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Related post: buttocks, while the upper two-thirds of the trunk had become quite clear. Both arms were now in- volved in their entire extent, the upper clearing as the forearms were invaded. Perhaps it would be well here to interrupt the description of the course of events to say a word about the character of the inflammation. It was not as severe on the trunk and limbs as on the face. In the former sites there was deep redness, but not much thickening nor edema. The ad- vancing edge was always sharply defined. The redness disappeared momentarily under the pres- sure of the finger. On the face the inflammation was brawny and edematous, the swelling caus- ing an obliteration of the features and complete closure of the eyes for a considerable time. The swelling involved the ears, the lower half of the forehead, both cheeks, the bridge of the nose, the upper lip and the chin but slightly. This curious exception of a general spread is noted by nearly all writers. On the 24th the redness had nearly disappeared from the trunk, but had spread down the thighs and from the forearms to the hands. On the 25th the inflammation had entirely dis- appeared from the face and trunk and almost entirely from the buttocks ; it had quite gone, too, from the thighs and upper arms. Both fore- arms and hands were now severely inflamed, being swollen and brawny; the hands were puffed, like balls, and very tense. In spite Buy Metoclopramide Online of all this infection the child was still taking its food well, but the iron made it retch and it had to be discontinued. The next day Purchase Metoclopramide Online the inflammation was less on the arms and hands, but had now spread down the legs to the ankles. On this day, too, appeared a slight redness on the right shoulder and chest and patches of erythema appeared on the face and chest, but disappeared again in a short time. The vulva became swollen and edematous. This curi- ous feature of the implication of the same part of the body a sectwid time I find mentioned by Cheyne. On the 27th the arms, legs, and vulva were better; the hands still swollen. The only parts of the entire body that had not been aflfected were Metoclopramide Online the feet and scalp. The stools were now foul and frothy. The next morning the child died, thirteen days after the appearance of the skin lesion. The treatment was the consistent use of ichthyol and the tincture of the chloride of iron, together with care of the bowels, baths for pyrexia and stimulation when needed. It was simply marvel- 338 MEARA: PEMPHIGUS AND ERYSIPELAS. [Medical Cheap Metoclopramide News ous to me how well the child stood this long siege and the involvement of an area of skin, which if burned to the second degree would have meant death in a short time. As regards the treatment aimed at the condi- tion itself, once could find justification for his procedures if he were to prescribe with his mental eyes shut, if he were content to take any of the drugs advised, for few conditions outside of dia- betes and neuralgia have nurtured a more prolific formular}'. My own procedure was based on that in vogue at the time at the New York Hospital, namely, ichthyol which as a local antiseptic seemed ra- tional, Metoclopramide Buy and, a deference to a time-honored em- pirical Buy Metoclopramide procedure, the administration of the tincture of the chloride of iron. One feels a little timid about pointing the finger of scorn at empiricism, even in these days of therapeutic nihilism, when one is forced to recognize the value Order Metoclopramide Online Purchase Metoclopramide of such drugs as iodine, mercury, and arsenic, in the face of a lamentable paucity of facts concerning their modtis operandi. Warren of Boston in Dennis' Surgery recom- mends the use of ichthyol when strong antiseptics are not to be used and such was the case in hand. Of local treatment. Osier says that ichthyol is at present much used, but perhaps as good an application as any is cold water, which was high- ly recommended by Hippocrates. Watson Cheyne advises tepid sponging or cold baths for the hyperpyrexia. He endeavors to give new life to the failing custom of painting the advancing margin with iodine or silver nitrate, explaining that it increases the leucocytes and Order Metoclopramide wards off the spread of Generic Metoclopramide the condition. In mild types this accumulation of leucocytes, he says, is characteristic, while ordinarily they offer no efficient barrier. Ziegler puts it nicely when he says, "they seem rather to limp after it." A suggestion made by Fischer of St. Peters- burg, quoted in the Philadelphia Medical Journal October 14, 1899, to use compresses of 85- to 95-per-cent. alcohol, in view of the reports of its efficacy in the inflammations caused by carbolic acid and its well-known antiseptic power, may have something Buy Cheap Metoclopramide in it. I simply mention this as among the newer methods outside the standard text-books.
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