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through union of the opposed folds of the vesico-uterine pouch. Slight flexion of the uterus is maintained by the crossing of the sutures. If the cervix is very long, it is amputated. The writer has performed this operation thirty- one times ; thirteen cases were entirely successful, three women subsequently becoming pregnant, one twice. Six women in all afterward became pregnant ; three were delivered spontaneously and one with forceps, the uterus remaining in the former position after involution had taken place. Diihrssen, in a lengthy paper, discusses Mackenrodt's operation, which, he says, is essentially the same as the one previously described by Differin Vs Epiduo himself, with the exception of the first step — splitting the anterior vaginal wall — which is superfluous, as well as suturing the lower portion of the bladder and attaching the vaginal flaps to the cervix. Moreover, there is the risk not only of wounding the bladder and causing a fistula, or of actually contracting the viscus, but of forming a dangerous pocket between the bladder and the vagina. In his own operation (which can be completed in from ten to fifteen minutes) the writer sim- ply opens the anterior fornix, pushes the bladder toward the symphysis with catheter and forefinger, while the cer- vix uteri is drawn downward and backward, and by means of temporary sutures gradually draws down the uterus until permanent sutures can be passed through the vesico- uterine pouch and fundus. The patient need be kept in bed only a week. This operation he has performed forty times with perfect success. Steinbiichel reports four cases of vagino fixation, per- formed according to Mackenrodt's method, the results of which were quite satisfactory. The operation was modi- fied by prolonging the median vaginal incision downward, and making an oval denudation when the vagina was much relaxed. Moreover, the peritoneum was dissected away from the fundus as far as possible, so that the sutures could be passed into it higher up. When these were fastened to the lower edges of the vaginal wound, pro- lapse of the bladder was prevented, and the uterus was firmly fixed in the desired position. Additional sutures were then passed through the uterus, thus bringing the anterior raw surface of the organ more directly in contact with the vaginal wound than in Differin Adapalene Cream 0.1 the original operation. — The American Journal of the Medical Sciences. Nervous Lesions in Diphtheria. — Dr. Stscherbak has published an account of some experimental researches which have been carried out in Professor Strauss's labora- tory. A summary of this paper is given by Dr. Rosen- bach. The animals experimented upon were rabbits and guinea-pigs, and they were inoculated with diphtheritic bouillon cultures or the filtrate of these. Many altera- tions were found in the nervous system of such animals after the inoculation, such as hemorrhages in the spinal meninges and in the gray matter of the cord, acute inflam- mation of the latter, degenerative changes in the spinal roots, neuritis of peripheral nerves, and changes in the muscles, Order Differin Online both parenchymatous and interstitial. Similar changes have been described by various observers as occurring in patients who have died from diphtheria, and Dr. Stscherbak's researches would seem to indicate that they are a direct result of the disease. Besides show- ing the correspondence between the conditions observed in man and those produced by inoculation in animals, however, these experiments indicate also the cause of diphtheritic paralysis as essentially consisting in inflamma- tion of the peripheral nerves, the other changes in the nervous system being of subordinate importance and sig- nificance. In all the cases in which paralysis followed the inoculation in these animals neuritic changes in the peripheral nerves were found. The intensity and extent of the neuritis corresponded generally with the degree and locality of the Differin Canada paralysis. The fibres of the peripheral nerves going to muscles were mostly affected. The neu- ritic processes were found to be independent of changes in the spinal cord and the latter were present in cases in which there was no paralysis. — Neurologisches Central- blatt. December i6, 1893] MEDICAL RECORD. 783 DRUGS AND "HEART FAILURE." Bv CHARLES E. PAGE, M.D., An important editorial in the Boston Globe not long ago, in commenting on the action of the Philadelphia Board of Health in refusing longer to accept " heart failure " as the cause of any death, undertakes to expose the ignorance on the part of medical men which has brought this term into common use. Whatever may have been the motive Buy Differin Cream of this action on the part of the Board of Health, whether it were the be- lief that many of these fatalities result from drug poison- ing, or simply to encourage greater care in describing the remote causes of death, it is the writer's belief, based on many years' observation in active practise, that fatalities are constantly occurring as the direct and natural effect of so-called medicinal doses of virulent poisons. To weak and exhausted patients the smallest dose may prove as inimical to life as the heaviest amounts administered for homicidal purposes. Whether or no there be the slightest ground for this opinion, what must we think of preaching and practise like the following, in which, despite the confession that Generic Differin Gel the patients "died cured," the impression is sought to be made that the treatment probably prolonged the lives that went out so suddenly shortly thereafter? A physician prominent enough in the medical world to be imported from Philadelphia to give a course of lect- ures before the Harvard Medical School Association re- lated the story of two brilliant cures of a certain form of heart disease under his treatment when he was a young man, by "enormous doses" of digitalis. Both patients had been taking ten-drop doses, and he increased the dose to forty drops. "The triumph seemed complete," said the lecturer, " and so it was for weeks; but mark the ultimate result. Mary, one morning, as she trod the doorway of the mar- ket-house, fell dead upon the threshold. The banker, stretching his arm across the desk that had Coupon For Differin Gel been to him the pathway to riches and power, Differin Gel Generic fell hushed and power- less into the eternal silence." Here was the point, as it seemed to me and, I trust, to others who listened to his address, for the speaker to warn in the most emphatic manner possible against such brutal treatment, or to make his bow and allow his hear- ers to draw their own moral. But, so far from doing this, the lecturer expressed the belief that it was Differin Lotion Coupon the forty-drop doses in place of the ten-drop doses that eked out poor Mary's life a few weeks, and that the banker also would have died sooner but for the same enormous doses of one of our most deadly poisons 1 The writer has had the after'management of quite a number of " digitalis hearts," but he has never sought to remedy the evil in any case by increasing the dose of digitalis. On Differin Gel Buy the contrary, he has always stopped the use of the drug short off, and has never had occasion to regret such action. I can see no difference between in- creasing the dose of digitalis from ten drops to forty in treating a digitalis heart, and ordering a man with a " tobacco heart " to smoke twelve heavy cigars in place of the three he is already taking. Personally, Differin And Acne Scars I have for the past thirty- five years been cultivating a tobacco heart, with occasional lapses from vice to virtue, during which I would always improve in various ways. After smoking several cigars a day for months my system Differin For Acne Scars gets pretty thoroughly saturated with the drug and I feel the necessity of complete abstinence, and, as I have remarked, I always Differin Oily Skin find relief therefrom ; but whenever I have at such times gone to the other ex- treme, smoking, say eight or ten cigars in an evening, as on a club night, I have observed most excellent effects for the time being from the Differin Gel Online increased dose, like unto those chronicled above from the lecture on digitalis. The next morning, however, always told a different story. Doubtless every old smoker will be able to recall similar experiences, although he may have learned a false lesson therefrom, Where To Buy Differin Gel as did the professor from his obser\'a- tions with digitalis. Certainly no bed- rock student of the laws of life but must feel a cold chill along the spine at the thought of the effect of such teaching on the minds ot the tyros who listened. Years of experience will teach the rare few among them better things, but these will have in after years many painful recollections : while the great proportion of pupils are likely to continue and end about as they began. 867 BoYLSTON Street. ^^^ TREATMENT OF DIPHTHERIA BY EUCALYP- TUS. By LEONARD LANDES, M.D., NEW VORK. In my investigations of the subject of diphtheria I extended my inquiries to various countries of the Old World, as well as this, and through the kindness of Mr. E. C. Little, General Consular Agent for the United States of America at Cairo, Egypt, I received a com- munication from Dr. A. Murison, a Scotch physician practising in Cairo and official physician to the Amer- ican Consulate there; and, among other statements re- garding diphtheria in that part of the world. Dr. Murison says that in the treatment of the disease bichloride of mercury is the general remedy, and the general result is death. Dr. Murison followed that treatment for some time, with the result stated, until he saw that a Russian doctor advocated the use of eucalyptus oil, and he used that remedy in the last ten or twelve cases that he treated, with the most happy results. He recommended it to his friends, who also used it successfully, not losing a single patient. His method is to take one part of eucalyptus oil and three parts of almond oil, giving one teaspoonful of the mixture every hour. Before the mixture is Buy Differin Gel 0.3 given a gargle of pure oil is used if the child is old enough, and if not a spray instead, and both, if it can be managed; also satura- ting the shirt and pillow of the patient with pure oil. and placing plates filled Epiduo Vs Differin with the oil about the room. The or- dinary rules of attending to the bowels, giving as much food as possible, securing plenty of pure air by open doors and windows, and maintaining cheerful surroundings, are to be observed. If signs of intoxication appear, reduce the dose to one-fourth the quantity. I have suggested the above treatment to a few of my friends, who promise to try it, as I shall myself when op- portunity presents itself; and I would recommend the medical profession to give it a trial ; and I would be obliged to those who Buy Differin Gel Online do so if they will let me know the result, as I am preparing a paper on the subject. I have also received a communication from Dr. George Helstron, chief physician of the Epidemic Hospi- tal at Stockholm, Sweden, for the year 1893. in which he says: " Our treatment is founded on the supposition of diphtheria being a local disease, with the production and Differin Xp Gel absorption of toxical substances from the infected quar- ter ; therefore at the Epidemic Hospital of Stockholm the galvano-cautery has been used for destroying the membrane." The treatment brought good results, and Dr. Helstron recommends me to give it a trial when suitable occasion offers. Stitching the Bladder in Siipra-pubic Lithotomy. — Close the lower third of the wound with No. i catgut, the stitches not entering the mucous coat ; then place two tubes in the bladder, and suture the upper part of the

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