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day, her twenty-fourth day, she was still in very poor shcipe, yet we were surprised at her vitality. The physi- cal examination showed nothing positive. Her lungs seemed normal ; the heart's action was feeble, irregular, and intermittent; a systolic murmur was heard over the ape.x and the rest of the cardiac area. The liver and Order Pantoprazole spleen were large. The abdomen was boggily distended. No tenderness. No masses were felt. The uterus was astonishingly well involuted, not ten- Buy Pantoprazole Online der, freely movable, with very little discharge; other- wise the examination was negative. Dia<)iio.iit^. — Possibly malignant endocarditis. Hers was not considered a case for laparotomy— in fact, she could not stand such an operation. Having read of the good results of silver salts in other kind° of infection, and also the remarkable ease of puerperal sepsis of Dr. S. S. Jones, read before the New York Academy of Medicine, and published later in the Medical Record, February 11, 1899, we thought it worth while Cheap Protonix to make a trial of tiiis treatment. At 2 p. m. a drachm of unguentum Crede was rubbed into the right groin. Another drachm was used at 10 Purchase Pantoprazole Online p. M. The pa- Generic Pantoprazole tient seemed to improve immediately. She had no fur- ther chills for three weeks. This treatment was contin- ued thirty-four days. It did not effect a cure, for in this time the patient had a number of complications. On January 29th she had a pulmonary infarct of the left chest with considerable pleurisy, requiring mor- phine and strapping. On Order Pantoprazole Online February 10th the small joints of the hands and feet, the wrists", elbows, and shoulders, the ankles and knees were red, tender, and swollen — very painful on motion. There was a papular erythema of the extremi- ties. Splints were applied and morphine was given for the pain. The next day the tcmporo-ma.xillary joint was involved. Tiiero were' no chills nor was there any ex- acerbation of the temperature. The patient looked deathlike, and her recovery was given up. On February loth, however, she was much better and the splints were removed. She looked astonishingly well and felt hun- gry. The temperature was much lower. On February 17th, her forty-fiftli Buy Protonix was negative, except for a large tender tumor in the right lumbar region. This was probably the kidney. Analysis showed the urine to be acid; specific gravity, 1.020 ; a trace of albumin ; five per cent., of pus. Purchase Protonix Chills followed for two days. On Feiiruary 20th the tumor was smaller and less tender; twenty "per cent, of pus in the urine. The tem- perature now rose for a sliort jieriod each day till Marcii 4lh. The rises were probably due to the retention of pus in tlie kidney, a5 the tumor was larger from time to time and there was an intermittent pyuria. On .March 1st the use of unguentum Crede was dis- continued. On March 8th she had her hist rise in temperature, 102.8° F. ; no pus. After this tiic kidney was not pal- pable, and there was very little i)iis in the urine. She was now gaining rapidly. Pantoprazole Online She got up out of bed March nth, and was discharged March 23(1 in first-class con- dition, eighty days post partiiin. rHar/no''iK. Purchase Pantoprazole — i'lierperal sepsis, py.Tmia, phlebitis, glu- teal absfosscs, pulmonary infarct, general arthritis, and suppurative nephritis. Remarks. — 1. It is to be regretted lliat no eulliirc; was taken eitlier from the blood or from the uterus at the onset, for certainly there were more virulent germs at work than the colon bacillus. 2. The recovery from such a protracted and severe pj'ffimia is remarkable. 3. The antistreptococcus serum did no good, nor did it accomplish any harm. 4. The improvement after the use of the inunctions of the silver ointment did not seem to be a coincidence; although it did not effect an absolute and immediate cure, as in Dr. Jones's case, it certainly turned the tide toward recovery. The general condition improved at once. The patient was hungry and more rational. The ointment did not prevent complications, but undoubt- edly Cheap Pantoprazole it fortified the patient and increased her resistance, so that she managed to survive them. The chills, which had Protonix Mg been occurring twice a day, stopped immediately and did not occur again for three weeks, and then they were due to the suppuration in the kidney. These chills were much less severe. ■5. The ointment is not a remedy for all cases of sepsis. The preliminary curettement of the uterus, the frequent douching as long as the discharge is profuse and the uterus is not draining well, the forced feeding, and the vigorous stimulation must be used with good judgment at the beginning of the infection and during this method of treatment. At Order Protonix the Sloane Maternity Hospital we have used the inunctions in one other case. This patient died. She had gangrenous metritis, so general that hysterectomy at the onset alone could have saved her. G. There Buy Protonix Online were sixty-eight inunctions in this case, a Buy Cheap Pantoprazole drachm each, Schcring and Glatz's preparation of un- guentum Crede. There was no depression, no albumin in the urine, no argyria, and there were no poisonous or bad symptoms from its use. I'his case Buy Pantoprazole occurred in the service of Dr. E. B. Cragin, with whose kind permission I publish it. 447 West Fiftv-nintb Street. TlIK USE OB' nOLOCAINE AS A hOCAL ANJ^ISTIIETJC

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