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various reasons, but in place of this the speaker suggested, in the presence of infectious process in the large intestine, the rectal injection of the proper organisms. Thus the colon bacillus, which is said to inhibit the growth of the organisms both of typhoid voltaren sr 100mg fever and of dysentery, might be given per enema in fluid agar cultures. A less radical method would provide for the maintenance of con- ditions favorable to the growth of the bacterial flora already present in voltaren for sale the gut. and this end might be attained by appropriate feeding rather than by drugs. Moro found, for example, that Bacillus bi- tidns, a nonpathogenic organism present in the in- testine, grows with surprising rapidity when human milk is administered and soon appropriates the field to itself, the other bacteria being repressed. The discovery in its present shape is not likely to have any immediate application, for it would hardly be feasible voltaren xr 100 to supplant the trained nurse by a wet nurse in a case of typhoid fever in the adult, voltaren ec 75 mg but it may be possible to discover the element in human milk which favors the growth of this organism and so to turn the discovery, if discovery it is, to orac- tical account. It would be worth while to follow up this lead for a time to see if it is really of value, for the suc- cessful control of intestinal infections still consti- tutes one of the leading problems of medicine. In- testinal antiseptics, although introduced in great variety, have not been generally successful, and this failure has led to the introduction of the serum treatment in certain forms of dysentery and in ty- phoid fever ; but though encouraging results have 828 MFDICAI. RFCORD. [Nov. 24. 1006 been obtained, ibe therapeutics of intestinal infec- tions still lacks much before it can voltaren sr 75 mg tablet be placed on a firm and practical basis. PROSTATECTOMY IN TWO STAGES. Among surgical procedures in general there is none attended with more hazard, comparatively speaking, than the removal voltaren 75 sr of the prostate gland under certain conditions. Although the percentage of mortality has been greatly reduced within recent generic for voltaren years by im- provements in the technique of the operation, there are factors which prove an almost unsurmountable barrier to a successful outcome. generic name for voltaren Among the most noteworthy are the age and generally reduced vital- ity of the patient added in most cases to an impaired condition of the kidneys and other internal organs. The kidneys bear such an important relation to the immediate recovery and future prognosis in every patient that any damage which they may have pre- viously sustained will probably be seriously aggra- vated by the additional strain imposed by an opera- tion of this character. Hemorrhage, shock, urinary suppression, and general toxemia may be summed up as the main difificulties consequent upon voltaren rapid 25mg a pros- tatectomy, and the mortality rate will be found to bear a more or less definite relation to the existence of these features in any given case. A complete and radical removal of the gland, par- ticularly in cases in which an voltaren xr 100mg emergency exists, nec- essarily increases the hazard. In order to improve the patient's chances, C. H. Chetwood, writing in the Annals of Surgery for October, 1906, suggests that the operation under such circumstances be done in two stages. He reports a series of eight cases of a severe type and threatening in character, in which death would almost infallibly have followed a radi- cal primary voltaren topical operation. The ages of the patients varied from sixty-five to eighty years, and all could be classified as poor surgical risks. After prelimi- nary drainage a complete radical removal of the prostate was done in each case with excellent results, the former giving the patient immediate relief from his symptoms and an opportunity to voltaren xr 100 mg gain in strength as a preliminary to the second operation. The writer lays great stress on the control of the hemorrhage during the operation and has had ex- cellent results with formaldehyde gelatin as a local hemostatic. The postoperative conditions are thus greatly improved and the drainage is more perfect than in cases in which the tube is constantly clogged by blood clots. It is also claimed that the secondary operation can be more readily carried out because the congested tissues no longer obscure the field and the necessary procedures can be more quickly done, with a consequent reduction in the amount of hem- orrhage and shock. Postoperative toxemia is also eliminated, as the patient has had an opportunity during the preliminary period of drainage to fortify his normal resisting powers. The suggestion con- tained in Dr. Chetwood's paper is timely and sensi- ble, and, although its voltaren 100 mg retard value has been tested in only a small number of cases, there seems to be no good reason why it should not give equally good results in the hands of other operators. EARLY OPERATION IN TRAUMATIC IN- TRACRANIAL HEMORRHAGE. Very little doubt exists in the minds of surgeons as to the necessity of early operative interference in the presence of hemorrhage from the intracranial blood-vessels, and yet the diagnosis of the condition presents so many difificulties that many sufferers are not afforded this source of possible relief. The per- centage of recoveries from expectant treatment is very small, and it is a matter of experience, as shown by autopsy results, that early resort to trephining would have been followed by success in many a fatal case. The absence of focal symptoms, even when the evidences of general and increasing cerebral com- pression are present, is considered by some surgeons sufficient reason for desisting from operation, be- cause no definite information is afforded where the trephine should be applied. In most instances, how- ever, a definite history of trauma may be obtained, and a careful examination of the scalp will reveal a contusion or abrasion as the desired guide. A good deal of uncertainty also exists regarding the condi- tion known as cerebral concussion, which, it should be remembered, is transient in character. Many so- called cases of concussion are in reality cases of compression, and an earlier recognition voltaren 50mg diclofenac of the true condition would result in operation while there is still a chance for relief. A timely article by F. W. Murray, appearing in the Annals of Surgery for September, 1906, is one of the latest contributions to this subject. In this early operation is advocated, although the writer does not go to the extent of advising an exploratory operation in every doubtful case, as some extremists would do. The necessitv of oper- ating in hemorrhage from the middle meningeal artery is evident, but as regards the propriety of sim- ilar treatment in cases of subdural voltaren generic name hemorrhage there is still some difference of opinion. As Murray states, and with justice, this view is inconsistent, for it is only rarely that the symptoms are suffi- ciently voltaren ec tablets 50mg characteristic to allow of a differential diag- nosis, and very frequently it is only by exploration that the source of the hemorrhage is ascertained. Whether extra- or subdural, the result of hem- orrhage is always compression by the clot, and the sole indication of treatment is the removal of the clot and the checking of the bleeding. The impor- voltaren in canada tant point is to recognize the presence of intracranial hemorrhage, and, if the symptoms of compression are severe, to relieve the compression immediately, no matter what the source of the hemorrhage. The Use of Alcohol in Pneumoni.a. The exact indications for the administration of alcohol in acute diseases, and even to a great extent the entire rationale of its behavior in tlie human liody, are still far from being thoroughly under- stood. Medical opinion has already undergone sev- eral reversals in regard to this question, and the end does not yet appear to be in sight. It was only sixty years ago that a German physician was pub- licly accused of having caused the death of a patient ill with typhoid fever because he had administered wine to him, whereas, at a later period, the use of alcohol became so universal and indiscriminate as Nov. 24, 1906] MEDICAL RECORD. 829 no doubt to have caused the loss of many lives. This extreme attitude has now been abandoned, but there are still many pros and cons to this important question. Foch of Hamburg publishes in the Miiiichener medizinische Wochenschrift of Oc- tober 30, 1906, the results of an effort he made to arrive at the consensus of opinion as to the use of alcohol in acute disease, taking as his example pneumonia. He directed a series of questions to a very large number of emi- nent physicians in Germany, Austria, Switzerland, Denmark, Sweden, and England. The answers re- ceived were sufficiently numerous to enable Fock to present a very interesting review of current opinion in Europe on this matter. The questions were the following : "Do you prescribe alcohol in every case of pneumonia, or only in special cases? In what form and in what quantity do you administer alcohol ? Do you voltaren in usa consider that it is necessary to give alcohol in pneumonia occurring in alcoholic pa- tients? What effect do you expect from the admin- istration of alcohol, and do you get it? Could this effect be obtained by the use of other meas- ures?" As was to be expected, the answers received presented a wide disparity of opinion, and cannot be discussed in detail here, but it may be said that the majority of those questioned considered that alcohol should be given only in selected cases of pneumonia. The majority were also united in declaring for the advisability of not depriving alcoholic patients of all stimulant when suffering from pneumonia. There were many opinions as to the effect to be expected from the use of the drug, and very many of those questioned admitted that other remedies n-.ight be expected to give equally good results. Of especial interest were the statistics of the London Temper- ance Hospital, which is second to none in its cures of pneumonia, and yet in the four years from 1901 to 1904 reports the use of alcohol only 11 times in treat- ing 297 cases of pneumonia. Many clinicians are of the opinion that while the use of alcohol may not be unfavorable to the course of the disease itself, the convalescence of the patients who have received it is more protracted than that of those who have not. This, of course, is very largely a matter of opinion, and is hardly susceptible of statistical demonstra- tion since the patients receiving alcohol are apt to be the victims of the severest infections. Indeed, this whole inquiry of Fock's, wliile interesting as por- traying the lack of uniformity in opinion among voltaren ec some of the most prominent European clinicians, does not help a great deal toward the solution of the problem. Definite results can be expected only when in large hospitals long series of cases are treated in strict rotation, first one with alcohol and the next without, of course making exceptions in cases in which the welfare of the patients seems to demand it.

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