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planations do not agree, but what matters? The case is over. Dr. Kingsbury has vindicated his conduct and shown that the enormous influence of the associa- tion cannot crush an independent man who has noth- ing to be ashamed of. The lesson was needed, and it is to be hoped will be laid to heart in in both the editorial and advertisement offices of the Journal. How the evidence of Sir D. Duckworth, Sir T. Stokes, and Dr. Cousins broke down at the trial was duly recorded in your columns at the time. fluticasone spray . The fuller light shed on the matter in Dr. Kingsbury's pamphlet confirms the opinion then expressed. As to advertising, the lesson will now perhaps be learned that what is sauce for the general practitioner is sauce for the consultant. Dr. Kingsbury scored a success, for although he had to modify a resolution he submitted, he carried flovent mg that part of it which invited the council to draw up a code of ethics to be submitted to the association. It might seem that some of the council were scarcely suitable persons to entrust with this task, but no doubt their recommendations will soar above their practice. Ignorance of ethics was openly professed by some and a definition demanded. But on Wednesday a section of ethics was opened under the presidency of Dr. r.Xnson, who told his audience in his address that "their ethics were comprised in their duty to their brother practitioners, their patients, and the world at large." This is comprehensive enough, though surely "the world at large" includes brethren and patients. But the president went on to particularize by adding to his statement " and the necessity of upholding by any and every means in their power the honor and dignity of their profession." I do not desire to criti- cise these rather loose expressions ; the subsequent discussions would have been more edifying if some of the speakers had conformed to the president's de- scription. For it cannot contribute to our honor and dignity to purchase flovent online give way to temper in discussing burning questions, and I am sure it is contrary to so-called ethics for speakers to hurl opprobrious epithets at one another. The annual dinner went off with the usual eclat. The bishop was present and returned thanks for the toast of the clergy and ministers of all denominations. He humorously pretended that he nearly fell " into a trap " by buy flovent online speaking in an assembly of doctors of the other denominations as " irregular practitioners," and then, referring to the next toast, the military one, claimed them flovent online as "auxiliary forces" and paid them full compliment as brothers in arms. Surgeon-Captain Witchurch, who won the Victoria Cross for his heroism at Chitral, also spoke and was received as enthusiastically as when the gold medal was presented at the general meeting. The temperance breakfast is now regularly looked for. For some twenty-five years the National Tem- perance League has invited the members to a break- fast. This league is devoted to the spread of temper- ance by moral suasion. Sir Wilfred Lawson, who is the leading advocate of legislative suasion, was also present, and some delightful humorous passages were exchanged between him and the bishop, making this one of the most successful fluticasone salmeterol entertainments of the kind. The journey back to London on Saturday generic flovent was much retarded by the crowded state of the line carrying thousands in the opposite direction. Members who stayed until Monday, the bank holiday, were doubt- less much more inconvenienced. Not a few took the opportunity of a few days in the lake district. The Third International Congress of Dermatology has been sitting in London all the week, but notes of its proceedings must stand over and for once the metropolis give place to the border. OUR BERLIN LETTER. (From our Special Correspondent.) RENAL DIABETES — URIC-ACID DIATHESIS HOT-AIR FIXATION OF BLOOD SPECIMENS DIPHTHERITIC MVELOCYTH^MIA. Beklin, August 8, 1896. A RECENT lecture upon renal diabetes by Dr. Klem- perer aroused a more than usually interesting discus- sion. The views enunciated by Dr. Klemperer may be summarized briefly as follows: In the healthy person, sugar is stored up in the liver as glycogen, but if excessive quantities of carbo- hydrates have been taken a certain amount passes the liver, enters the blood unchanged, and is cheap flovent excreted by the kidneys as sugar. This alimentary glycosuria is practically of a regu- lating nature. If we e.xcite an artificial diuresis, we may produce a glycosuria, when even very moderate quantities of arbohydrates are ingested. In the cases described by Klemperer as renal diabetes, we find a permanent excretion of sugar, though the quantity of carbohydrates ingested is not increased and the circu- lation is not accelerated by diuretics. In the discus- sion. Dr. A. Fraenkel buy cheap flovent opposed the idea of a diabetes strictly renal in character. According to his view the arrest of a glycosuria upon the appearance of a chronic granular nephritis maybe readily explained by assum- ing that the diseased kidney retains the ferment se- creted by the pancreas and this ferment in return enables the tissues again to assimilate the sugar. Dr. Fiirbringer had seen three patients with diabetes in whom glycosuria ceased as albuminuria appeared. Magnus-Levy had administered phloridzin hypoder- mically and found that, after doses of even only twenty centigrams the healthy as well as diseased kidneys would excrete sugar, but the largest amount would be excreted by the contracted kidney. These results are diametrically opposed to Klemperer's statements, who says that contracted kidneys excrete no sugar after the administering of phloridzin. The general conclusion of the discussion was that Klemperer failed to sustain his theory of a renal diabetes. Dr. Klemperer also flovent cost read another paper before the Berlin Medical Society on the prophylaxis of uric-acid concretions in the kidney. The treatment of such concretions in the urinary tract must be principally surgical, because a solution of these concretions by internal remedies is utterly im- 286 MEDICAL RECORD. [August 2 2, 1S96 possible, on account of the firmness of the combina- tion of the urates with the organic constituents. Pro- phylaxis, therefore, is what we must aim at. The kidney should be well irrigated, food substances which aid in the formation of uric acid (as nucleins) must be avoided, and as little meat as possible should be taken, milk, eggs, and vegetables being preferable. Not all nuclein-albumin, however, is turned into uric acid as a final product, for in the case of some its transformation is effected into urea. Certain drugs, such as caffeine, have a strong tendency to increase the formation of uric acid. Muscular exertion also is followed by an increased formation of uric acid. The elimination of uric acid is favored by an excretion of neutral or alkaline urine. Of remedies favoring this Klemperer recommends bicarbonate or citrate of so- dium. Urea especially has this property. It may be given in daily doses of twenty grams. It not only increases diuresis, but also is a solvent of uric acid. Piperazin, lysidin, and uratropin are more expensive than urea and of less therapeutic value than it in cases of the uric-acid diathesis. Of interest was a demonstration at the same meet- ing by Strauss, who diagnosed a mediastinal tumor with the aid of the .v-rays. In the photograph a shadow was to be seen in the thorax as large as a fist, situated to the left of the spinal column. According to Strauss this was a cancerous enlargement of a bron- buy flovent chial gland occurring thorough flovent price metastasis, the pri- mary lesion having been in the stomach. Attempts made to locate by means of the a-rays the position of the large cur\'ature of the stomach, after passing a metal sound, have not been successful. During the discussion Boas stated that by his method it was fluticasone nasal not at all difficult to locate the position of the large curva- ture by passing a tube. fluticasone propionate nasal He considered any compli- cated apparatus for this purpose unnecessary. At a meeting of the Society for Internal Medicine Kronig read an interesting paper concerning certain new methods of blood examination. One novel pro- purchase flovent cedure was the fixation of blood specimens in hot- air baths. Kronig has constructed a small and a large air bath. The small apparatus is a square metal box, with a receptacle for four specimens. It is placed over a gas flame; a thermometer is attached to show the temperature. With a temperature of 150° C, the fixation of the specimens is obtained in four or five minutes. In the large air bath the preparations remain for one hour at a temperature of 115^ to 120 C . At the same meeting Engel reported the discovery of certain peculiar conditions of the blood in diph- theritic children. He examined thirty-t\vo children seriously ill. He found the so-called myelocytes al- most entirely absent in those children nasal spray fluticasone who recovered. All those (seven) died who had a large number of myelocytes in the blood. order flovent online Engel calls this condition "myelocythamia" of diphtheria. All the children were treated with antitoxin. Engel believes that the poison of diphtheria acts injuriously upon the blood- forming structures just as it acts in producing par- enchymatous inflammation in various internal organs. Lacerated Wounds of Fingers. — In cases of severe injury to the fingers by laceration or order flovent contusion, put the entire hand into a very ample soaking-wet dressing. Do not trim off any pieces of flapping skin. Incision for drainage is all that is allowable until healing is very well under way. Vou may then look over the ground and see whether it is necessary to sacrifice any- thing. A half-inch of boneless finger may be of great value to its possessor. — International Journal of Sur- gery, May, 1896. Beiu iustvutncuts. A PORTABLE STERILIZER AND DRESSING RETAINER.' By JOHN PRENTISS LORD. M.D., OMAHA, NEB., PROFESSOR OF THE PRINCIPLES AND PRACTICE OF fluticasone nose spray SURGERV, CREICHTON MEDI- CAL COLLEGE; ATTENDING SURGEON, ST. JOSEPH'S HOSPITAL, AND CON- SULTING SURGEON, PRESB^TERIA.N HOSPITAL. In the summer of 1894 the author conceived the es- sential features of the portable steam and hot-air ster- ilizer and dressing retainer herein described. Think- ing that the market would aft'ord something of this character, a search was accordingly made, but with negative results. Sterilizers were too large or too small; the larger were cumbersome and ill adapted to convenient use outside of a hospital ; the smaller were inadequate for major operations and necessitated the carrying of a previously prepared aseptic roll for gowns, bandages, cotton, etc., which, as a consequence, were an extra incumbrance, and, furthermore, did not sufficiently simplify the technique of antisepsis in sur- gical preparations. It was considered a first essential feature to have a

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