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light in the figure falls) rises in bold relief, cropping out over the tegmenta brachium. These surface appearances indi- cate the actual relations of the lem- niscus tract to some extent. It may be regarded as a flat band, which is dragged out of the substance of the jions to overlap the tegmeyita brach- ium, to be overlapped itself by the crus and the post-brachium ; in its known course it extends from the thalamus region to the lowest levels of the oblongata. Unlike the pyra- mid tract, which is a single united decussauon of tegmenta brachii following refer to the pons : rmi. and rud. g^y ■ *• «■■'='?="="■ ?"Kin of G.cereblt.: Pom. Br., fonti's brachium, or middle peduncle of cerebellum divided across. The following relate to the oblongata : Pyr. X., decussation of true pyramids : 01. dent., dentated or mam part of olivary nucleus ; 0/ ;>M,tfrfanr«/j; Tegmt.Br.X., .. i- t 1 • 1 • 1 , ... brachium conjunctivum, also known as Wernekinck's commissure. The SySteil) 01 Unitorm pllySlOlOglCal rela- Jditorj- and facial nerve roots cut across : ««, nuclei of pons tionS, the lemnisCUS traCt iucludeS a ed through the courtesy of Professor James L. Little. The pons exhibits dorsad the upper half of the floor of the fourth ventricle. Ventrad a bridge of nerve-substance apparently jointing the cerebellar hemispheres. If the Buy Acticin beginner will conceive a conical piece of wood, whose base is turned upward, split by an a.xe, while a band is Acticin Cream 5 thrown around the middle of its length to prevent the split from extending through to the apex of the cone, he will have a crude idea of the relations of the pons as seen at the base of the brain. The Buy Cheap Acticin two parts on each side of the split are the pedal crura; the split is the interpedun- number of nerve-bundles having dif- ferent destinations and different gan- glionic connections. Indeed, with our increasing knowledge of this part of the cerebral projection system, it will, I think, become recognized that the including of all these bundles under one generic term is improi)er and misleading. One feature is found with all of them, that they are (in part, at least) related to functions regarded as centripetal and sensorial, as far as we may draw surmises from structure. The part * Arm of the posterior pair of the corpora (]uadrigemina. In the figu teresting variation is shown ; this arm exhibits its two characteristic div and bfi'), and at the end of the pointer, b/>', the ganglion geniculatum tnediaU. Abp October ii, 1884.] THE MEDICAL RECORD. of the brain axis, in which the lemniscus tracts are seen in their clearest relation, and where the various designa- tions of authorities are most in accord, is exposed by a transverse section through the posterior pair of the cor- pora quadrigeniina or a little behind this, through the I'ahiila.' Typically each lemniscus stratum consists of an L-shaped area, so situated that the area of each lem- niscus stratum touches the median (line) raphe with the free end of the horizontal branch, thus [ '. Even in sections which are inclined to the axis more or less, as in Figure 2, a similar appearance is noted. Here a on the right side represents the Generic Acticin horizontal branch, and 2 on both sides, 3 and 4 on the right side, represent the verti- cal portion. This figure indicates at the same time as much of the entire course of the lemniscus tracts as any one section can. It is seen to extend from above the pyramidal de- cussation at e between the olives at li, then spreading over an immense area, along 6, 5, 4, 3, 2, r, to the thai- ami, gradually becoming more and more remote from the median raphe, while another detachment remains near to it, at c, b, and a. As in all sections of this character, the apparent continuity of the fibres is accidental, the vari- ous parts are intermingled somewhat ; but as other sec- tions and other methods of study show, all of them ap- pertain to the lemniscus tract. Let us proceed to dis- cuss these in detail. (To be continued.] SOME POINTS OX THE USE OF HEAT AND COLD IN THERAPEUTICS.' Bv JAMES B. HUNTER, M.D., LKGEON TO THE WO.MAN Purchase Acticin Online I AM well aware that the subject of the application of heat and cold in therapeutics is a very large and cou)- prehensive one, and I shall attempt no more than to present a {&\v points which have been suggested by my own experience. The use of heat and cold, in some form, for the relief of disease is almost universal. There is hardly a disease known in which, at some stage, it is not deemed neces- sary to interfere with or modify the existing thermal con- ditions, the interference varying between the use of the actual cautery on the one hand and of ice or freezing mix- tures on tile other. Between these extremes the ways and means of modifying temperature are very numer- ous. The necessity for some interference is taken for granted. Some of the most advanced professional minds have for centuries past grappled with the problem of temperature as modified in disease — while every house- hold has its favorite theories and Acticin Price maxims concerning the treatment of diseases and injuries by means involving a change of temperature. Yet, notwithstanding the antiquity of what may be called the thermal method of treating disease, and its almost universal application in some form, there exists a surprising diflference of opinion concerning the use of heat and cold, especially as to which of these powerful agents should be employed in any given case. Professional opinion is assuming greater uniformity on this point with the advance of physiological science : but popular opinion, which often reflects the professional opinion of a former generation, differs very widely. But whether heat or cold is preferred, public opinion Order Acticin is al- ways in favor of the generous use of one or the other. A gentleman of my acquaintance wiio was spending some weeks in a country region, chanced to sprain his ankle. He was carried helpless to the nearest farm- house, where he was prescribed for by two experienced matrons. One insisted on placing the limb under a stream of cold water from the puni)), and keeping it there for half an hour, assuring him that he would be able to walk the Acticin Cream next day if her advice were foUoweil. The other advised placing the injured limb in a pail of : the Practitioners' Society of New Vork, October 3, 1884. water nearly boiling hot, and keeping it there for half an hour, promising the same result on the morrow. Mean- while a boy was despatched to the nearest village for medi- cal aid. The doctor sent for was not at home, but his assistant visited the patient promptly, and endorsed the prescription of cold water, which was thoroughly carried out. On his return in the evening, the senior physician, thinking the patient a gentleman of some consequence, hastened to see him, examined the ankle carefully, and advised that very hot water should be applied during the whole night. A similar difference of opinion is common both in the profession and out of it. Whether it be a sprained ankle, an inflamed knee-joint, a bruise, a wound, a burn, a fever, there is often a radical difterence of opinion as to whether heat or cold will give the greatest relief or ac- complish the most good. The explanation of this dif- ference of opinion is probably to be found in the fact that many diseases and injuries require at different stages the use of both heat and cold, and that the indications for the use of either one are not always clear. In the earliest stages of inflammation the prompt abstraction of heat often suffices to abort or control the inflammatory process. After inflammatory changes have taken place, the application of heat to the same part may, by stimu- lating capillary and lymphatic action, hasten absorption and be eminently Acticin Permethrin Cream proper. In some cases this explana- tion does not apply, as in the use of both hot and cold water for the arrest of hemorrhage, or of hot and cold applications for the relief of neuralgia, regarding which there still exists some difference of opinion. It is safe to say that in no given case is it a matter of indifference whether heat is Order Acticin Online added or subtracted. The same differ- ence of opinion exists, however, as to the use of some medicinal agents quite opposite in their effects. But I must necessarily pass over or allude very briefly to many points which suggest themselves in connection with this subject. I. I will first consider briefly some of the diseases in which the abstraction of heat, generally or locally, is de- manded. Typhoid fever, perhaps better than any other disease, illustrates the good effect of antipyretic treatment. Dr. G. L. Peabody, in a valuable statistical paper read be- fore the County Metlical Association, March 17, 1884, on the treatment of typhoid fever, says : "The effect of high temperature is very deleterious upon normal tissues, and its influence is distinctly evil in reference to the possible healing of intestinal ulcers." .-Ks the result of his own experience, and a careful examination of the records of the treatment of typhoid fever in seventeen large hospitals, in this city and in Europe, those of the British Purchase Acticin army and navy, and of our own army. Dr. Peabody em]5hatically endorses the use of cold water in the treatment of that disease. He shows the mortality to be only seven and one-fourth per cent, in a series of over eight thousand cases ; and a series of two hundred and eleven cases in Dr. Brand's private practice all re- covered under the antipyretic treatment. Dr. Peabody laments the difficulty of introducing the practice gener- ally, the necessary appliances being cumbersome and expensive. Buy Acticin Online The affusion of cold water he has not found satisfactory ; the cold coil he considers unsuitable ; and the cold bath the only really efficient method. Now, a cold bath in the immediate proximity of a ]iatient sick with typhoid fever is not often obtainable. The ))atient may be sick in a country house, where bath-tubs are unknown ; in a hotel, where they are fixed and re- mote from the patient's room. Even in a private house with all modern appliances it is not an easy matter to transfer a patient from a sick-bed to a bath-tub and

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