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"The Clinical Significance stromectol purchase of Small Hemorrhages from the Gastrointestinal Tract." He pointed out the value of the test for occult blood in the stools, from both negative and positive standpoints. Care must of course be taken to exclude hemorrhoids and other varicose conditions of veins as sources of hemorrhage. The most common stromectol buy causes of bleeding are ulcer and carcinoma of the stomach or intes- tine, although occasionally pyloric stenosis and also ero- sions, as well as such disorders as scurvy and purpura and the like, may give rise to the same phenomenon. Dr. Will- iam S. Wadsworth presented a communication entitled "Gunshot Wounds." He discussed the subject on the basis of a considerable experience in the National Guard and in the autopsy room, and he pointed out the varying effects in accordance with the character of the weapon, of the explosive, of the missile, the distance of impact, the struc- ture affected, and a number of other factors. Dr. Augustus A. EsHNER read a paper entitled "Paralysis Agitans With- out Tremor." He maintained that this disease is not a true palsy and sometimes even the tremor is absent. When present the tremor is made of rhythmic movements, four or five in the second, taking place almost invariably during rest and ceasing, temporarily at least, on voluntary action and also on passive movements, as well as on an effort of the will and on psychic motor impulse, and apparently at times spontaneously. Sometimes it is so little marked as almost to escape observation, but even then the diagnosis of paralysis agitans can be made from the peculiar facies, the stolidity of countenance, the stooping attitude, the rigidity of posture, and the deliberation of movement and of speech. Dr. Eshner reported the case of a weaver, 6l years old, presenting a fi.xed countenance, stooped shoulders, and a tendency to propulsion. No tremor was present at the first observation, but at a later time slight tremor was appreciable in the thumb of one hand suggestive of the pill- rolling movement, and also tremor of intrinsic muscles of the hand. In this case, as in others like it, the absence of tremor was not constant, and the temporary absence was attributed to restraint through muscular rigidity. The tremor may hypothetically be ascribed to interruption of motor impulses responsible for muscular tone, in conse- quence of interference by nenrogliar hyperplasia with the transmission of nerve-force. The subsidence of the tremor on voluntary movement effort is in turn due to amplifica- tion of the tonic motor impulses necessary for the execu- tion of a given movement. Restraint of the tremor by passive movement or by psychic impulses must be considered as reflex. Philadelphia Neurological Society. At a stated meeting held October 23 Dr. Carl D. Camp read a paper entitled "Motor Palsy as an Early Symptom of Tabes Dorsalis." He reported illustrative cases and pointed out the generic stromectol relative rarity of the association. Dr. S. D. LuDLUM presented a communication entitled "Trauma Pre- ceding Probable Syringomyelia and Tabes," and he demon- strated two patients. In one of them symptoms of loco- motor ataxia developed in consequence of a fall from a scaffold at a considerable height, and in the other symptoms of syringomyelia made their appearance following a blow inflicted by the patient upon another person. In each it was a question whether the morbid manifestations and lesions were a result of the injuries or merely came into prominence in the sequence of them. Dr. G. R Price reported "A Case of Adiposis Dolorosa. The patient, who was exhibited, was a middle-aged woman, who presented enormous enlargement of the lower extremities, with varicose veins and pendulous masses of fat in the upper extremities. The hyperplastic fatty tissue was the seat of pain, spontaneous and induced in various ways. The thyroid gland was not palpable. There was a history of syphilitic infection acquired through the husband. Dr. J. W. McCoNNEix presented "A Patient with Probable Tumor of the brain in the Parieto-OccipiUl Region." This occurred in a man, about 55 years old, who had had head- ache, vomiting, unilateral weakness, and impairment of tactile and painful sensibility, astercognosis, with Jack- sonian convulsions and homonymous hemianopia. Marked improvement took place under treatment with mercurials and iodides. A similar though less pronounced condition had existed six years previously, and perfect recovery had resulted. Dr. T. H. Weisenburc exhibited a patient pre- senting "Astereognosis Without Motor or Sensory Involve- ment." The symptoms disappeared buy ivermectin entirely following treatment with mercurials and iodides. Dr. A. Gordon reported "A Case of Bulbar Palsy, with Total Aphemia." The patient, who was exhibited, was a colored woman, 35 years old, who, following an attack of angina, supposed to be diphtheritic, had difliculty in swallowing and in speech, with double facial palsy and weakness of the ocular muscles. The condition was thought to be due to poliencephalitis, although the opinion was expressed in the discussion that it was more probably a peripheral neuritis involving several of the cranial nerves. Dr. Gordon also presented a communication entitled "The Second Anatomical Proof of the Value of the Paradoxical Reflex." He reported the case of a young man having convulsions, with unilateral paresis. The knee-jerk was increased on the paretic side and the Babinski stromectol for scabies reflex was absent, but on grasping the muscles of the calf firmly between the thumb and fingers of both hands extension of the toes of the foot took place. Accordingly, it was decided that there was irritation of the cortex on the opposite side of the brain and order stromectol trephining was undertaken, with relief of the symptoms. stromectol for lice The discharge becoming retained at a later period, the symptoms returned, including the paradoxical reflex described, and with the restoration of the discharge the symptoms once more dis- appeared. In another case, one of hemorrhagic pachymen- gitis, the localization of the lesion was made accurately from the presence of the reflex. Philadelphia Pathological Society. At a stated meeting held October 25 Dr. W. M. Late CoPLiN presented specimens illustrating "Pyloric Stenosis." In one of these the excavation caused by ulcerating car- cinoma at the pyloric extremity of the stomach resulted buy cheap ivermectin in (he formation of a flap that gave rise to occlusion of the pylorus. In the other the pyloric order stromectol online orifice was constricted by carcinomatous infiltration. Dr. S. Leopold presented z specimen of "Carcinoma of the Pancreas." This was scirrhous and unattended with metastasis. There was pres- ent a second carcinomatous growth of a different character on the peritoneal surface of the rectum. Dr. D. Riesman exhibited a specimen of "Hypernephroma." The growth came from an elderly woman who had a tumor in the right hypochondrium, at first thought to be a gall-bladder, and later, by reason of the presence of suggestive physical signs, to be tuberculosis of the kidney. Operation was undertaken and the removed kidney was found to be the seat of a hyper- nephroma. The patient made a satisfactory recovery, but since the operation confirmatory evidence of pulmonary tuberculosis has developed. Dr. H. J. Sommers presented a communication entitled "Detection of Typhoid Bacilli in Milk and Water." He described the difficulty of detecting these germs in the fluids named, largely on account of the more active growth of other microorganisms, particularly the Bacillus coli communis. He decided to use milk as a culture medium base, and with appropriate apparatus he was able to isolate typhoid bacilli in a number of instances that otherwise would have yielded negative results. Dr. Joseph McFarland read a paper entitled "Further Obser- vations on Experimental Phagocytosis." With the aid of Dr. L'Engle he endeavored to determine whether there was any relation between the virulence of microorganisms and the activity of phagocytosis, and the results of the observa- tions seemed to indicate that there was no such relation. 8o4 MEDICAL RECORD. [Nov. 17, 1906 ^iirgtral ^uggpsttottH. A New Method of Gastrostomy. — Prof. Tavel of Berne has recently published notes on a new method of performing the operation of gastrostomy. All the older methods of performing the operation have the disadvan- tages that the opening made closes easily or becomes too small, and that the wall of the stomach is fixed to the ab- dominal wall. This can be avoided when the stomach is attached to the skin by the intermediation of a loop of in- testine that is allowed to retain its mesenteric attachment. This is formed like a new esophagus, with its peristaltic action functionating toward the stomach. The only disad- vantage of the operation cheap stromectol is that it takes more time than the other method. — Medical Press. Iodine-Benzine Disinfection. — Heusner warmly advo- cates the routine use of 1-1,000 solution of iodine in ben- zine as a disinfecting medium for surgical use. It is used as follows : 200 or 300 c.c. of the solution are placed in a disinfected porcelain dish and the dry hands are brushed with stromectol canada this for the space of five minutes. They are then rinsed in a fresh dish with the same solution. The pa- tient's skin is not scrubbed with a brush, but is wiped off with bits of gauze. Finally, the hands and the operative field are anointed with vaseline containing 2-1,000 of iodine. At first this treatment makes stromectol price the hands somewhat rough and fissured, but even the most sensitive skin soon stromectol online becomes habituated to it. Bacteriological and clinical tests speak highly in favor of the method. — Zentralblatt fi'tr Chirurgie. Aseptic Wound Dressing. — Walter von Oettingen, after extensive experience in the Russo-Japanese War, has come to the conclusion that the aseptic dressing is much preferable to the scabies stromectol use of antiseptics in dealing with the wounds of military surgery, and in all probabiHty in pri- vate practice as well. His idea is to prevent as much as possible the access of fresh germs to the wound, believing that efforts to kill all of those already present are worse than useless, since the chemicals used, if in proper strength to be effective, must inflict serious damage on the tissues. He accordingly makes no attempt to cleanse the wound or its environment, but as soon as the patient comes under his care paints the entire surrounding skin for a space the size of the palm of the hand with a varnish composed of gum mastich 20.0 g., chloroform 50.0 g., and linseed oil 20 drops. A dry sterile compress is immediately ap- plied to the wound, which is thus completely sealed beyond the possibility of any exposure. — Zentralblatt fiir Chirurgie. The Treatment of Postpartum Hemorrhage. — A method of controlling postpartum hemorrhage without hav- ing buy stromectol online recourse to uterine packing, which latter is always diffi- cult for the unassisted practitioner, and involves grave risks of infection, is described by Meyer-Ruegg. The procedure consists in the introduction into the uterus of a pear- shaped, broadly-corrugated instrument of aluminum stromectol uk mount- ed on an appropriately curved handle and having a width buy cheap stromectol of S cm. and a thickness of 3 cm. In cases of impending or actual hemorrhage this metal tampon is introduced into the cavity of the uterus and is used to massage its walls. If atony is marked and no contractions can be induced the uterus may, by means of the instrument, be pressed against the anterior abdominal wall and compressed through this with the left hand. The instrument is allowed to remain in position for twenty to thirty minutes, at the end of which time there is usually little risk of recurrence of the hemorrhage. — Zentralblatt fiir GynUkologie. Movable Artificial Eye. — E. A. Hall describes his operation as follows : General anesthesia, insertion of speculum. Circular incision, with sharp-pointed, curved scissors, of sclerotic directly posterior to the ciliary region, and in front of the insertion of the recti. Removal by sharp curette of vitreous retina and choroid. Insertion of speculum blades within the sclerotic, thus exposing the interior of the globe. With mouse-tooth forceps, catch the point of entrance of the optic nerve, pierce the sclerotic with the stromectol 3 mg scissors, and sever the nerve twenty mm. behind the junction, then complete the circuit of sclerotic close to the nerve, and remove the sclero-optic junction. Check hemorrhage, which is usually not profuse. Irrigate with saline. Insert a small gauze drain within the sclerotic, appro.ximate sclerotic and conjunctiva vertically. Withdraw drain after twelve hours. We have now left a zone of sclerotic nourished by a few twigs of the short posterior, and by the long posterior ciliary arteries, with muscular and nervous connections undisturbed. Thus is formed a movable pad upon which the artificial eye is placed. The artificial eye is usually inserted within a week and worn for a few hours each day. The movement of ivermectin stromectol the artificial eye is free up to twenty degrees vertically, and about thir- ty-five degrees horizontally. This procedure is not applica- ble in malignant involvement. ST.\TE BOARD EXA^^N.■^.TION QUESTIONS.* Regular Board Medical Examiners, State of Georgia.

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