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growth of bacteria in cultivation fluids by both Vaughan and Baginsky. Dr. H. M. Biggs agreed with the previous speakers that no direct light had been thrown as yet on the exact nature of the bacteriological activities which went on in tlie intestine; but still the general study of bacteria had given us many explana- tions of what might and in all probability did occur in the in- testine in certain cases in consequence of the presence of bac- teria. It seemed at estrace cream least probable that there were three forms of disease arising in the intestine due, directly or indirectly, to the action of bacteria. In the first class of ca*es the disorder arose from the absorption of ptomaines formed outside the body and taken in with the food. In the second class it was due to saprophytic bacteria taken in with the food and causing it to ferment. In the third class it was caused by specific germs, which acted directly on the raucous membrane estrace 2mg of estrace ivf the alimentary tract. In a certain asylum recently two thirds of the inmates had suddenly been seized with estrace 1 mg vomiting and diarrhoea, which had lasted fi'om six to forty- eight hours. The weather at the time was very warm. Investigation had revealed that a certain quantity of meat afterward eaten by those who had been sick had by mistake been left outside the ice-house for two buy estrace or three days, and had become badly tainted. This illustrated the first class of disorders. In the second and third classes the results represented the ratio between the tolerance (or resistance) of the individual and the dose of bacteria he took in ; and, if the germs were taken in together with an excess of food, or with indigestible food, still more marked results would follow. As an apparent illustration of the former statement he would men- estrace cream coupon tion a case of sporadic cholera of peculiar causation estrace for ivf which he and Dr. Prudden had studied together. A man who estrace coupons sold pro- visions to the Italians working on the Croton Aqueduct, wlio had previously been well, had been suddenly seized in the night with vomiting and purging, and had died in collapse in about twenty-four hours. There had been nothing in the history, so far as food was concerned, to account for the attack. The case had been reported to the Board of Health by competent physi- cians who were in attendance estrace coupon as Asiatic cholera. As this had been just after the epidemic of cholera among the Italian immi- grants detained at quarantine in 1888, and alter the release of these immigrants, additional significance had been attached to any symptoms suggesting cholera as strongly as they did in this case. At the autojjsy the intestines had been found full of rice- water fluid similar to that which had been discharged, and in this fluid had been found almost pure cultivations of the Bac- terium coli commune, but none of Koch's comma bacilli had been present. Apparently, then, this saprophytic bacillus, al- though normally present in the colcn, might under certain unknown conditions become a cause of fatal disease. lie would give another excellent illustration of the relation of bacteria to intestinal diseases which had come under his notice during his service in the Almshouse Hospital on Black- well's Island. During June and the first two weeks of July there had been an epidemic of dysentery among these adult pa- tients, in which about a hundred cases liad occurred and thirty deaths. He had been told that they always had dysentery there during estrace 2 mg the hot season. estrace estradiol For that reason, apparently, nothing had been done toward preventing it. He had next dis- covered that the water-closet, or rather privy-vault, had not been cleaned out for a year, and at the time was four feet deep with semisolid fsecal matter, and that the outlet of the drain was almost choked estrace price with old clothes that had been thrown into the vault. He had had the vault emptied and cleaned, and thereafter flushed out daily, with the surprisingly good result of not having another case of fatal dysentery so long as these sani- tary measures were kept up. In about ten days the disease buy estrace online had almost entirely disappeared. However, they had stopped flush- ing the vault, he had learned, after his terra of service had ex- pired, and in September dysentery had again appeared in the wards. Dr. Holt remarked that the experiments of Baginsky seemed to show that the fermentation caused by the estrace and ivf Bacterium lactis aerogenes mig\ith%Q,om& pathological if it exceeded normal hmits. The Bacterium coli commune had been found by Booker to be less abundant in diarrhoeal than in healthy stools, while in dys- enteric stools it was absent altogether. The speaker had pur- posely omitted all reference to the use of antiseptic drugs; the subject was a complex one, and too large to be considered with- in the limits of the pa|)er. He considered that at present the most scientific treatment, and the one most successful in prac- tice, was that directed estrace cost against the bacteriological processes go- ing on in the intestines. This must be carried buy estrace cream out in its fullest and widest sense, reference being always had to the conditions of soil present. Failure in the past had resulted largely because lesions had not been taken into account. These were some- times produced with great rapidity. Dr. W. II. Flint took a favoral)le view of the value of in- ternal antiseptics, both in the stomach estrace tablets and in the intestines. His experience had been chiefly among adults. A Review of Several Obscure Cases of Ulness.— Dr. J. E. Winters read a paper thus entitled. (It will be published hereafter.) Primary Carcinoma of the Pancreas.— Dr. W. Oilman Thompson read a report of sucli a case. (See page 407.) Knots at the Bottom of Deep Cavities.— Dr. C. D. Soud- der exhibited a simple in.struraent designed to facilitate the ty- ing of a knot at the bottom of a deep and narrow wound. It consisted of a slender metal rod, forked at the end into two flaring branches, wiiose smooth ends were turned outward estrace creme and contained eyelets. A knot being made around the shank of an artery forceps, the ends of the ligature were estrace online to be passed through these eyelets and retained in the fingers of the operator

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