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(Materia Medica, Pharmacy, and Therapeutics, Potter, 1901).

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Differential Diagnosis of Biliary Calculi, Gastralgia, Intestinal Colic and Renal Colic.

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History of case.

No tube casts.

Pus in urin.

Dropsy rare.

Differential Diagnosis of Pyelitis, Nephritis and Cystitis.

Nephritis.

Cystitis.

Increast micturition; sweat and chills Micturition accompanied by tenesmus;

rare.

Albumin and various kinds of casts.
Pus rarely found.

Dropsy common; urea diminisht.

often burning pain.

No tube casts.

Often blood at end of micturition. Never find dropsy.

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Gastric Indigestion.

Hydrochloric acid administered during the period of gastric digestion disappears very rapidly from the stomach, and it should always be given in combination with pepsin. Both pepsin and hydrochloric acid are necessary for the peptonization of albumen, and the acid and ferment are best administered proportionately. The acid-pepsin combination should be given only when the secretion is deficient and during the period of gastric digestion. The time of administration and the dose should be regulated by the functional signs and by the quantity and quality of the diet. The greater the quantity of albumen in the meal, the larger should be the doses, and the sooner should their administration begin. If the meal consists largely of non-nitrogenous food, the smaller should be the doses, and the later should they be given. The supply thus meets the physiological demand, and an opportunity is given for salivary digestion. The best results are obtained by repeated doses during the period of gastric digestion. This period has no fixt

length, but varies with the character of the meal. After a light meal that remains in the stomach about three hours, two doses will usually suffice-half an hour and an hour after eating. After the chief meal one or two more doses may be given, an hour apart." (Diseases of the stomach; Van-valzah-Nisbet.)

Criminal Abortion.

There has been no time within the known history of the human race when women have not sought to avoid maternity. The induction of abortion as a means of limiting reproduction was known and practist by the Egyptians, the Greeks, and the Romans. Altho certain social theorists have enunciated the principle of justifiable feticide, it remains an unprovep assumption that the practise is more prevalent to-day than in former times. That it is prevalent to day, however, there is no means of denying; nor can the deleterious results of the practise upon the reproductiv organs of the woman be ignored. Infections induced in this way, when not

fatal, almost always destroy fecundity and render relief by surgical means imperativ. (Text-Book of Gynecology, Reed, 1901, D. Appleton & Co., New York.)

Impetigo Contagiosa.

One of the commonest of the transmissible diseases of the skin is that designated as contagious impetigo. This affection is attracting more and more the attention of the general practitioner because of its increasing frequency. It is extremely common in schools and in institutions for children, where it often becomes rapidly disseminated. The disease appears to be greatly

ally regarded as constituting a disease per se. Impetigo contagiosa is characterized by the occurrence of pin-head to pea or finger-nail sized, rounded vesicles or blebs which tend rapidly to pustulation. These are extremely thin walled, superficial and flat. The contained fluid is at first a clear serum, but in twelve to twenty-four hours it becomes turbid and finally frankly puriform, drying into ochre yellow or brownish friable crusts. These crusts being surrounded by little or no areola have the appearance described by Fox, of being "stuck on." The eruption is essentially discrete, altho at times a coalescence of

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on the increase. The statistics of the American Dermatological Association from 1878 to 1887 showed this disease to constitute but 2 per cent. of all cutaneous affections. Since this time impetigo has become one of the most frequently encountered skin diseases in dispensary practise. During the past year at the Philadelphia Polyclinic, out of 1,100 cases treated 10 per cent. were impetigo contagiosa.

The word "impetigo" means pustule, and the term was used in the early part of last century to denote all pustular affections. In 1862, Tilbury Fox, of London, restricted its use to certain cutaneous manifestations which are now pretty gener

neighboring lesions occurs. Still the discreteness of the eruption is one of the most characteristic features. Sometimes the borders of the crust curl up, whilst the dried center is deprest, giving the crust an umbilicated appearance. Beneath the crust is a superficial erosion which soon heals over, and upon the shedding of the former a reddish stain is left, which fades in the course of a few days.

The exposed surfaces, namely, the face, neck and hands, are the most common regions affected. A common complication in children is a paronychia which results from contact of the digits with the facial lesions. The mucous membranes are in

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nearly all cases exempted; however, they may in rare cases be invaded. The eruption may consist of but a few lesions, or they may be extremely numerous. When the eruption is profuse, there may be slight rise of temperature. The disease is far more common in children, and particularly those under ten years of age. Within recent years, however, adult cases have been greatly on the increase. It is not unusual for several members of the same family to simultaneously present evidences of the disease. The above description applies to the form of impetigo ordinarily encountered. There are some less usual types that at times come under

crusting. Some cases of impetigo are characterized by the development of blebs which may vary in size from a bean to a cherry. Blebs may occur interspersed here and there in ordinary cases, such as is seen in Fig. 2, or the entire eruption may be bullous in character. According to Engman, of St. Louis, bullous impetigo is extremely common among infants in that city during the summer months. He has observed and recorded several epidemics occurring in institutions for infants. The disease selects the progeny of the poor and those improperly nourisht. When the lesions are extensiv and deep and the infants young, death may result from septic

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observation, to which profitable reference might be made. Occasionally it is noticed that after the crusting of a lesion, the surrounding skin shows an undermining of the epidermis by a turbid secretion. This spreads peripherally until a patch the size of a five-cent piece or a quarter dollar is reacht. With peripheral extension there occurs, pari passu, central healing, so that with the dropping out of the central crust an annular or circinate patch is left. At times the ring is incomplete, producing a crescentic patch, such as is seen in Fig. 1. Again in rare cases, the patches may spread to an enormous size, leading to the development of gyrate and serpiginous

absorption. The epidemic is dispelled by the first cold wave.

It is generally conceded that impetigo may be transmitted from one individual to another by direct contact or thru the mediation of certain articles. Moreover, it may be transferred in the same individual from one part of the body to another. In other words, this affection is both contagious and autoinoculable. It is further generally recognized that the disease is due to the invasion of the skin by the common pyogenic cocci or organisms morphologically indistinguishable from them. There is, however, considerable difference of opinion as to whether the offending

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