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tively small. If the ferment is peptonized or undergoes other destructive changes, it loses its potency. There is but little evidence that ferments entering the body Zofran Cost from without retain any activity, and experiments in this direc- tion can be regarded as successful only if the foreign fer- ments can be rendered resistant to gastric digestion. Bencse has observed a case of chronic syphilitic indura- tive pancreatitis. The diagnosis of chronic atrophic Zofran 4 Mg hepa- titis had been made four years previoush' on the thirty- seven-year-old patient. Recently she had presented emacia- tion, diarrhea, small spleen, no ascites. There were six or eight stools a day, the feces being gray in color and fatty. The urine contained 8 to 10 per cent, of sugar, and three to fourteen liters a day were voided. The administration of one hundred grams of butter gave rise to lipuria, butter floating on the surface of the urine. The patient died in consequence of gastric and intestinal hemorrhages. The symptoms pointed toward involvement of the pancreas, probably diffuse, as catarrh and impaired meat digestion were present, and with probably destruction of the cells of Langerhans. The syphilitic nature of the condition was probable, owing to the presence of enlarged cervical lymph glands, and as one pregnancy had terminated in a still birth and the other in an abortion. The diagnosis was confirmed at autopsy. Balas has resorted to iodoform wax in order to fill the cavity left after exenteration and total removal of the orbital roof. The patient was a man forty-one years old, whose right eye had been removed two years before, owing to the presence of a new growth, which recurred and caused intense pain. The entire orbital cavity was cleaned out and 8 Mg Zofran the new growth removed, together with the roof of the orbit, which had to some extent been eroded by the tumor. Two days later Mosetig's iodoform wax was employed in the following way: The cavity was first disinfected with concentrated formalin solution, and then the warm iodo- form-oil-wax emulsion was Zofran 4 poured in. After it had con- gealed the eyelids were united over it. Healing was un- complicated. Boston Medical and Surgical Journal, November 8, 1906. Achylia Gastrica. — F. W. White gives a general de- scription of this condition, basing his observations on nine cases of the disease seen in 235 consecutive cases of chronic disease of the digestive organs, in which number there were forty-one cases of subacidity. He therefore regards the simple achylia gastrica as a relatively common condition. The symptoms are not characteristic, and the diagnosis must be made from the physical examination of the patient, and of his stomach contents and feces. Those cases are best classified as achylia (although not such in the strict Cost Zofran sense of the word) in which there is an entire lack of HCl secretion, but in which very minute traces of pep- sin or rennet are retained. In making the diagnosis of gastric cancer we should remember the frequency of simple Price Of Zofran achylia. Zofran 8 Mg which may resemble it closely. The examination of the feces for invisible blood is, under these circumstances, especially useful. The etiology of Zofran Price simple achylia is unproved; its course suggests a functional origin. Its most satisfactory treatment Cost Of Zofran is hygienic and dietetic. The Analytic Method in Psychotherapeutics. — H. Lilienthal and E. W. Taylor refer to efforts made at the Massachusetts General Hospital to systematize methods of mental treatment. Zofran 4mg Those familiar with neu- rological hospital patients know that very many of them do not require the use of drugs or mechanical means of treatment, but rather analysis of the dis- ordered mental state and the treatment of the condi- tion based on the results of such an analysis. Two illustrative cases are given illustrating the methods followed. Thus in one case regarded as hysterical aphonia in which the usual therapeutic procedures gave but transient relief, it was found that the patient was in a condition of deep despondency, owing to the in- sanity of a brother who was confined in an asylum. The patient, a young woman, was finally induced to tell the whole circumstances of her brother's case, and measures were taken to relieve her mind of the popular prejudice existing about insanity. She was given to understand that insanity is a Zofran Iv misfortune and not a crime, that there is no more shame connected with it than there is with physical disease. Moreover, the condition was fully analyzed to her, and in simple language she was given to understand how her trou- ble ori.ginated. The aphonia never returned after the first explanation, and, although she came regularly to the clinic for several months, she did not lose her voice once. On one or two occasions she came in with hoarseness, but no loss of voice. The condition cleared up completely, and now, after ten months, the patient is well and considers herself cured. The authors be- lieve that the application of the analytical method is perfectly practicable, and that in the greater majority of cases a little perseverance will accomplish the de- sired results. The patients themselves Zofran Buy quickly learn to realize the value of the suggestions made to them in the course of the analysis of their conditions, and appreciate also the time given and the effort made by the physician in their behalf. New York Medical Journal, November 10, 1906. Surgical Treatment of Certain Lesions of the Upper Abdomen. — J. B. Boucher refers to certain conditions in which surgical intervention is now recognized as the proper procedure. Zofran Ondansetron He discusses the symptomatology of gallstone disease, and chronic dyspepsia, which so often leads up to ulceration or is confounded with it. He believes that it is often difficult, and at the present time impossible to draw a hard and fast line which shall divide the cases into those in which medical, and those in which surgical aid is indicated. The au- thor says that many patients with the first attack with- out serious hemorrhage, who can give up the time and who realize the importance of prolonged rest, will re- cover permanently under medical treatment, but the Nov. 24, 1906] MEDICAL RECORD. 837 following types should be considered surgical: (a) Cases of relapsing acute hemorrhage; (b) cases with persistent hemorrhage causing anemia; (c) perfora- tions; (d) recurrent ulcer, pure and simple, attended with dyspepsia and starvation; (e) pyloric obstruction; (f) adhesions following ulcer or independent of it; (g) scar contraction of body of stomach giving hour- glass condition; and (h) some cases of intractable dys- pepsia originating in an ulcer and for which the definite pathology is unknown. Appendicitis: a Plea for Early Operation in Pus Cases. — W. D. Ward gives the histories of a scries of cases, showing the chant;c which has occurred in gen- eral surgical opinion regarding the advisability of early intervention in appendicitis. He is opposed to the Ochsner method. He notes the low mortality in gen- eral, acute, and also in the interval cases, but declares that the mortality is still too high in those cases in which the appendix has ruptured, and in which pus is present about it either as a circum- scril>cd abscess or as a general peritonitis. Delay or incomplete work in such cases means that there may result subphrenic or hepatic abscess, pylephlebitis, splenic abscess, and infections in Zofran 8mg various parts of the body. The author declares that in a pus case after in- cising the abdominal wall we should carefully place gauze sponges so as to separate as effectually as pos- sible the infected areas from the uninfected, then evac- uate the pus first with mops, then by a local irrigation, free from the appendix, and remove it, then separate the adherent coils of large and small intestine, evacuate all secondary pus pockets, wipe the lymph from the in- testines, and make them as clean as possible, remove the protective gauze pads, and put in fresh ones for drain- age. Take the greatest possible care, he says, in placing drains, build up as it were a wall of gauze which will hold the intestines away from the infected areas, and then use central Zofran Odt ropes of gauze to drain the infected spots; leave the abdominal incision wide open, no sutures. If, after the separation of adhesions, it is found that the inllaniniation has already spread beyond the boun- daries of the right iliac fossa, a second irrigation should be given according to the following rules: Use a large tube at least three quarters of an inch in diameter; hold the funnel high so that Zofran Mg there is plenty of force; turn the patient on the right side, and keep two fingers of the left hand spread wide apart in the incision, so that the exit is very free, and use at least two or three gallons of water. An irrigation given in this way does not spread pus. it cleanses. In these cases of general peritonitis use the Fowler position and Murphy's method of continuous saline infusion by rectum. The Importance of Early Recognition of Nasal Obstruction and Its Relation to Later Respira- tory Disturbances. — F. .\. Faught calls attention to the importance of the nasal functions of warming, moistening, and purifying the inspired air. If these results are not properly attained, the lungs are bound to suffer. Children who breathe imper- fectly at night or who seem dull and backward at mental development should be thoroughly examined. The author enumerates the lesions which in varying combinations are found in these children. In spite of the prevalence of adenoid disease in the pharyngeal vault and the abundant opportunity offered for its study, we are still in doubt as to its true underlying cause. Ultimately the chronic rhinitis and disturb- ances of aeration give Iv Zofran rise to ear complications. The author describes the appearances of the parts as seen in routine examinations, enumerates the symptoms of the various lesions, and gives suggestions as to treat- ment. The paper brings forward nothing new. Journal of the American Medical .-issociaiion, November 17, 1906. Utilization of the Broad Ligaments. — E. C. Dudley describes the mechanism of descent of the uterus, pointing out the importance of restoring the normal axes of the uterus and vagina and the preservation of the pelvic floor. In complete prolapse of the uterus the condition is practically a hernia, and should be treated like other hernias by reducing it and excising the sac in such a way as to expose strong fascial edges, which should be firmly united by sutures. He Odt Zofran there- fore proposes the adaptation of his operation, described in igo2, of end-to-end approximation of the broad liga- ments for holding up the pelvic floor after vaginal hys- terectomy, to support the replaced uterus. The opera- tion is described in connection with semi-diagrammatic illivstrations and its advantages, when employed in hys- terectomy, are enumerated. He proposes its utilization to hold the uterus in place, in hopes that it will be found more effective than the superficial operations which, at best, have been unsatisfactory. At least it will be less mutilating than the alternative operation, vaginal hysterectomy. He also refers to his operation of reefing the broad ligaments in the removal of the appendages, also proposed in 1902, and mentions its advantages. The Diet and Albuminuria.— H. Stern recapitulates the results of a series of experimental studies of eighty- two patients who had albuminuria. The object was to determine the influence of certain types of nutritives Ondansetron Zofran and ingcsta not on the underlying disease, but on the accompanying symptoms of albuminuria. The sub- stances tested were protcids in the form of milk, eggs, and meats, the commonly employed cabohydrates, and water. Before adding the other proteid-containing in- gesta the patients were kept on an exclusive milk diet for two weeks; other proteid materials were then sub- stituted for the milk. The changes observed during the milk diet were diminution of the albumin, in the larger number of cases in which any changes at all occurred, and in a smaller proportion an increase. The influence of rest in diminishing the albuminuria seems marked in these experiments. The change to other

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