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back several times a day without a good deal of dis- turbance to the patient, and an abundance of physical help. I would therefore suggest as equally efficient and far more practicable the use of the well-known, but somewhat buy aldactone online neglected ICibbee fever-cot, or something 598 THE aldactone 25 mg MEDICAL RECORD. [October ii, 1884. equivalent to it. This cot, which was first devised and used by Dr. Kibbee for the treatment of scarlet fever, during a severe epidemic of that disease, consists essen- tially of a common cot or frame on which is stretched strong canvas or other material sufficiently coarse or open to permit water to pass through aldactone 50 mg it. Under this is placed a rubber sheet, to catch and convey the water to a pail placed at the foot of the bed. The patient lies comfortably on this bed, on a blanket and sheet, but of course without mattress. Such a bed can be improvised almost anywhere at a very small expense. I once made a very efficient one, in the country, with an old coftee bag ; and I once used an ordinary wire mattress. Any cot covered with canvas may be made available as a water-cot by cutting a sufiicient number of holes in the canvas. When it is necessary to apply the cold water, tlie covering of the patient is removed from the body (not from the e.xtremities), which is enveloped in or covered by a sheet ; upon this sheet warm or tepid water is poured gently from a pitcher or watering-pot ; the tem- perature of the water is then gradually reduced until it is sufficiently cold. The stream is kept up for ten or fifteen minutes, a dry blanket is then thrown over the patient, and sleep generally follows. Having had considerable experience in the use of this method of reducing the temperature in cases of peritonitis and septicx^mia following operations, and some e.xpe- rience with it in typhoid fever, I know it to be very easily managed, to come within the skill of any intelligent nurse or attendant ; and that by its means the temperature can be reduced to any desired point and maintained there. The apparatus is simple, it requires but a small quantity of water, it involves no movement of the pa- tient, and occasions no shock whatever. I therefore be- lieve it to be the best means available in all cases of fever where artificial reduction of the temperature is de- sirable. This method was adopted very successfully by Dr. Thomas, for peritonitis following ovariotomy, in 1876. Ne.xt in point aldactone order of efficiency, for the same purpose, I would class the wet pack, by which I mean a folded sheet, wrung out of tepid or cool water, and wrapped quickly around the patient's body. In this case cooling takes place partly as a buy spironolactone result of evaporation. If the attend- ants are industrious much may be accomplished by the use of towels wrung out of cold water jilaced upon the body and limbs, and frequently changed. Least useful of all, though very grateful to the patient, is sponging with cold water. If done often enough some heat is abstracted, and if alcohol is used with the water evapora- tion aids in cooling. Where it is necessary to effect a local reduction of temperature, there are better means than the fever-cot. In threatening peritonitis after laparotomy, for instance, the use of a coil of lead or rubber tubing, through which water of any temperature may be continuously passed, affords a perfectly simple and efficient means of accom- plishing the purpose desired. M. buy spironolactone online Galante, of Paris, in 1852, devised a rubber ap- paratus for continuous irrigation of the eye. Dr. Petit- gand, of Paris, had manufactured for him an apparatus of rubber tubing for this purpose in 1859; cheap aldactone and in 1866 he published a description of a head-cap made of rubber tubing for the use of cold water, and a sachet, a flat coil of rubber tubing precisely similar to the abdominal coil now in use. In 1879 Dr. Dumontpallier published a de- scription of a series of tubular covers and mattresses, by the use of which, according to experiment, he claimed to be able to accomplish much more rapid and uniform re- frigeration in typhoid, varioloid, and other fevers, than could be accomplished by the cold baths of Brand. The use of the head coil of lead or rubber is now very general ; and the abdominal coil is likewise becoming popular. Nothing can be simpler or less disturbing to the patient than the use of the abdominal toil, and in buy cheap aldactone incipient peritonitis nothing that I am aware of is so efficient. The aiiplication of the rubber coil to this particular class of cases was suggested by Dr. ,\. B. Townsend, in the Woman's Hospital, in 1881. The coil is applied directly to the skin, or a thin towel is inter- posed. A bandage is then placed around the body to keep the coil in place ; a pail of water, containing a lump of ice, stands on a purchase aldactone online table near the head of the bed, and a pail under the bed receives the water as it passes through. At the latter extremity, where the water es- capes, there is a stop-cock by which the flow may be nicely regulated or entirely stopped, as may be rendered necessary by the temperature of the patient, as shown by a thermometer placed in the axilla from time to time. Unless the apparatus should be irksome to the patient, which is seldom the case, it is not necessary to remove it as long as there is any likelihood that it may be required. By simply opening the stop-cock the flow of water begins, and the cooling process may be stopped or resumed with- out waking a sleeping patient. I have used in the manner just described both the rubber coil and the coil of fine leaden tube known as Leiter's coil. The latter have not been generally in the market, or I think they would have taken the place of the rubber in many cases. They are not so heavy, when full of water, as the rubber coil ; they are not liable to become dirty, and have not the unpleasant odor of rub- ber. They are more durable and less expensive. They are not more liable to become clogged with dirt, if the precaution is taken to envelope the receiving end of the tube in a piece of gauze or coarse muslin, which should be done in all cases. With this precaution, and one nurse of ordinary intelligence, I have sometimes kept the leaden apparatus in use for three days and nights without a moment's interruption. One advantage of the metal coil is that it requires less water, and that it is sel- dom necessary to use ice. Being a much better con- ductor than the rubber, the use of water at a temperature of 45° or 50° is quite sufficient. I consider these appli- ances of the greatest possible value where inflammation is threatened, and most important means of limiting in- flammation when it has developed. In case of bad operations, where there is every reason to expect peri- tonitis, I have the coil placed upon the patient im- mediately after she is put to bed, so that it may be ready for use at any moment. In ordinary cases I wait until the temperature rises above 100° in the axilla. In the method spoken of the object aldactone mg of course is to reduce bodily temperature ; but cold is sometimes used as aldactone buy a means of impressing the nervous system. Chap- man's ice-bags act on this principle, and have been found useful in many nervous disorders. My own experience with these ice-bags has been limited chiefly to their ap- plication in cases of painful and scanty menstruation. In a certain class of cases the application, for half an hour at a time, of a bag of crushed ice to the region of the lumbar vertebrx and sacrum, has the effect of pro- moting the menstrual flow. Applied to the dorsal ver- tebra;, in an an:\;mic patient with cold extremities, the tendency of the ice-bag is to equalize the circulation and promote warmth throughout the whole body. P'riction with ice is employed in frost-bite. The late Dr. Peace, of Philadelphia, claimed to have had ex- cellent results, in a cholera epidemic through which he passed in Europe, from vigorous friction of the limbs and body with lumps of ice. Where it is necessary to stimulate the nervous aldactone online system, the alternate application to the spine of a flat brick of ice, and a very hot iron, protected by flannel, is sometimes very effectual. I shall merely allude to the popular and time-honored belief in the styptic effects of cold ; to the undoubted value of cold for the relief of pain in burns ; and to the efficacy of ice-cold applications in the causalgia conse- quent on injuries of the nerves from gunshot wounds. II. Of the manifold forms in which heat is employed as a remedy for pain and disease, I shall dwell on a few only of the most striking, at the risk, as in what I have October ii, 1884.] THE MEDICAL RECORD. 599 said of (5old, of telling a thrice-told buy cheap spironolactone tale. For the arrest of hemorrhage a high degree of heat has been long in vogue. The hot iron has held its place as a styptic prob- ably for order aldactone online many centuries ; and the cautery in some form is still constantly employed for the same purpose. The use of a moderate degree of heat for the arrest of a more general hemorrhage is of recent origin. To Dr. Em- met we are indebted for having demonstrated the hremo- static properties of hot water. AVhere ice and cold water were formerly used, hot water is now found to answer a better purpose. In hemorrhage from the uterus after miscarriage, or after removal of a fibroid, or from any other cause, injections of very hot water at the same time arrest the hemorrhage and promote contrac- tion of that organ. This is one of the many applicitions of heat where experience has placed its value beyond a doubt. For the arrest of hemorrhage from an exposed surface, towels dipped in very hot water and pressed firmly on the bleeding part for a few minutes will gener- ally act much more promptly and permanently than cold water used in tlie same way. A stream of very hot water thrown with a syringe into any bleeding cavity, if there are no vessels of large size, will generally prevent further flow of blood. The remarkably good effect of hot water for this purpose, during and after operations, may be witnessed every day in many of our hospitals. One great advantage, purchase aldactone if there were no other, in favor of the use of hot water for exposed surfaces, or for the uterine cavity, is that the process of boiling is purifying, and one of the most reliable means of destroying organic matter, bacteria, or other minute organisms which are believed to play so destructive a part in the human body. A higher tem- perature than that of boiling water has been proven to destroy some germs which escape simple boiling. For that reason 1 always, if practicable, employ for anti- septic solutions and for surgical purposes water from the boiler of a steam-engine, which has usually been heated to about 250°. The beneficial effects of vaginal injections of hot water are now generally appreciated, and form an important part of every-da)' gynecological treatment. So much de- pends upon the manner in which generic aldactone these injections are aldactone cost given, that I will venture aldactone price to describe the method I con- sider the best. The jiatient should lie flat upon a bed or sofa, with the hips raised upon a broad bed-pan, ca- pable of holding four or five quarts of water. With a Davidson's syringe, having a hard-rubber nozzle not per- forated at the extremity, a stream of water as hot as can be borne, from 100° to 110°, should be gently thrown into the vagina for ten or fifteen minutes, or until tliree or four (juarts of water have been used. The David- son's syringe is better than the fountain ; a bed-pan with- ■out pipes or openings or stoi)-cocks is better than a more complicated apparatus. It is difficult to keep the sim- plest vessel of the kind clean, and almost impossible some of the more complicated ones. The effect of injections given thus night and morning is often quite surprising. The hot, swollen, congested mucous membrane or the vagina assumes a normal ap- pearance, the offensive discharge ceases, the extreme tenderness disappears, the aldactone tablets engorged cervix softens and diminishes in size, there is a marked general improve- ment without any medication whatever, and the patient has made a great ste]) toward getting well. I make a rule of ([uestioning a i)aticnt in detail as to whether she has taken her injection thoroughly. .V pint or two of

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