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g. The where to buy synthroid function of the sympathetic nervous system is to supply (i) the muscles of the vascular system, by means of the vasoconstrictor and vasodilator nerves, also the accelerator and inhibitory nerves of the heart; (2) the muscles of the various viscera; (3) various glands, such as the lacrymal and parotid glands. 10. Protcids, carbohydrates, fats, and water are all es- sential to health. HISTOLOGY and EMBRYOLOGY. 3. The lymphatic circulation is, strictly speaking, not a circulation at all ; since the lymph flows only in one direc- tion, namely, toward the heart. The lymph capillaries take up any excess of the blood plasma which is not required for the nutrition of the tissues. These capillaries consist of a single layer of epithelium, and empty themselves into vessels very like the veins. The lymph vessels are well provided with valves, which are so closely approximated as to give the vessels a beaded appearance. All the lymphatic vessels, except those of the right upper half of the body, empty into the thoracic duct, which terminates in the left subclavian vein, where the left internal jugular vein also enters. Those from the right upper half of the body dis- charge into the right lymphatic duct, which, in turn, empties into the right subclavian vein at its junction with the right internal jugular vein. 4. About the end of the third month of fetal life the primitive epidermis, over the end of the digits, thickens, and the nail area is outlined by a furrow. The root of the nail is then marked by an ingrowth of the rete Malpighii. A little later, the upper cells of the Malpighian layer be- come covered with granules, which eventually become hard- ened to form the nail substance; at the same time the stratum lucidum cells increase in number, and help to form the body of the nail. Last of all, the free edge of the nail is formed by the shedding of the stratum lucidum. The growth of the nail is caused by the addition of cells at the posterior margin; it gains in thickness by additions from the stratum mucosum at the lunula. 5. Peyer's patches are large, oval groups of lymph fol- licles, closely packed together, and held in place by adenoid tissue. They are chiefly found in the ileum. CHEMISTRY AND TOXICOLOGY. 1. An acid is a compound of an electro-negative element or radical with hydrogen, part or all of which hydrogen it can buy cheap synthroid part with in exchange for an electro-positive element, without the formation of a base. A base is a substance which can enter into double decomposition with acids to produce a salt and water. 2. Valence is the combining power of an atom of an element as compared with that of an atom of hydrogen. Calcium is bivalent ; sodium and potassium are univalent. 3. Ammonia is prepared by heating a solution of am- monium hydroxide : NH.HO=NH,-FHjO 4. An anhydride is an oxide capable of combining with water to form an acid. 5. Ferments of the body are: (i) proteolytic, e.g. trypsin ; (2) amylolytic, e.g. ptyalin ; (3) steatolytic, e.g. steapsin; (4) inverting, e.g. invertin ; (5) coagulating, e.g. milk curdling ferment. 6. Gastric juice consists of ninety-nine and a half per cent, water, and half of one per cent, solids. It contains hydrochloric acid, pepsin, a curdling ferment, mucin, salts, and water. The amount of free hydrochloric acid is about two parts in a thousand. Tests for free hydrochloric acid: (i) Add to a few drops of filtered gastric juice one drop of a solution of dimethyl-amido-azo-benzol ; a cherry red color develops. (2) The buy synthroid reagent is prepared by dissolving two grams of phloroglucin and one gram of cost of synthroid vanillin in 100 cc. of 90 per cent, alcohol ; then place an equal number of drops of this reagent and of gastric juice (filtered) on a porcelain dish, and allow the fluid to evaporate slowly; a rose tint appears at the edge. 7. Symptoms of poisoning by bichloride of mercury are : a burning pain in the mouth, pharynx, and stomach ; the mouth and tongue are white; the vomitus is white, with synthroid cost shreds of mucous membrane, and tinged with blood ; bloody stools, also salivation may occur. Treatment : the antidote is white of egg, but too much must not be generic synthroid given at one time; this should be followed by an emetic. 8. In opium poisoning there may be three stages : (l) a period of excitement, in which the patient is active, talk- ative, and has hallucinations : (2) a period of drowsiness, in which the patient is sleepy, but may be aroused ; his face is pale, lips livid, pupils contracted; this passes into (3) the stage of coma, from which the patient cannot be aroused, the reflexes are abolished, the pupils are very contracted, 8o6 MEDICAL RECORD. [Nov. 17, 1906 the pulse is slow and irregular, and the respirations are in- frequent and shallow. In alcoholic poisoning the pupils are not contracted, the respirations are about normal, and the skin is cooler than in opium poisoning. 9. In cocaine poisoning there will be found pain order synthroid online and fullness in the head, pulse first quick, later feeble and slow, extremities cold. The symptoms are not constant. 10. The continuous use of acetanilide may give rise to decrease in the number of red blood cells ; the face is livid and covered with perspiration, the respirations become slow and shallow, the pulse soft, compressible, and gradu- ally weaker. Treatment: stop further administration of the drug, then support the patient by stimulants, warmth, and strychnine. BACTERIOLOGY. 1. Bacteria are unicellular organisms of vegetable na- ture, devoid of chlorophyl, and multiplying by fission. They are recognized by their shape, size, mobility, synthroid online grouping, growth, and behavior to cultures and staining reagents. The chief culture media are: milk, blood serum, bouillon, gela- tin, agar, potato. The conditions favorable for their growth are moisture, temperature of between 10° and 40° C, nu- tritive material in the shape of decomposable organic mat- ter, a medium of neutral or faintly alkaline reaction, and rest. Bacteria enter the body through the abraded skin or mucous membrane, or through the respiratory and ali- mentary tracts. 2. The sputum purchase synthroid online must be recent, free from particles of food or other foreign matter; select a cheesy-looking nodule and smear it on a slide, making the smear as thin as possible. Then cover it with some carbolfuchsin, and let it steam over a small flame for about two minutes, care being taken that it does not boil. Wash it thoroughly in water and then decolorize by immersing it in a solution of synthroid levothyroxine any dilute mineral acid for about a minute. Then make a contrast stain with solution synthroid cheap of Loeffler's methylene blue for about a minute ; wash it again and examine with oil immer- sion lens. The tubercle bacilli will appear as thin red rods, while all other bacteria will appear blue. 3. The bacillus of tetanus is characterized by its peculiar spore, formed at one end of the bacillus, and giving it the appearance of a pin; it is purely anaerobic, and cannot be developed at all in the presence of oxygen. It generally comes from the soil, and is found in penetrating wounds. It appears in two forms, the spore-bearing form, as de- scribed above, and the vegetative form, which is a short bacillus with rounded ends, and which may occur singly or in pairs, or may form long filaments. It grows in gelatin stab cultures in the middle of the medium, and the colonies look something like a fir tree; its growth is slow, and a disagreeable synthroid mcg odor is at the same time emitted. In bouillon, it grows near the bottom purchase synthroid of the tube, and produces gases. 4. Ptomaines are the putrefaction products of dead ani- mal tissues or fluids. Toxins are the products of pathogenic bacteria or of ptomaines or leucomaines, and are actively poisonous. Toxoids are toxins whose poisonous properties have been reduced or modified. An antitoxin is a substance formed in the body, of a protective character, and capable of rendering inert the poisonous products of bacteria. An antitoxic unit is the quantity of antitoxin, which, on being inoculated into a guinea pig weighing 250 grams, will neutralize one hundred times the lethal dose of toxin. 5. A sterile swab is rubbed over any visible membrane on the tonsils or throat, and is then immediately passed over the surface of the serum in a culture tube. The tube of culture, thus inoculated, is placed in an incubator at 37° C. for about twelve hours, when it is ready for examina- tion. A sterile platinum wire is inserted into the culture tube, and a number of colonies of a whitish color are removed by it, and placed on a clean cover slip, and smeared over its surface. The smear is allowed to dry, is passed two or three times through a flame to fix the bacteria, and is then covered for about five or six minutes with a Loef- fler's methylene-blue solution. The cover slip is then rinsed in clean water, dried, and mounted. The bacilli of diphtheria appear as short, thick rods with rounded ends; irregular forms are characteristic of this bacillus, and the staining will appear pronounced in some parts of the bacilli and deficient in other parts. The dose of diphtheria antitoxin is from 2.000 to 3,000 units to be injected as soon as possible, and, if necessary, to be repeated in twelve hours ; in severe cases it may be repeated earlier. In laryngeal and severe pharyngeal cases a larger dose may be used, up to 5,000 units. The im- munizing or prophylactic dose is from 200 synthroid price to SOO units. SITRGERY. order synthroid I. Local anesthesia can be caused by applying a mixture of salt and ice, or by spraying the part with ether or with ethyl chloride. Cocaine hydrochloride, in watery solution of about 5 to 8 per cent., can also be applied to a mucous surface, or in a one per cent, solution it can be dropped into the eye. The same drug can be used hypodermically in solution of from one to four per cent., but it does not act on inflamed tissues. When injected into a finger or toe, its action can be increased by the application of a tourniquet, which prevents the solution from being carried away price of synthroid in the blood current. Hypodermic injections of sterile water are said to have the same eflfect as those of cocaine. 2. Sepsis is a condition due to the entrance and multi- plication of bacteria in the body, or by the absorption of their products. The stages are (i) that of septic fever, with rapid rise of temperature, remitting each morning, pulse full and rapid, anorexia, furred tongue, dry skin, constipation, scanty, high-colored urine, headache; (2) hectic fever, due to retention of discharges, with fever, flushed face, anorexia, tongue dry and red, diarrhea, pro- fuse sweating, urine loaded with urates, and tendency to formation of bedsores; (3) in long-standing cases amyloid disease may follow, especially when there is a long-con- tinued discharge ; albuminuria and diarrhea are commonly present in this stage. 4. The indications for inguinal colostomy are: (l) congenital absence of the rectum when incision by the per- ineal synthroid mg route fails to reach the intestine; synthroid tablets (2) chronic ob- struction of the large intestine, which cannot be relieved by other means; (3) volvulus of the sigmoid flexure which cannot be otherwise reduced ; (4) cancer of the rectum when a radical operation is inadvisable; (s) as a prelimi- nary operation to excision of the rectum. 6. The chief complications of fracture are : compound fracture, injury to blood-vessels, gangrene, synthroid buy online degeneration and contraction of muscles, stiff joint, atrophy of limb,

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