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ments suffered first. There was a furry feeling of the mouth ; inability to speak ; motor and sensory paralysis lasted about four hours, yet at no time did he sleep, at no time become unconscious, but cost of erythromycin 500mg remained for some time in a condition of jolly delirium. Later, however, the de- lirium became painful, then horrible ; then a state of double consciousness set in, in which he suffered from de- lusions and wild fancies, but still was conscious of his price erythromycin india sit- uation. Eight hours after taking the drug all evidence of motor disturbance had disappeared ; sensory disturb- December i6, 1893] MEDICAL RECORD. 795 ance left him later. At no time did he sleep. The drug tended to dry up the secretions. Ur. Spratling thought its action went to confirm Dr. Dana's recent experiments which pointed to common centres for motion and sensa- price erythromycin gel tion. He thought the drug admissible only in chronic diseases of the nervous system. Dr. Williams had found hyoscyamin and hyoscin hyp- notic in small doses, and useful when thus administered in some cases of acute mania, as well as in chronic affec- tions. OUR LONDON LETTER. (From our Special Correspondent.) SO- SCARLET FEVER ITS LOCAL LESION PATHOLOGICAL CIETY — cost erythromycin eye ointment STREPTOCOCCUS PNEUMONI.t; IN CEREBRO-SPINAL MENINGITIS ROVAL MEDICAL AND CHIRURGICAL SOCIETY OPERATIONS WITHOUT AN.SSTHESIA USE AND ABUSE OF AX.tSTHETICS — CHRISt's HOSPITAL GENERAL MED- ICAL COUNCIL MEETING THE PHARMACOPOilA THE COLLEGES PURIFYING THE REGISTER MEDICAL SOCIE- TIES EXHIBITION OF LIVING PATIENTS THE CHANGES THAT OCCUR IN THE URINE IN MYXCKDEMA DURING THE THYROID TREATMENT. London, November 25, 1893. Scarlet fener has been so prevalent that a paper on the local lesion read at the last meeting of the Pathological Society (21st) may claim the interest of being timely. The author, Dr. W. Dowson, having pointed out that al- though endemic in certain areas a very large proportion of the population escaped, all but about five per cent., and the disease was infrequent after the age of sixteen. Searching for a reason of this, he was led to think that cost erythromycin ophthalmic the primary local lesion is in the tonsils and cervical lymphatics, general infection occurring through the ab- sorption of toxines. Cases of sore throat and fever oc- curring during an epidemic he regarded as mild scarlet fever. When primary infection took place through a wound the throat might escape and differences occur ac- cording to the tissues involved, hence the variations in sur- gical and puerperal cases. P'urther it was suggested that acquired immunity may order erythromycin be merely local, the changes in the tonsil induced by one attack being of a fibrous nature and so price erythromycin ointment preventing the entrance of the toxine afterward. So again the natural development of the tonsil at puberty and over thirty years still further limits the chance of in- fection. He compared the affection of the tonsils and cervical glands to the chancre and bubo of syphilis, and the intestinal ulcer and enlarged glands of typhoid fever. Dr. Cayley opposed the theory, and had no doubt that the poison was contained in the skin, and the epidermis continued infective long after the throat was well. More over he had seen many cases in which there was no sore throat, but the acquired immunity was just the same as in those in which the tonsils were much damaged. cost erythromycin topical Dr. Goodall corroborated Dr. Cayley, and remarked that severe nephritis and desquamation were common after the mildest cases. Mr. Shattock pointed out that price erythromycin ophthalmic ointment younger animals were more susceptible to microbes than older ones, instancing the white rat, which is well known to be susceptible to anthrax when young, while the adult is not. Dr. Dow- son in reply, said very young infants were exempt from tonsillar lesion, as they suckled and so the throat was not likely to be wounded by sharp particles of food. Dr. Kanthack then read a communication on the streptococcus pneumonia; in cerebro spinal meningitis, and showed the cultures from a case at St. Bartholomew's Hospital which was not complicated with pneumonia or other lesion. Inoculation into mice killed them rapidly, and cultures from the heart's blood of these mice grow more rapidly, assuming true streptococcus form and losing their vinilence toward mice. The pneumococcus shown by Dr. Kanthack approaches the streptococcus pyogenes form. But some thirty other varieties have been de- scribed ! At the meeting of the Royal Medical and Chirurgical Society, after the question of the Presidency, which I have already noticed, Mr. Keetley read a paper on operations without anesthesia. This was not an account of the terrors of surgery in olden times but rather a dissuasive from the abuse of anassthetics and a suggestion that these agents are too commonly employed for minor operations. The author reminded the audience that on the discovery of general anesthesia its dangers were not at first realized, and that now both surgeons and the public seem to have forgotten what can be done without it. Mr. Keetley had operated in a case of thyroid tumor by the aid of nominal local anaesthesia, and he thought that minute quantities of cocaine acted through the imagination and that some operations, especially in the abdomen, reported as under cocaine, were really of this kind, as also were many under hypnotic influence. He proposed, therefore, that general anesthesia should not be induced in a strangulated hernia, in the old or debilitated, in colotomy and similar cases when the proceedings can be planned beforehand, in tapping, aspirating, sounding, or even in laparotomy by a small incision for exploration, or perhaps for evacuation of fluid (or even of a simple nonadherent cyst). He considered nitrous oxide appropriate for not a few cases in which ether or chloroform is often given, as simple in- •cisions of any length, encapsuled tumors of any size, if superficial, for refracturing mal-united bones, etc. Mr. Power related some of his experience price erythromycin philippines in the pre- anesthetic era when such an operation as enucleation ot the globe was very serious. Now in eye operations cocaine locally, five or ten per cent. , is sufficient for all, except, perhaps enucleation or abscission. Dentists came most directly in contact with acute pain and he mentioned a personal experience of exhaustion and de- cost erythromycin ophthalmic ointment pression after abstraction of a molar. On the other hand he was once suffering from pleurisy and surprised that the passage of a trocar through his chest wall was painless. Other speakers to some extent supported Mr. Keetley as to many cases, but it was suggested that chlo- roform was generally necessary for children for operations about the rectum, and some held that only in a very small minority of cases could general anesthesia be avoided. Others thought we should not resort to gen- eral when local anesthesia could serve — that the latter might be used in strangulated hernia, especially if the patient was aged or exhausted. So, too, in tracheotomy for diphtheria, in advanced phthisis, and in goitre pressing on the trachea local anesthesia was often sufficient. In re- ply, Mr. Keetley admitted the use of chloroform in children except for an operation such as that for imperforate anus in early infancy. He said, too, that the Swiss surgeons had generally discarded anesthetics for operations on goitres. In reference to the question thus brought forward, I may express a belief that in some quarters general anes- thesia has certainly been too frequently resorted to when local anesthesia would have done all required. It is curious, too, how little the ether spray has been used by some. It is harmless and effectual for many cases. I have seen it much used for tracheotomy and goitre, and with complete success. It is admirably adapted for inci- sions, after which a very weak solution of cocaine may be used to supplement it for deeper work, such as the enu- cleation of encajjsuled tumors. Last month scarlet fever broke out in the Blue Coat buy cheap erythromycin School. The scholars were accordingly dispersed and a sanitary inspection of the premises undertaken. This disclosed a most primitive state of the arrangements, and the City Medical Officer of Health has reported, that with a full sense of his responsibility in interfering with such an cost erythromycin ancient and important institution as Christ's Hospital (to use its official name), he cannot avoid the conclusion that nothing short of an entire reconstruction of the drainage would suffice to render the school fit for its purpose. Steps have therefore been taken to carry out his recommendation. 796 MEDICAL RECORD. [December i6, 1893 London, December i, 1893. The General Medical Council met on Tuesday, and is still sitting. Professor Gairdner, the new member for Glasgow University, was received with unusual demon- strations of pleasure. Sir R. Quain delivered his presi- dal address, indicating the various subjects that de- manded the attention of the Council. This address would be interesting if it were not rendered useless by the fact that each subject it touches upon has to be sub- sequently discussed. It must be how much does azithromycin cost strange if a body of learned cost erythromycin gel and distinguished men require a recapitulation of the business of the week before they can begin it. There are so many complaints of the limited time of the Council that perhaps a saving might be effected by the omission of the address. Perhaps the most interesting subject of discussion on your side the Atlantic will be the approach toward an International Pharmacopoeia. The medical authorities of India and the colonies have been in communication with the Council as to their wants, and as a new edition of the British Pharmacopceia will be wanted in about a couple of years, it will not im- probably be adopted for the Empire as far as the com- mittee can manage. average cost erythromycin I wonder if America will some day join in this work so as to have a codex for the English- speaking world. The Dublin College of Physicians claimed to compete with purchase erythromycin its London sister in granting a complete diploma, but as it never has examined in surgery, the Council re- • ferred it to the law courts for an interpretation of its charter. Wednesday and Thursday were devoted by the Council to their judicial duties under the Penal clauses of the Acts. Certain persons' names were ordered to be erased from the Register. Condemnation of certain proceed- ings was expressed, and other cases were remitted to the law ofiScers of the Council to prosecute. A number of returns respecting examinations cheap erythromycin and other documents came under the consideration of the Council. The exhibition of living specimens of disease gains rather than loses in favor, and " online erythromycin chnical evenings" at the societies often attract larger audiences than elaborate papers. The last meetings of the Medical Society and the Clinical Society were thus occupied, and at some of the other societies there have been a considerable num-

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