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the large intestine, and depends, according to Nothnagel, on diminished anatomical activity of the ganglion-cells. 2. Cases where a stool is passed daily, but each time thin, pulpy, and mixed with mucus. 3. Cases with irregularity in the state of the bowels, sometimes consti|)ation, some- times diarrhcea, and sometimes an alternation between the two ; the diminished activity of the nerve-cells explains the constipation, and the irritation of the faeces causes eventually the diarrhcea, which may also be excited by a very small error in diet. 4. Cases with continued diar- rhcea. Here, however, chronic ulceration of the bowels must be distinguished from catarrh. Where diarrhcea is present without ulceration of the large intestine, Noth- nagel has always found an affection of the small intestine as well. When the food does not undergo its normal changes in the small intestine, it acts as an irritant on the mucous membrane of the colon, and causes the diarrhcea. Some patients have a stool after each meal, some after a mid-day meal only, and some after an evening meal only. Nothnagel would explain this by referring it to nervous influence. • Freckles. — Freckles, or lentigo, may sometimes be made to disappear by an application of citrid acid night and morning. The method employed by dermatologists, and attended with considerable success, is to apply a solution of corrosive sublimate, one to three grains to the ounce of water, or emulsion of almonds night and morning. Dr. Duhring reports the latter as the most satisfactory, and advises its application until a slight amount of desquamation takes place. Loosening of the Teeth. — Dr. Sewill, British Med- ical Journal, alludes to a disease which appears to be on the increase at the present time, and is characterized b}' a chronic wasting of the alveoli. The symptoms com- mence with inflammation of the free edge of the gums and the alveolar periosteum. The gums and alveoli slowly waste until the cipro cheap teeth are lost. The teeth are commonly of good structure and free from caries. There is in many cases deposits of tartar on the denuded surface of the root, and beneath the swollen and loos- ened margin of the gums. As a rule, several teeth are affected at the same time. The disease commonly shows itself about middle life. It sometimes accom- panies diabetes, and also gout, and cases of debility and ansmia. The treatment consists in periodically removing the tartar, and swabbing the necks of the teeth beneath the loosened gums twice a week with pure carbolic acid. Foreign Bodies in the Bladder. — In the "Mittheil- ungen aus der Chirurgischen Klinik zu Tubingen " is con- tained a paper on foreign bodies in the bladder, based on thirteen cases that have been treated in the Tubingen clinic in the course of the last thirty years. The term foreign body is used in a restricted sense, so as to ex- clude stone and such bodies as are formed within the organism. In by far the most cases the foreign body enters the bladder by the urethra. According to the sta- tistics on this subject published in 1856 by Denuce, of Bordeau.\, males and females constitute the subjects of this injury in almost ecjual numbers. In males, the for- eign bodies are most frequently pieces of stalk or straw, wire, lead-pencil, and in females any of the different forms of needle and needle-case. The female patients are for the most part young, while most of the men are advanced in years. In six of the thirteen cases recorded by the author of this paper, the foreign body had passed into the bladder by the urethra. The patients in three cases were males, and aged respectively, forty-five, forty- nine, and fifty-four. Of the three females one was aged sixteen, one twenty-four, and the last twenty-five. A much smaller group is that of cases in which the foreign body consists of a broken and detached piece of some surgical instrument, as, for instance, a catheter, bougie, or sound, a lithotrite, caustic-holder, etc. Catheters of German-silver become very fragile after having been kept long, and ought not then to be used. Of elastic October i8, 1884.] THE MEDICAL RECORD. catheters and bougies, Nelaton's catheter of vulcanized caoutchouc, after it has been kept long unused, becomes extremely fragile, while the ordinary elastic bougies be- come dangerous only after frequent use and i)rolonged retention in the bladder. Gutta-percha catheters, it is pointed out, are particularly dangerous. In most of the cases of this group the accident buying cipro online is owing to a fault rather of the patient than of the surgeon, and is the result of ioo frequent and prolonged use in catheterization of a worn-out instrument. The author's list includes five of such cases. In two instances the foreign body was the end of a metal catheter, and in the other three the end of an elastic catheter. The second way in which foreign bodies may reach price of cipro the bladder is through a wound in the wall of this organ. The injury in such cases is buy cipro online either cipro hc a penetrating or a gunshot wound. The penetrating wound tlirough which the foreign body is passed is usu- ally caused by some blunt instrument driven into the bladder from the perineum or anus. The retention of foreign bodies in the bladder occurs much more fre- ■(|uently after gunshot wounds. Of 285 cipro 250 cases of gunshot wound of the bladder collected by Barteis, 81 were complicated by retention of foreign bodies, consisting of portions of the tire-arm, or a fragment of bone, or a small portion of tiie clothing. Associated with the above injuries are those rare instances of ruptured blad- der complicated by fracture of the pelvis, in which one •or more loose fragments of bone are driven into the vesi- cal cavity. The third and least frequent way in which a foreign body can reach the bladder is through a 1 alhological communication between the bladder and neighboring organs. The foreign body in such cases is usually some- thing that has been swallowed, and has ultimately passed into the bladder from the ileum or rectum after adhesion and ulceration of their walls. By perforating ulceration, also, fcetal remains of extra-uterine pregnancy, sequestra from necrosis of the pelvis, and the contents (teeth, hair) of dermoid cysts of the ovary, have penetrated into the bladder. The foreign body is seldom expelled sponta- neously by the urethra. 0^391 cases of foreign bodv in the bladder collected by Denuce, 13 only terminated in this way. In 2 of the 13 Tubingen cases there was a spontaneous discharge. The foreign body in one case was a long piece of metal catheter which had been four weeks in the bladder, in the other a straw. The foreign body, after prolonged detention in the bladder, becomes invariably incrusted with lime-salts, and may form the nucleus of a vesical calculus. Small and round bodies are soon completely incrusted, cipro cost while long thin bodies are incrusted only in the middle, and are quite free at their ends. If cipro price a fragile body, a straw for instance, be broken up in the bladder, each of the fragments mav form the nucleus of a distinct stone. The rapidity of xhe incrustation and the size of any calculus that may be formed depends on the nature of the substance forming the nucleus. Vegetable material becomes rapidly in- crusted, and of hard materials silver and gold and glass are less readily incrusted than iron. Beyond tliis in- crustation and formation of stone, the presence of a foreign body in the bladder very seldom gives rise cipro order to any special complication. In six only of the many cases col- lected by Denuc6 was death due to the direct action of the foreign body on the wall of the bladder. Some few instances have been recorded of the foreign body in the bladder of the female having jienetrated into the vagina. The surgeon having assured himself of the presence of a foreign body in the bladder, it becomes very necessary for him, before deciding as to the means of removing it, to make out its size, form, consistence, i)osition, and mobility. This may be done by digital exploration from the rectum, by bimanual examination by cipro online pharmacy the rectum and anterior wall of the abdomen, and by the use of litho- triptic instruments. The endoscope, Dr. Knoller thinks, is not likely to prove of much service in these cases. The last and most difficult problem is the removal of the purchase cipro online ' foreign body in the readiest and least dangerous way. If the body be of small size, and have not been long in the bladder, the surgeon may await for some time the chance of its being passed spontaneously with the urine. To favor this, a large thick bougie may be passed into a distended bladder, and then withdrawn so as to allow the urine to rush out in a full stream. Extraction by the cipro 250mg natural passage is indicated when the circumference of the foreign body does not exceed the calibre of the urethra, and when it can be broken uji within the blad- der. Since the introduction of iithotrity, and with the progressive improvement in the mstruments used in this operation, the extraction of the foreign body by lithotomy has been less frequently performed. The statistics of Denuc6 show that, while before 1830 extraction was per- formed in 27, and lithotomy in loo, out of 127 cases; since this year, out of 122 cases, extraction was practised in loi and lithotomy in 21. In dealing with a foreign body in the bladder of a female. Dr. KnoUer would advocate forcible dilatation of the urethra, introduction of the finger, and extraction by means of slender forceps. — London Medical Record, August 15, 1884. Treatment of Acute Inflam.matiox of the Kn'ee- JoiNT. — Dr. Barwell draws attention to a method of treating severe inflammations of joints, and more espe- cially those of the knee. In a sprain or cipro online wrench of a previously healthy joint, a severe attack of cipro 500mg synovitis fol- lows, with pain and swelling, but if dislocation takes place, no such symptoms follow, for the torn and syno- vial membrane permits the hypersecretion of the in- flamed membrane to drain away, and thus relieve the tension. Acting on this doctrine, the method adopted by the author is as follows : Suppose the knee to be the injured joint, it is to be enveloped in a broad bandage of elastic webbing ; or, if that be at the time unattain- buy cheap cipro able, an ordinary calico bandage will answer the purpose, care being taken to leave between two of the turns a little interval on the inner side on a level with the upper margin of the patella. At this point there is passed into the joint a tubular needle, thoroughly cleansed and asep- ticised. The fluid runs away as a rule easily, and when the flow has ceased the needle is withdrawn, the puncture covered with purchase cipro strapping-plaster, made adherent by spread- ing on it turpentine (a potent aseptic), and this is to cipro 250 mg be painted over with collodion. Pressure by means of strapping-plaster must then be applied and the limb placed at rest on a splint for a few days. Dr. Barwell strongly urges that, in all cases, joints which show evi- dent marks of tension should be evacuated in the above manner. cost of cipro Four cases are cited in which puncture was performed, the results being that in a few days the pa- tients were convalescent. — London Lancet. HoMtKOPATHY AND THE TREATMENT OF DVSENTERV. — Dr. D. A. Baldwin, of Englewood, N. J., writes us con- cerning the method of treating dysentery with small doses of corrosive sublimate, as recommended again recently by Dr. S. B. Childs, Mkdicai, Record, August 23d. He says : " ' Hull's Jahr,' for thirty years a leading man- ual of honneopaihic practice, gives, under treatment of dysentery, mercurius bichlo. for painful bloody stools, and colocynth for the griping pains and tenesmus. The editor says : ' A successful ])rocedure in our practice is the alternate administration of colocynth and mercury for many forms of dysentery. Colocynth first, trit., alter- buy cipro nate with the mercury, when the gri|)ing i)ains and tenes- nnis are intense".' Every work of honueopathic practice published since recommends the same." Dr. Baldwin makes the extraordinary charge of "gross plagiarism," based upon the above. The charge, however, will fit better against Jahr. At any rate, mercury in small doses was recommended in Trousseau's " Treatise on Thera- peutics," and was used more than thirty years ago by Leclerc. 434 THE MEDICAL RECORD. [October i8, i! •The Medical Record

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