bid suspicion of everything and everybody. Oper-
ated June, 1906. Right frontal, ethmoid and max-
illary antrum contained pus and granulations ;
modified Killian operation and maxillary antrum
opened through canine fossae. Cured.
Case IV. Female, white, age twenty-one. Disease
of nose for several years ; for two weeks previous to
operation, mind sluggish ; indifferent to her condi-
tion or surroundings ; responds slowly and hesitat-
ingly to questions, but accurately. Operation
March, 1905. Both frontal, ethmoid, and both max-
illary antra full of offensive pus and granulations.
Case \'. Male, white, age forty-two. Disease of
nose for fourteen years; for some months troubled
with insomnia and mental depression ; feared he
would take his life ; had syphilis in youth. Operation
January, 1905. Left frontal and ethmoid full of
pus ; no granulations. Cured.
Case VI. Male, white, age thirty-three. Syphili-
tic ; disease of nose for four years ; mentally de-
pressed ; indifferent to his whereabouts or surround-
ings ; slovenly and immodest in his dress ; whereas
in his normal condition was a Chesterfield in his
tastes. Operation June, 1904. Empyema of right
frontal, ethmoid, and maxillary. Entirely relieved,
but syphilitic deformity of nose Trimox 500 Mg rapidly followed
Case \'ll. Female, white, age fifty-five. Great
mental depression ; desired to be left alone ; this
condition had existed for two months and growing
worse ; had so increased that she remained in bed
for five weeks prior to consulting me, two weeks of
which were spent in hospital under treatment for
melancholia. Operation May, 1905. Frontal -and
ethmoid empyema. Cured.
Case VIII. Female, white, age forty-one. Dis-
ease of nose for seventeen years ; morbid fear she
would take her life : Amoxicillin 500 Mg was in everybody's way ; feared
to be left alone. Operation August, 1904. Empyema
right frontal, ethmoid, and maxillary. Entirely re-
lieved except occasional Trimox 500 migraine.
Case IX. Male, white, age thirty. Disease of
nose for six or seven years ; stupid from pain ;
sleeps a great deal : mind enough to do his work
but felt sure he was losing his mind ; would some-
times wander miles from home without a motive.
Operation December, 1905. Empyema Trimox Online right frontal,
ethmoid, and maxillary. Entirely cured ten weeks
after operation but relief was immediate.
Case X. Male, white, age fifty-one. Disease of
nose and throat for twenty years; had syphilis in
youth ; increasing mental depression with suicidal
inclination (threats). Operation August, 1905.
Empyema left frontal, ethmoid, and maxillary. Com-
Case XI. Female, white, age thirty. Disease of
the nose for eleven years ; syphilitic : melancholia
with suicidal inclination : asked to be locked up so
she would not disgrace her family by killing her-
self. Operation May, 1905. Empyema left frontal,
ethmoid, sphenoid, Generic Trimox and maxillary. Complete relief.
The cause of the pronounced mental depression in
the majority of my cases can better be explained by
ihe neurologist and alienist, and we have as yet little
data outside of the clinical history to base conclu-
sions upon, owing to the fact Amoxil Trimox that medical men do
not attach more importance to the condition of the
nasal cavities, either Trimox Antibiotic at the bedside or on the post-
mortem table. When this is done, the association
of disease of the accessory sinuses and cranial cavi-
ties will be more fullv substantiated. "Whether
the symptoms and conditions described are due to
intracranial pressure, direct or indirect meningeal
irritation, reflex nervous conditions, disturbed cere-
bral circulation, or toxemia, is not determined. But
the fact remains that in these cases ventilation of
the occluded sinuses or cure of the purulent process
cured the psychosis : on the other hand, retention of
pus aggravated the mental defect, or return of the
purulent infection in the sinus w-as accompanied by
return of psychosis'.' (W. Sohier Bryant).
[Nov. 24, 1906
The Trimox Side Effects presence of pus or granulations in the sinuses
is not necessary to produce marked toxic symptoms,
with pain and mental depression. In some of my
most aggravated cases, no pus was suspected and
none found, but as soon as the obstructing middle
turbinal was removed, the relief was immediate.
"The etiology of this condition depends Buy Trimox on the
anatomic relation of the middle turbinates to the
hiatus semilunaris and infundibulum. The air, in
the frontal and anterior ethmoidal cells is impris-
oned there by pressure of the middle turbinal
against the lateral nasal wall, the turgescent tis-
sues filling in the hiatus semilunaris and effectually
blocking it. Tlie lining membrane of the sinuses
absorbs the oxygen in the imprisoned air and thus
creates a vacuum. The absorption results in nega-
tive pressure and consequent swelling of the lining-
membrane with increased blood supply to this region.
Stasis, to a greater or less degree, results; pressure
of the congested tissues on the contained nerve end-
ings, together with this stasis, produces the symp-
toms and results in reflex vasomotor disturbances
in the circulation of the neighboring structures.
This theory is advanced by Brawley, Robertson.
Ewing. and Sluder, and seems to me to be worthy
of acceptance. Trimox Indications
The mental symptoms in the class of cases under
consideration may be due to a meningitis of a pass-
ing type, namely a meningitis serosa (Amberg).
The anatomical conditions favor the easy appear-
ance of such a coaffection of the surrounding parts
of the sphenoid, ethmoid, and frontal sinuses. Un-
doubtedly toxins developed by fermentation and
putrefaction in the gastrointestinal tract — a faulty
metabolism — and from the poison in the blood de-
veloping from acute affections (Stevenson).
These toxin-producing bacteria are probably the
chief agents combined with the sepsis from' pus
absorption, the influence of which acts upon the
cortical cells and nerve fibers of the brain. The
proximity of the acessory sinuses to the brain is of
signal importance if we can assume that an irritation
of the brain, directly or indirectly, in predisposed
or pot predisposed cases, is caused bv an affection
which has its seat in the sinuses, the indications for
interference is plain.
In conclusion it is worthy of note that in each
case presented in this paper the ethmoid cells were
extensively involved in the pathological process, and
I do not now recall ever having seen a case of frontal
or sphenoidal suppuration in which the ethmoid was
not implicated. My observations almost force me
to the conclusion that probably in the ethmoid or its
"offshoot" the middle turbinate, is to be found the
cause for the majority of cases of infection of the
frontal, maxillary, and sphenoidal sinuses, and the
statement made by me at this society in a paper
on a similar subject Where Can I Buy Amoxicillin in 1904, is repeated with greater
emphasis at this time, viz., "the middle turbinal
most frequently causes obstruction of the natural
openings of the accessory sinuses and thus inter-
feres with free drainage and ventilation, and the
early removal of its anterior third decreases the
necessitv for more extensive and radical operations
Only the mental symptoms that were most con-
spicuous and gave rise Buy Amoxicillin to most anxiety are mentioned
in this Amoxicillin 500 series of cases, but in these and in many other
cases of chronic ethmoiditis I have noticed one or
several of the group of symptoms associated with
this disease mentioned by Beaman Douglas, Amoxicillin Amoxil the
cause of which has not been explained. "It is evi-
denced by a slow deterioration of the mental facul-
ties, an inferior quality of work, loss of memory.
disability for continued application, overanxiety,
general incapability, and procrastination."
In neurotic subjects and those with a lowered
vitality from any cause, an ethmoidal, sphenoidal,
or frontal sinus affection may start the vicious circle
composed of the sinus affection proper and the
neurasthenia or hysteric conditions which later we
know, may reach a form and a degree which some-
times allows us to classify the bearer as one "bor-
dering on insanitv."
THE Trimox 500mg DIAGNOSTIC VALUE OF THE CYST-
OSCOPE AND URETERAL CATHETER.*
By JOHN EGERTON CANN.\DAY. M.D..
PAINT CREEK, W. VA.
SURGEON-IN-CHARGE SHELTERING ARMS HOSPITAL.
Lesions of no part of the body are, perhaps, more
difficult of diagnosis than those of bladder, ureter,
or kidney. For many years surgeons felt the need
of some means whereby they might obtain more
definite information concerning the actual state
of affairs present in a given pathological urinary
tract. From comparatively simple and crude be-
ginnings there have been gradually evolved
through Order Trimox the united eft'orts of many colaborers
diagnostic instruments of scientific precision and
The entire subject is of comparatively recent
date. In 1874 Tuchman collected urine from one
ureter by compressing the mouth of Buy Trimox Online the other
with a forceps introduced into the bladder. About
this time Hegar proposed tying the ureter per
vaginam for the same purpose. In 1875 Simon
catheterized the ureter by the aid of a finger used
as a guide, passed through the dilated urethra.
General anesthesia was required, the after-eff'ects
were unpleasant, and the procedure was diflicult.
Pawlik, a Privat Decent in the clinic of Billroth,
discovered in 1880 a method of introducing the
catheter by the guide of external anatomical land-
marks ; this method is not easy and yet has some
practical points to commend it. In this method
the operator is guided largely by the sense of
touch. Newman, Kelly, and Byford have worked
along the same lines without Trimox Dosage adding anything to
Pawlik's method. Later Brenner, Grunfield, and
Kelly began to practise ureteral catheterization
by aid of endoscopy, which rendered the orifices
of the ureters visible. Kelly, in his dry method,
dilates the urethra gradually then introduces a
speculum with an obturator which, on with-
drawal, allows the bladder to fill with air. Then,
by the li.ght thrown from a head mirror, the ure-
teral orifices Where To Buy Amoxicillin are located by direct vision. Morris
exposed the mouths of the ureters by the use of
straight tubes with obturators.
In 1876 Nitze conceived the idea of a cysto-
scope, after much patient effort, in which he was
joined by Hill, Fenwick, Thompson, Boisseau, Du
Rocher, Caspar, Albarran, and others, and by Lei-
ter, an instrument maker of \'ienna, the cysto-
scope has been so perfected that it leaves but little
to be desired.
Inasmuch as for obvious reasons a compara-
tively limited number of physicians will ever
make use of the cystoscope and ureteral catlieter,
and as not all cases can be catheterized, there
will always be a demand for some other means
of obtaining the separate urines of the two kid-
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