans (Kaposi, Neumann) advise them only as a last resort, and consider them below inunctions in value. Fournier says : " My opinion is Buy Cheap Remeron that it is not a good treatment. The injections are painful, they interfere with the patient's avocation, they necessitate frequently re- peated visits, .\bove all, the method is not practicable. In private practice patients will not tolerate it. In hos- pital practice it is possible, but note the result. Patients leave the Du Midi and Lourcine, where this treatment is employed, and flock to the St. Louis, where they know they will not receive it." In England, Hutchinson, who is facile princeps the leader of the British syphilographers, says : ," Hypoder- mic injection has come but little into employment in English practice, nor does it appear to increase in favor with those continental surgeons who at one time Mirtazapine 15 thought highest of it." Dr. L. B. Bangs, of this city, says : " I instituted some experiments a few years ago, in private practice and in my ser\-ice at Charity Hospital, which satisfied me that the hypodermatic method of treating syphilis was so rarely useful as to be valueless. Moreover, the claim that it 'cures syphilis in a much shorter period,' etc., will not hold, for in my opinion it takes just about so long to ' cure ' the disease, whatever may be the method of treat- ment employed. The effect of hydrargyrum upon a symp tom can be obtained by the other methods with no pain and with less risk than by the hypodermatic method." Nearly all the prominent specialists in this countrv concur in this opinion. Dr. White thinks from the evidence collected that it is safe to conclude— jj I. The hypodermatic treatment of syphilis has not as yet shown results which warrant its adoption as a routine method to the e.xclusion of, or in preference to, other methods, but, on the contrary, has some apparently in- superable disadvantages, and even dangers, which render it improbable that it ever will be so adopted. Order Remeron Online 2. The circumstances under which hypodermatic medi- cation should be employed may be summarized as fol- lows : a, Those cases in which other methods of treatment have been tried and failed ; b, those cases in which, owing to idiosyncrasy or intercurrent disease, the skin and the digestive tract cannot be used for the introduction of mer- cury Remeron Online ; c, those cases Remeron Cost in which, owing to grave and ad- vancing lesions, rapid mercurialization is absolutely nec- essary ; d, those cases in which obstinate localized lesions can be most directly reached by this plan : e, possibly those cases referred to by Jullien, in which early differen- tiation between syphilis and malignant disease, or tuber- cular ulceration, is extremely important, should be in- cluded in this list ; I certainly feel inclined to employ the method in all doubtful cases which admit of it, particu- larly in those conditions of the tongue which often leave the surgeon for a considerable time in doubt as to their exact nature Mirtazapine Mg ; anything which promises to shorten this period of doubt, by rendering the therapeutic test more rapid and more certain, would be of great advantage ; I should, however, in such instances, feel obliged to use potassium iodide by the mouth at the same time ; f, a theoretical possibility of the employment of mercury hypodermatically has suggested itself to me, but I have not as yet Buy Remeron Online actually employed it. It may be that its use by this method will aid in shortening the period of doubt which often intervenes between the appearance of the pri- mary sore and the development of general adenopathy, or of the e.xanthemata. If in the presence of a sore of uncertain character the employment of mercury hypoder- matically resulted in rapid cicatrization, no local treat- ment being employed other than cleanliness, it might occasionally throw light upon the case without being open to all the objections which attend the systematic and slower administration of mercury by the mouth. It is possible that the idea is worth a trial in exceptional cases, but I do not think it should be adopted as a routine practice. 3. .\s to the choice between the two great classes of mercurials, the soluble salts Generic Remeron are to be preferred to the in- soluble in the large majority of cases as more e.xact in the matter of dosage and much less dangerous and less likely to be followed by local disturbances. They are always to be used when there is need for rapid mercurialization. The insoluble salts should probably be reserved for those in which frequent visits to the surgeon are impossible, and in which no contraindications exist. In cases of defective kidneys, diabetes, profound anaemia, marked atheroma, great debility, etc., such methods are dangerous, and the case, even if urgent, will probably do better under some other form of treatment. 4. Finally, as to the special preparation to be employed : Among the soluble salts the bichloride is probably to te preferred. The results from its use are not strikingly dif- ferent from those obtained from the other compounds of this class, but its stability and great solubility and its ger- micidal qualities seem to warrant its selection. The dis- advantage is the pain which it causes, but the evidence in this direction shows that in the hands of impartial inves- July 8, 1893] MEDICAL RECORD. 49 tigators not responsible for the introduction of the par- ticular substance employed each of the salts on the list

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