ness. There was then great swelling in the region of
the left tonsil. There was no fever, and but little pain,
except on swallowing. The patient had expectorated a
little blood mingled with pus. The treatment consisted
simply of cataplasms and cold drinks. The hemorrhag_e
increased in amount and the patient died on the follow-
ing day. On autopsy an abscess cavity was found in the
left tonsil, and at the bottom of the deep cavity, filled
with clotted blood, was the internal maxillary artery, its
walls thinned and ulcerated. The carotid and other
ve.ssels were normal. It would seem that local pressure,
had it been employed, might have checked the hemor-
rhage in this case.
The second case is that reported by ^'ergely■ in 1886.
A man, thirty-four years of age, was taken sick on July
26th, and entered the hospital on the 30th. The pharynx,
palate, and faucial pillars were intensely red. On the
left side there was swelling of the soft palate and an-
terior pillar, and projection of the tonsil. There was
great resistance everywhere to the finger, no fluctuating
point could be felt, nor any pulsation. The pain and
swelling extended from the back of the throat to the
angle of the jaw, and later to the mastoid region and
below the hyoid. Buy Lamictal Online The patient was pale and prostrated.
Surgical treatment was deferred for the development of
fluctuation. On July 31st the symptoms were worse,
but there were still no signs of pointing of pus. On
August ist the condition was the same. The tonsil and
adjacent parts were of a dark red color, ^'ergely was
about to puncture the tonsil Lamictal Rashes when the patient showed
him a little expectoration of mingled pus and Mood.
The operation was then again deferred to the next day,
but in the afternoon the patient died with a sudden pro-
fuse hemorrhage. On autopsy no suppuration was found
in the tonsil or pillars, but behind, in a little retro ton-
sillar pocket, were some large black clots and bits of
gen. de The'r., 1885, vol. .\Iviii., p. 517. Weinlechner : Wiener Med.
Blatter, 1885, vol. viii., p. 1623. Moizard : Jour, de Med. et de Chir.
prat,, 1886, vol. Iviii., p. 347. Postemski : Gaz. de Med. di Roma,
1887, Feb. 15. J. N Hall : Boston Medical and Surgical Journal,
1887, vol. cxvii., p. 604. Murphy: Loc. cit. Dunn: Univ. Med.
Mag., 1890 and 1891, vol. iii., p. 455.
Loc. cit. - Loc. cit.
[October 28, 1893
necrotic cellular tissue. The internal carotid artery was
cut in two about two centimetres above its origin. The
upper end of the vessel was not found.
In this case, as in two others of our series, the opera-
tion had been deferred for a day or a few hours and the
surgeon thus escaped the charge of having precipitated the
hemorrhage. But, on the other hand, had the incision
been made early, without waiting for Purchase Lamictal signs of fluctuation,
the ulceration of the artery might have been prevented
and the life Buy Lamictal of the patient saved.
In seeking an explanation of the Buy Cheap Lamictal spontaneous rupture
of the carotid artery in phlegmonous inflammation of the
throat, it has been suggested that there must be present
some general constitutional dyscrasia, or perhaps an im-
paired state of the walls of the vessel, due to previous
attacks of inflammation in its neighborhood. In only
four of our cases was there any such cause for the acci-
dent. Two patients were suffering from scarlet fever
when the throat affection began, and a third was said to
be subject to abscess of the tonsil. In Duke's case the
blow on the head was undoubtedly a most important
Vergely ' believes that the vicinity of the air passages
is the great local exciting cause of the accident. Micro-
organisms and foul gases are constantly inspired and ex-
pired and may easily give a septic character to the pus
in the neighborhood. According to Verneuil,'' the outer
arterial coat becomes thickened in an abcess cavity, if
neither fever nor septicaemia occurs. But if these com-
plications arise, the protecting cover disappears and the
artery is denuded. In angina the pus and gases con-
fined in the pharyngo-maxillary space, kill the arterial
wall before compensatory hypertrophy has time to take
place. Probably the septic character of the Lamictal Use pus com-
bined with Rash Lamictal pressure are the important agents in eroding
the artery. Hence the supreme importance of relieving
the tension of the parts even if suppuration has not yet
taken place. Bosworth " tells us that we may expect the
formation of pus by the end of the second or on the
third day. In protracted cases, Purchase Lamictal Online lasting ten days or two
weeks, suppuration is not delayed, but the abscess is
probably deeply seated in dense tissue and approaches
the surface slowly.
I have already Cheap Lamictal said that the hemorrhage occurred in
three of our cases on the third day, so that the accident
could hardly have been anticipated. It should be noted
that in two of these cases scarlet fever had been present
for a week or more, which may account for the rapid
yielding of the arterial walls.
It is rather remarkable that the great majority of the
patients were men. The sex is noted in sixteen cases,
and of these twelve were male, one was female, and three
were very young children. This preponderance of the
male sex naturally suggests syphilis as an etiological fac-
tor, but this disease is not mentioned by any observer.
Conclusions. — i. In quin.sy, the inflammatory process is
usually situated without, and not within, the tonsil. 2. If
pus forms it should be evacuated at the earliest possible
moment. 3. Unless there are signs of pointing else-
where, the incision should be made through the soft pal-
ate directly backward. 4. If the tension of the parts is
very great, the incision is indicated, even though pus
has not formed. 5. If ordinary surgical care is exercised,
there is no danger of wounding the internal carotid
artery. 6. In cases of deep-seated inflammation, in
which the pus comes to the surface slowly, erosion of the
arteries in the neighborhood may take place. In such
cases, therefore, we Lamotrigine Lamictal must be ready to deal with arterial
hemorrhage at the moment the abscess discharges into
Senile Vesical Irritation is often juomptly relieved by
a ten grain dose of phenacetin at bedtime. — Green.
' Loc. cit.
' Bui. de Soc. deChir.,
' Loc. ciL, p. 116.
. P- 74°.
MODIFIED " MILK— BY PRESCRIPTION-
MILK LABORATORIES, ETC." Lamictal Online
By W. p. NORTHRUP, M.D.,
This meeting is in the interests of fresh and clean milk
for infants and invalids. Reports say our present milk
supply is a mixture twenty-four and thirty-six hours old.
The question is, can fresh Lamictal Mg and uncontaminated milk be
obtained ; how, and where, may it be obtained ? Lastly,
concerning an improved form of milk feeding for infants.
The topic which has been assigned to me is, " Modified
Milk by Prescription — Laboratories," etc. As there are
but two all-around illustrations of my topic in the world,
and but one in New York, I can best compass the ground
by speaking of this plant, and what it seems to be able to do
for us toward meeting our demands. A milk laboratory
must control its primal milk .supply. I shall, therefore,
bring this paper into harmony with the intent of the meet-
ing by beginning with the dairy. Laboratory, prescrip-
tion writing, and general indications will follow. I may
say briefly, for those not familiar with the work of this
Section, that we are Order Lamictal Online speaking of a milk laboratory re-
cently started in New York, a duplicate of that in Boston.
Its function is, having taken fresh cow's milk, to change
its relative proportions of fat, sugar, and albuminoids to
the relative proportions of the same found in good Lamictal Discontinuation average
breast milk. This prepares the way for rational substitute
feeding and such other modifications as invalids may
Cows. — Animals Lamictal Xr of quiet temperament are .selected
from native good grade stock, avoiding the Order Lamictal strictly butter
breeds — inexpensive, good milkers, such as tend to get
fat when undisturbed. These are carefully inspected every
month l)y a veterinary surgeon, and any cow which is not
entirely well is thrown out. The stables have water-tight
floors, manure is carried to a distance, certain amount of
breathing space secured to each animal, etc.
Bedding for the cows is white sand four inches deep.
It has been necessary to abandon the use of straw ; some
bacterial growth occasionally got from it into the milk,
causing an unpleasant taste.
It is considered desirable for infant food to use a diffi-
cult-creaming milk, i.e., a milk from which the cream rises
slowly — the fat globules being small, and remaining long
The feeding of the cows is such as will secure alkaline
milk as near as possible. But what is considered more
important is to procure the milk of a cow in her normal
condition, not over-stimulated. What is to the dairy-
man's interest in quantity of milk is considered opposed
to the interest of milk for infant feeding. On the other
hand, a strictly butter cow is not considered a baby's cow.
The baby's cow /tar excellence is the cow best calculated
to raise her own calf upon her own milk.
Modifying Milk. — On its arrival at the laboratory the
milk is less (at present time) than two hours old. Im-
mediately it was drawn, the glass jars into which it was
drawn were ])ut into an ice and water mixture, and cooled
to 45° F. In its journey to New York it rises two
degrees, but still remains below 50° F., a safe limit
against rapid bacterial growth — so found by experience.
The first act of modifying is to pass the milk through a
centrifugal machine and whirl out the cream at the high-
est and innermost level, the separated milk next, and
leave against the peripheral wall any impurities that may
have fallen into the milk, such as hair or particles of
dust. The speed of the centrifugal cream machine is
about 4,400, the lowest that will "separate." A low speed
is thought to break the fat-globules less — almost none.
We have, then : i , cream sixteen Generic Lamictal per cent, fat (stable
percentage); 2, milk free of fat ; 3, against the wall any
impurities. These are removed at intervals and the ma-
The freshness and cleanness of milk has come to mean
' Read before the Paediatric Section of Academy of Medicine at a
so-called " Milk Meeting," October 12th.
October 28, 1893]
MEDICAL RECORD. Lamictal Buy
more and more to baby feeders, and will Lamictal Lamotrigine be touched upon
by other speakers more fully. Suffice it to say that for
'• modifying," milk must be fresh.
The following is the history of certain milk coming
daily into New York from a farm in Westchester County.
At 4.30 A.M. milking begins; at 8.15 the milk is deliv-
ered at the milk laboratory, having in that time been in
an ice-and-water mixture an hour, and upon the cars 40
minutes. Adams Express Company gets from the farm
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