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
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
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-
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.
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-
SOME POINTS IN THE THERAPEUTIC APPLICATION OF HEAT
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-
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
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
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
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,
He saw quite a number of these cases treated by cold
applications. He had studied them with a perfectly im-
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