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to make it different from any of its kind, and propor- tionately valuable. Dr. Loomis is particularly happy in making clear the indications for treatment of the different diseases as based upon pathological conditions. He is seen at his best in his discussion of fevers and chest and kidney diseases. It is safe to say that the chapters on these subjects have no equal for practical worth in any language. His divisions are natural, scientifically systematic, and thoroughly practical, really leaving nothing to be desired on the part of the learner who wishes for a broad and solid foundation, upon which he can base his facts of past and future experiences. The difficult subject of auscultation is made strikingly simple not only by word description, but by means of diagrammatic representations. The latter are of the greatest value to the student in making out the relation of the auscultatory signs to the different pathological changes in the lungs and heart. It is difficult to conceive how they could be indicated more satisfactorily. The chapters on fevers are, as already intimated, of great value. Typhoid fever receives the attention which its great frequency of occurrence demands. There is scarcely any acute disease the treatment of which gives the practitioner more anxiety than this. There are so many circumstances to be taken into account, and Buy Avanafil so many conditions to be fulfilled, that he cannot study them too thoroughly, or cannot be too well prepared for emergen- cies. Professor Loomis treats this disease as he does all others, from a clinical standpoint, and the rules which he lays down are eminently safe, and will commend them- selves accordingly to the good sense and experience of every one who has seen much practice in that line. These remarks will be found to apply specially to reduction of temperature by cold baths and by quinine. The latter in large doses is a favorite with the author, and his reasons for Buy Avandia Online the practice are very intelligibly given. The division of fevers is the same as that adopted by most authors, with the exception that the typho-malarial type is treated under the head of continued malarial fever. The author believes that the latter is caused by the combined influence of a malarial and a septic ele- ment. His treatment, however, does not differ essen- tially from that advocated by Purchase Avandia Online observers who first studied the disease during the late war. We are inclined to be- lieve that the new Avandia Tablets name is a good one, and will be gen- erally adopted as best expressing the Avandia Mg general features of the disease. Bright's diseases are treated of under three leading heads : First, the form in which the morbid changes commence in the uriniferous tubules, designated par- enchvmatous nephritis ; second, the form in which the change commences in the intertubular tissue, the cir- rhotic kidney ; and third, the variety in which the blood- vessels are first diseased, viz., the amyloid kidney. This division is simple and Avandia Price founded on advanced pathology. While speaking of this disease we wish to refer to the admirable rules laid down for treatment, and congratu- late the author on the masterly manner in which he has simplified the whole subject. The figures showing microscopical changes of organs are admirably drawn, and were specially prepared for the work by Dr. M. N. Miller, of the University Laboratory. Of these there is a large number, giving all the leading pathological changes in the tissues of the different in- ternal organs. In summing up our conclusions in regard to the book as a whole, we repeat that it is the best of its kind and is destined to be the most popular work on practical medi- cine yet published. It is a matter for great congratulation that by means of his admirable book the distinguished author can now reach thousands who, unfortunately for them, have not had the opportunity of enjoying his teaching in the class-room or hospital ward, and learn- ing those methods of diagnosis and treatment which have tended to Avanafil Buy make him a successful practitioner in every sense of •■'^e term. THE MEDICAL RECORD. 413 PRACTITIONERS' SOCIETY OF NEW YORK. Stated Meeting, October 3, 1884. Dr. a. Brayton Ball, President, in the Chair. Dr. James B. Hunter read a paper (see page 397) en- titled SOME POINTS IN THE THERAPEUTIC APPLICATION OF HEAT AND COI.D. Dr. George F. Shrady was ready to endorse Dr. Hunter in his remarks on the relative value of hot and cold applications in the treatment of surgical cases. There was no question in his mind as to the value of the cold coil, as recommended by the author of the paper, in the treatment of traumatic peritonitis. In such cases cold was used as a preventive or arrester of a formidable and rapidly spreading inflammation. In general, how- ever, in the Purchase Avandia treatment of surgical injuries, when an at- tempt was made to fulfil these indications, there was often a failure, for the reason that the cases were not seen suf- ficiently early. This was certainly so in hospital practice. And from other contra-indications these applications were frequently painful to the patients, especially those who were suffering from synovitis and sprains. Conse- quently he was getting into the habit of using hot appli- cations in preference, particularly for joint sprains, ac- companying such treatment with rest and following it with a firmly supporting bandage. In many cases of recent sprain he used nothing but the bandage and rest. ^Vhen inflammation was fairly under way and incapable of arrest, hot applications were indicated; even in trau- matic peritonitis, especially if these were combined with the internal administration of opium in full doses. In regard to the application of cloths soaked in hot water to oozing wounds there could be no doubt of its value, Order Avandia nor of that of the injection Buy Avandia of hot water into stumps in a like condition. Rubber bags filled with hot water formed a very useful means of making hot applica- tions to limited inflammatory troubles. Dr. Samukl Sexto.n said that the paper called to his mind an early experience in the use of hot water, which had started him to using it a great deal. In 1870 he met a gentleman in the wash-room of the Union League who was unsuccessfully trying to stop a severe nose-bleed by the use of cold water. Dr. Se.xtcn recommended him to snuff hot water up the nose. Tiiis was done and the at- tack stopped almost instantly. Since then the speaker had used hot water as a hemostatic in all cases, after re- moving polypi ; also as a gargle after tonsillotomy. With regard to the use of cold, in the early years of his practice he had used freezing applications in the am- putation of fingers, as a local anaesthetic. They had prevented suffering and acted very well. Dr. a. A. Smith had used both rubber and LEAD COII.S IN pyrexia. In some cases of typhoid fever, with a temperature Generic Avandia of 105' to 105^ K., a single application of the lead coil had reduced the temperature to below 100' F. The coil used had been considerably smaller than those shown by Dr. Hunter. It would not only reduce the tempera- ture but keep it down. In one case of typhoid fever the coil had been kept on continuously for nine days, the Avandia 4 Mg temperature being kept below 100 . Dr. Smith had noticed that the pulse was not always reduced in rapidity correspondingly witii the temperature, and he thought that, as a rule, when the temperature is reduced Cheap Avandia rapidly the pulse is reduced in a much less de- gree. He had been for a long time a ver)' strong believer in the reduction of temperature by cold as a therapeutic measure in the pyrexia; ; but he also believed that it was capable of doing much harm. He did not believe in the heroic application of cold in typhoid fever after the tenth or fourteenth day, or when there was a tendency to heart failure, for it might then cause ner\ous shock. '.He believed that the applications of cold acted in much the same way as the various antipyretics, referring especially to kairin and antipvrin. These will reduce temperature, but they also reduce the force of the pulse. The new agent, antipyrin, reduces temperature very powerfully, but it weakens the heart also. The speaker doubted if Americans had the con- stitutions which would stand the powerful antipyretic measures to which the more stolid Germans are sub- jected. He felt, therefore, that the safest means of ap- plying cold was the kibbee's cot. He had been much pleased, however, with the action of the coils, and they seemed to furnish a safe way of apply- ing cold. The speaker recalled the introduction of cold applications in fever at Bellevue Hospital, in 1870-71. The impression received then was that the application of cold locally in the form of ice-bags, in pneumonia, seemed to increase the tendency to involve new lung tissue. Dr. Kinnicutt had found that the most satisfactory way of applying cold in typhoid fever was Avandia 8 Mg by means of the Kibbee cot. He had given it a very thorough trial in St. Luke's Hospital. He had succeeded in obtaining all the good results of the full-length bath without the discom- fort to the patient of the latter and the increased labor entailed upon the attendants. A large receptacle for the water was placed upon a stand above the patient's head ; a rubber tube was attached, ending in a numerously perforated nozzle. The patient, uncovered or covered simply with a sheet, was then continuously sprinkled from head to foot, for a time corresponding to that usually employed in giving Avandia Online the full-length bath. Dr. Kinnicutt's experience diftered from Dr. Smith's in that, as a rule, he had found, by either the full-length bath or by Buy Cheap Avandia the application of cold by means of Kibbee's cot, with Order Avandia Online a reduction of temperature there had been a corre- sponding reduction in the frequency of the heart's action. Was it not possible that the coil acted Avandia Cost in a somewhat different way in lowering temperature from cold water bathing ? Dr. A. Brayton Ball said, that when he went upon iiis service at Bellevue Hospital, he had been told that the cold coils had been tried in typhoid fever, and that they had failed. He, therefore, had' not tried to use them. Dr. Fordvce Barker said that he had been studying clinically the subject of the antipyretic use of cold ever since Dr. Wilson Fox's paper appeared on the " L'se of Heat and Cold in Hyperpyrexia." By hyperpyrexia he meant a condition in which the temperature rose to 107'' or 112 F. This was an essential fever and a rare one. He had seen but very few cases. He had thought that in the use of cold as an antipy- retic one point had been overlooked in practice, and that was the looking at the pyrexia as the essential dis- ease, instead of regarding it as one of the, perhaps, inci- dental symptoms, which might or might not demand treatment. Two or three years ago there began to be a great deal of interest in regard to the use of cold in arresting or preventing and even curing peritonitis. That treatment was most enthusiastically advocated by several surgeons, notably by Dr. Thomas. The speaker, however, was obliged Avandia Canada to say that he had reached conclusions in some respects quite different from what he had expected. He was not certain but that there was a very essential difference between surgical peritonitis and idiopathic, or what he would call, for want of a better term, obstetrical peritonitis. He saw quite a number of these cases treated by cold applications. He had studied them with a perfectly im-

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