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work. Perhaps it was too much to expect that typhoid fever should be excluded from our camps, unprovided with sewers and occupied by new levies of troops, hav- ing for the most part inexperienced officers both of the line and in the staff departments. The medical offi- cers of regiments were appointed by the governors of States, and, as a rule, flomax generic were competent professionally, but they wore called upon to assume new responsibili- generic of flomax ties for which they had no special training. Unfortu- nately, hygiene and practical sanitation are subjects which receive little attention in our medical schools or flomax online from physicians and surgeons engaged in the practice of medicine. But even in those cases in which the regi- mental surgeon was fully aware of the importance of camp sanitation and urgent in his sanitary recommen- dations, he was unable to control the sanitary situation unless the regimental and company officers enforced the necessary measures for protecting the health of the command. flomax price And just here is the fundamental difficulty when we are dealing with new levies of troops. The odicer.i and enlisted men of our volunteer regiments were, as cost of flomax a rule, intelligent, patriotic, and brave, but they were not disciplined. Each man was in the habit of judging for himself and of acting in accordance with his individniil judgment. Discipline consists essential- ly in an unquestioning obedience to orders from those having proper authority to give them. Trained officers can not at once establish discipline among untrained troops, and when both officers and enlisted men are without military experience, it is evident that, with the best material, time will be required for the establish- ment of discipline. And in the absence of discipline it is impracticable to enforce proper sanitary regulations- in camp. The surgeon-general may formulate sanitary regulations, and the general commanding an army corps or a division may issue the necessary orders, but in the absence of discipline these orders will not be en^ forced. A reckless recruit will drink the water which has what is flomax been condemned as unsafe, and at night will defile- the ground in the vicinity of his tent rather than visit the company sink, which, possibly, is in a disgusting and \insanitary condition because of a failure to carry out the orders to cover the surface of excreta " with fresh earth, or quicklime, or ashes, three times a day." And now, in order that the " sanitary lessons price of flomax of the war " may not be lost sight of, and may be made available hereafter if we should again have occasion to assemble flomax 0.4 a large army on short notice, I consider it my duty to- speak plainly with reference to one of the principal causes of the epidemic prevalence of typhoid fever in our camps. As a rule, this flomax prices disease was called by some generic for flomax other name by the medical officers on duty with regi- ments who first saw the cases. Usually it was assumed to be malarial fever, alternative to flomax and was treated as such until the patient became so sick that it was found necessary to send him to the division field hospital or to a general hospital. This general statement is flomax alternative based upon the carefully made investigations of a board of medical offi- cers appointed upon my recommendation. In a paper read by Major Victor C. Vaughan at the- meeting of the Association of American Physicians, held' in Washington city early in May, which paper may be regarded as a flomax tamsulosin preliminary report of the board, the fol>- flomax for women lowing statements are made: " We had not finished our first day's work at Camp Alger before we saw that one factor in the problem must be thoroughly dealt with before we could hope to reach a satisfactory solution. Fortunately, we promptly took steps to acquaint ourselves with this factor. It can not be denied that scientific medicine would have gained much had this factor been provided for at an earlier date. I refer to the question of the scientific diagnosis of typhoid fever. In the division hospital at Camp Alger we found most of the febrile cases diagnosed as malarial. We believed that they were typhoid fever, but the surgeon in charge had diagnosed them malaria. We requested that competent men, properly equipped for making blood examinations for the malarial Plas- modium and the Widal test, should be sent to each of the larger camjjs. The surgeon-general acted promptly on this suggestion. " When we began to study the regimental sick re- ports wo found that, in order to flomax in women obtain satisfactory in- June 10, 1899.] SKENE: THE VOICE IN DIAGNOSIS. 809 formation, we must endeavor to ascertain how flomax cr many cases of typhoid fever there were in each regiment, and it soon became evident that the regimental sick reports did not give this information. Of two regiments in the same brigade, one had more than two hundred cases of typhoid fever, as shown by the regimental reports, while the other regiment on like evidence had only two cases; but the records of the second regiment show more than two hundred cases of protracted malaria, and these furnished a mortality as high as that of the ty- phoid fever in the first regiment. For the reasons already given, we have included all the protracted ma- larias among our list of the typhoids. It may be asked how long we have considered it necessary for a so-called malaria to run in order to make it a probable typhoid. In answer to this I will state that we have regarded all so-called malarias of ten flomax cost days or more in duration as possible cases of typhoid fever. We think that the great rarity of true malaria, and the readiness with which these rare cases have yielded to quinine, and the fact that quinine was so generally flomax women administered, justi- fies us in this conclusion. Practically, however, the number of doubtful ca-ses is exceedingly small. " Typhoid fever was not only diagnosticated as ma- laria, but it was covered up by many other names. In one regiment the death-rate from indigestion amounted to fifteen flomax 0.4 mg per cent, of the completed cases. In another regiment at Chickamauga dengue is a frequent diagno-

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