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102 East Fifty-seventh Street, October 14, 1S84. October iS, 1884.] THE MEDICAL RECORD. 431 ^voQvcss £>t Medical Science. Adynamic coming off 10mg cipralex Dilatation of the Stomach. — Dr. Enrique de Argaez has lately published a monograph on the above subject (Paris: Asselin & Co., 1884), which embodies a few novel points touching the pathogenesis and treat- ment of cipralex price india this interesting disease. In typical cases the author has usually found, on inspection, abnormal prom- inence of the epigastrium, and, more rarely, visible peristaltic movements of the stomach. The var\ ing quality 10 20 mg cipralex of resonance getting off cipralex 10mg obtained by percussion over the colon, the small intestine, and the stomach, enables the observer to define the boundaries of the dilated cipralex⬠10/- 20 mg filmtabletten organ. Succussion yields a characteristic sound, due to the simul- taneous ])resence of gas and liijuid in the stomach, and sometiuies a metallic tinkling. Af. Germain See, in whose service, at the Hotel- Dieu, most of the cases observed by Dr. de Argaez were observed, finds proof of the ex- istence of adynamic dilatation in the presence of gastric resonance at a distance greater than twelve or fifteen centimetres beyond the left mamillary line, or the pres- ence of the gastric succussion sound six hours after eat- ing. Under the head of symptomatology the familiar phenomena of epigastric pain, flatulence, emesis, and constipation are described. The principal causes of the dilatation are general weakness, disturbed local innerva- tion, and excessive ingestion of aliment. The differential diagnosis involves the exclusion of gastralgia in ataxic patients, whose stomachs are not, however, found dilated, and of gastric ulcer. In the latter disease, blood, either pure or partially digested, and presenting the familiar coffee-ground aspect, is often present. This feature is al- ways absent in atonic gastric dilatation. Other diseases to be excluded are alcoholic gastritis, fibrous stenosis of the pylorus, and carcinoma. In pyloric stenosis, whether of a benign or of a malignant character, the entire con- tents of the stomach are rejected by vomiting, which is not the case in adynamic dilatation. Under the head of treatment the author suggests a diet calculated to leave no undigested residue in the stomach, such as eggs, and tender meats, moderate exercise, gentle laxatives, and the use of Kussmaul's pump and Fancher's siphon-tube, to evacuate the distended stomach. The gastric pain is best relieved by chloroform, administereil in small doses by the mouth, and by the continuous galvanic current. The author is in the habit of placing the positive pole at the centre of the epigastrium, and the negative over the sternum. The current is allowed to pass ten or generika f𴱘r cipralex twelve minutes at each sitting. Wnv Negroes are Hlack. — Surgeon-Major Alcock has contributed to Nature a communication on the reason why tropical man is black, in which he suggests cipralex 20 mg tablet that, as in the lowest animals pigment-cells placed behind a trans- parent nerve-termination exalt its vibration to the highest pitch, the reverse takes place when, as in the negro, the pigment-cells are placed in front of the nerve-termina- tions, and that the black i)igment in the skin serves to lessen the intensity of the nerve-vibrations that would be caused in a naked human body by exposure to a tro|)icul sun. In fact, he thinks that the pigment |)lays about the same part as a piece of smoketl glass held between the sun and the eye. The Treat.me.nt of Psoriasis. -;-ln the treatment of psoriasis, Professor Neumann, of Vienna, reconnnends arsenic m the form of the so-called "Asiatic pills," which are composed thus : Arsenious acid, gramme i.o ; black pepper, grammes 5.0; acacia gum, gramme 1.5 ; with a sufficiency of distilled water. The ingredients nnist be thoroughly pulverized and mixed, then enough giun arabic must be adiled to make two hundred pills. Each pill con- tains 0.005 graunne of arsenic. These are to be taken each day at first, and gradually increased till ten or twelve are taken. The soft-soap course, as an external remedy, in the form of the ■' Pfeuffer'schen Cyclus,' is strongly recommended in cases'of universal psoriasis, and is thus carried out : The patient, undressed, is laid between blankets and is rubbed twice a day for six days, and once a day for three more days, with the ordinary soft soap, one hundred grammes being used each time. The rubbing is conducted in sucli a manner that the whole of the affected skin is well rubbed each time, and, at each application, a fresh portion is rubbed in with a hard brush in such a man- ner that the surface commences to bleed. The patient remains in woollen cloths night and day, and on no ac- count is bathing allowed till the fourteenth day, and the longer this is delayed the more easily will the dried skin and soap be separated, and the less pain and sense of stretching will be experienced. In case the bath is taken too early, the skin will feel too short and tight, movement will be difficult or impossible, and rhagades are very likely to occur. Essential Anemia. — Dr. Rosenbach, of Breslan {^Deutsche Med. Wochenschriff), points out three charac- teristics of this disease, i. It recurs at certain seasons of the year, so that we can distinguish a spring, a summer, and an autumn form. Cases occurring in winter are ex- tremely rare, and those belonging to the height of sum- mer seem to be the most severe. 2. .-V peculiar craving tor acids is displayed by the patients, which must not be supposed to indicate merely a deficiency of hydrochloric acid in digestion, as any other acid, and even fresh fruit, may supply the want. The desire for acids ought to be gratified, as it is the assimilation of the patient that is at fault, and the organism instinctively demands what is needed. 3. Instead of feeling strongest in the morning, the patients are at their best in the late afternoon and evening, or sometimes even far into the night. Their desire for food follows the same cipralex 15 mg hinta rule, and it is best to let them eat at the times when they feel most appetite, irre- spectively of ordinary meal times. can take 30 mg cipralex It cipralex 20 mg tabletten is also of no use to try to ensure brightness and freshness in the morning by making them go early to bed, as they do not sleep until their time of feeling strong has passed off. They ought to be as much in the sun and fresh air as possible, but ought not to fatigue themselves with walking. The anjemia cipralex 20 mg fiyat of puberty is not included in these remarks. Dr. Rosenbach has found that the prognosis of the cases of essential anajmia is more favorable when the weakness and want of appetite are periodical, cipralex 20 mg 56 tablet than when the patients are always tired, and refuse all kinds of food alike. Medicinal Treatment of Habitlal Constipation — Dr. Mortimer Granville, cipralex 10 mg insomnia in the British Medical Jour- nal, gives three prescriptions for habitual constipation. Where there is a lax and torpid condition of the muscular coat of the intestine, the following is recommended : IJ. Soda: valerianatis, gr. xxxvj.; tinct. nuc. voni., 3 j- ; tinct. capsici, illxlviij.; syrupi aurantii, 3Jss. ; aq. ad 3 vj., 3 ss. ; water half an hour before meals. Where there is a deficiency of glandular secretion throughout the intestine the following is useful : \),. Aluminis, 3 iij. ; tinct. quassia;, 3J.; infusi quassiie, ad 3 viij. ; 3J. after meals. A third form of constipation, which depends chiefly on interruption of the natural habit of periodic discharge, is benefited by directing a regular attempt to go to stool, and to take the following draught the first thing after rising from bed : Amnion, carb., 3 j- I tinct. valerians, 3J. ; aq. camph. ad 3 vj. ; take a sixth part as directed. Generalized Sarcoma of the Skin Cured hv Sub- cutaneous Injections of Arsenic. — Generalized sar- coma of the skin occurs very rarely. Professor Kijbner's patient {Bcriuur Klinisclie Wochenschrift), was a girl eight and a half years of age. The tumors, which were e.xceedingly numerous, existed over the whole surface of the cual generico cipralex body, except the nose and abdomen. They were bluish-red in color, and mostly of the size of a lentil to a split pea. They were hard anti almost painless on pressure. The larger ones were of the size of a haricot bean. The lymphatic glands were swollen, and the liver 432 THE MEDICAL RECORD. [October i8, 1884. and spleen were slightly enlarged. There was no fever, but a feeble appetite and generally defective nutrition. The diagnosis was confirmed by an examination of two tumors which were excised for that purpose. The treat- ment adopted was subcutaneous injection of Fowler's solution of arsenic, diluted with two parts of distilled water to one of the solution. A dose equivalent to two and a half to four drops of Fowler's solution cipralex 15 mg biverkningar was injected daily ; and between September T2th and December 9th, eight grammes of Fowler's solution had been injected. It had been necessary to occasionally suspend the 15 mg cipralex injections, so that in three months only fifty injections had been made. From December loth the dose of Fowler's solu- tion was raised gradually to nine drops (diluted always in proportion). The result of the arsenical treatment was the gradual dispersion of the tumors and the diminution of the enlarged lymphatic glands. Pigmented spots ex- isted for some time over the seat of the tumors, and in November (1882) the skin had become pliant and smooth. Duly on the legs were there some small papules of lichen pilaris, and a verj' few similar papules on the arms. All the cicatrices had become pale, and on the limbs in particular a great number had entirely disap- peared. Warts. — In precio de cipralex 15 mg a course of lectures on dermatology, re- ported in the Medical Ke'ics, Dr. Duhring sa}s that ver- ruct-e, or warts, either hard or soft, consist of variously sized and shaped papillary formations. Verruca vulgaris, or common wart, occurs about the hands, especially on the fingers. Verruca plana, or flat wart, is found on the back and about the shoulders. Verruca filiformis, con- sisting of a thin threadlike formation, is encountered on the eyelids and neck. Verruca digitata, a broad excres- cence with finger-like processes springing from the bor- ders, is found upon the scalp. Verruca acuminata, also called cauliflower excrescence and venereal wart, is a pinkish, violaceous, or bright-red fleshy vegetation occur- ing usually about the genitalia of either sex, and often accompanies venereal disease, being caused by purulent secretion or excessive heat and moisture. It may also occur independent of any venereal disease. It takes on various forms, and, as a rule, appears like the head of a cauliflower or a cock's comb. It consists of a prolifera- tion of the epidermis, the development being rapid ; th^ papilla; of the corium and the corium itself are also greatly hypertrophied, and the blood-vessels dilated, rendering the growth exceedingly vascular. The most satisfactory treatment of these growths is excision, and cauterizing their bases. The galvano-caustic ligature, chromic or nitric acid, or acid nitrate of mercury may be used. The oleate of arsenic is also said to act very well. In the treatment of venereal warts astringent lotions together with some dusting powder are highly useful. The writer has employed with satisfaction the method of touching cipralex farmaco generico these warts with nitrate of silver and covering with absorbent cotton. Chronic Intestinal Catarrh.— Professor Noth- nagel, at a recent meeting of the Royal and Imperial Society of Physicians at Vienna ( Wiener Med. Blatter), spoke on the subject of chronic intestinal catarrh, which he said had been but little mentioned in text-books. There is also no explanation given, in physiological manuals, of the fact that healthy individuals have generally only one stool in the twenty-four hours. Nothnagel thinks that no explanation can be given, but that it is one of those arrangements, depending partly on the anatomical relations of the parts, and partly on innervation, for cipralex 10mg weight loss which we cannot account. Chronic intestinal catarrh may be considered to be present when mucus appears in the motions, although the absence of mucus must not be re- garded as conclusive evidence against the existence of catarrh. Nothnagel divides the cases of chronic intes- tinal catarrh into four classes : i. Those patients who have a stool every second or third day, often produced artificially ; this is the type of primary chronic catarrh of

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