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15. Simple Method of CuUi\ating the Morax-Axenfeld Bacillus, By William H. Peters. I. Chronic Pancreatitis. — Deaver has to say concerning the treatment of this condition : The treatment of chronic pancreatitis begins with the amelioration of the predisposing cause or causes, if they can be determined. When gastroduodenal ca- tarrh is present as a result of vicious habits of eating or drinking, a reform must be instituted in these respects. When it is associated with disease of the biliary passages, treatment should be directed toward that condition. Wohlgemuth has shown that the pancreas responds actively to a carbohy- drate diet, and that if rest for the inflamed gland is desired it is necessary to be sparing in articles of that nature. Carnot is enthusiastic in advocacy of supplying the missing elements of digestion by ad- ministration of a preparation of the gland. Sailer also reports good results in two cases treated 011 this basis. While such measures may suffice for mild cases, or at times for more severe forms, there are others that go from bad to worse on careful medical treatment. Continued loss of weight, j^er- sistence of indigestion, recurring exacerbations, jaundice, or a lowered tolerance for carbohydrates as shown by transient glycosuria should cause the physician to advise operation. Especially binding is this obligation if there be associated disease nf the biliary Viagra Generico Funciona Como O Original tract. In the surgical treatment of chronic Viagra Generico Funciona Como O Original pancreatitis. Mayo Robson occupies the same position as Fitz does to the development of our knowledge of the disease. He was the pioneer in showing that free drainage of the biliary tract, and through this outlet, drainage also of the pan- creatic ducts, would in many instances enable the pancreas to cast off the infection and resume its normal function. This is. in a nutshell, the prin- ciple of the treatment, and though it may seem roundabout, its efficacy has now been demonstrated too often to admit of a question. The easiest and 796 PITH OF CURRENT LITERATURE. most advantageous method of providing drainage is Viagra Generico Funciona Como O Original by a cholecystostomy. If for any reason this is impracticable, drainage of the common duct should be done. .At times when the closure of Viagra Generico Funciona Como O Original the common duct is complete and likely to be lasting, a chole- cystenterostomy may be best, but as a general rule external drainage permits subsidence of the swell- ing of the pancreas and a reestablishment of the functions of the ducts. Drainage should be main- tained for three or four weeks at least. It is diffi- cult to keep the fistula from closing too soon, and in cases of marked pancreatic disease it is best to make a cholecystduodenostomy. Just how long this opening will remain patulous is a question. It should not be forgotten, also, that cholecystduo- denostomy is an operation of greater magnitude and slightly higher mortality than simple cholecvs- tostomy. Send patients early before complications create a mortality. 3. Vaccines in Otitis Media. — Weston and Kolmer have drawn the following conclusions: i. The best Viagra Generico Funciona Como O Original time, all things considered, for beginning vaccine treatment in cases of otitis media, is from the eighth to the sixteenth day of the discharge. 2. Continued high fever, nephritis, toxaemia, and various intercurrent aifections are contraindications to the administration of vaccines. 3. Under vac- cine treatment, three times as many patients are cured within thirty days and permitted to go home as under the usual treatment. This means that the average residence of a patient in the hospital has been considerably decreased. 4. In general, cases of otitis media offer a fruitful and encouraging- field for the employment of vaccine therapy. 6. Systemic Blastomycosis. — Washburn re- ports a case and concludes from his study of it that the prognosis in cases of systemic blastomycosis is exceedingly unfavorable. Of the recorded cases, only four have recovered. The course of the dis- Viagra Generico Funciona Como O Original ease is essentially chronic. Most of the cases have lasted from one to two and one half years. Only six of the cases have terminated in less than six months. Death has resulted in most instances from gradual exhaustion, due to chronic suppura- tion or to general dissemination of the disease through the various organs and tissues of the body. From this very unfavorable record of results, it may be assumed that the treatment of the disease is not very satisfactory. The only drug which appears to have any specific action on the disease is potas- sium iodide. The patients who have recovered have received it in large doses. Locally, the lesions should be treated like those of the purely cutaneou-^ form of the disease. One of the best local applica- tions is I per cent, copper sulphate solution in con- junction with the use of the x ray. 8. Drop Method of Giving Enemas. — Canna- day. to prevent expulsion of normal salt solution from the rectum, advises that the container be hung so that the solution is 8 or 10 inches above the level of the rectum. It should frequently be tested by a bath thermometer and the temperature kept about 100° F. A hot water bottle on either side of the douche bag or the frequent addition of small quan- tities of hot saline solution will serve to keep the temperature up. The most simple means of induc- ing the fluid to flow drop bv drop is not a h:emnstat but a hairpin and a match. An ordinary wire hair- pin is passed about the rubber tubing so that one of its prongs extends on either side; the free ends are secured from spreading apart Viagra Generico Funciona Como O Original by a Viagra Generico Funciona Como O Original twist of the wire with the fingers. Three or four wooden toothpicks or a match trimmed down to a wedge shaped point are induced between the wire hairpin and the rub- ber tube and gently pushed in until the flow is just as desired. As a rule it is not wise to attempt to give too much fluid at a time ; about 6 or 10 ounces every hour and a half or two hours will be sufficient. In giving Viagra Generico Funciona Como O Original saline solution regularly over a space of more than twenty-four hours one will find that more is usually absorl^ed at first than later after the sys- tem has been saturated with fluid. A soft rubber