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have been reported in which the reduction of fats has brought about buy atarax online a cure. Sometimes the removal of external sources of irritation, as adenoids, pedi- culi capitis, and adherent foreskin has occasioned improvement. The case again emphasizes the importance of de- termining the cause of the symptoms, and that the removal of the cause will cure the patient without recourse to external applications. It also points out clearly that an intolerance for sugar alone may be the cause. The case was not one of order atarax general eczema, nor even a severe facial eczema, and I know from experience that in these types, external applications are most helpful, but of far more importance must be the removal of the exciting cause. 4321 FrankI'Ord Avenue. CONGENITAL DIVERTICULUM OF THE URINARY BLADDER IN INFANTS AND CHILDREN.* A Contribution to the Clinical Diagnosis, with Reports of Tzvo Cases. By J. M. Wallfield, M. D., New York, Attending Physician, Williamsburgh and Kingston Avenue Hospitals. A pouch or sac opening out from a tubular organ is called a diverticulum. It seems to be of grave im- port when it is situated in the bladdder. Dr. H. Fisher (Congenital Diverticula of the Bladder, Surg., Gyn., and Obst., v, 10, p. 156, 1910) collected from generic atarax literature forty-eight cases, of which thirty-two ended fatally, including those operated in. Of the forty-eight cases, six were in children below fourteen years of age. Two children (eight and twelve years of age) were cured by operation. The youngest case reported was of a child purchase atarax online twenty months old. The ratio between the two sexes was about one female to ten males. The high mortality may be due to mistaken diag- nosis and sepsis. This anomaly is seldom thought of, and consequently easily overlooked, especially in infants and very young children, with disaster in the end. Since there is always residual urine in a blad- der with a diverticulum, there is always the danger of an ascending infection with a fatal result. Dr. William Lerche (Surgical Treatment of Diverticu- lum of atarax tablets 25mg the LTrinary Bladder, Annals of Surgery, *Read before the staff of the Williamsburgh Hospital, March i, 1915. L, 5, p. 285, 1912) quotes English, who by a radi- cal operation has had one death out of fifteen cases operated in. Such excellent results could not be expected if all fifteen cases operated in were in in- fants and very young children. However, by an atarax 10mg early diagnosis of the true condition in the bladder, some youngsters could be saved from infection, which is the main cause of atarax cost their early death. The two cases which had been seen by me in private practice led me to believe that a diagnosis of con- genital diverticulum of the urinary bladder in early life is probable. Case I. W., white, male, American, aped nine years. Family history, negative. Previous history : Two years ago liad a order atarax online similar attack to the one to be described, which his physician diagnosed as atarax 50 mg cystic calculi, otherwise negative. Present status : Well nourished and normally atarax online developed boy in perfect health. He tried to urinate where to buy atarax and felt a sudden pain. He was unable to void. The desire to urinate increased, and the pain grew in intensity. His mother had tried hot ap- plications to the region of the bladder, without success. A soft rubber catheter was tried by me, but it failed to enter the bladder. A hard cheap atarax rubber catheter relieved him of his agony. Within a couple of weeks, he had another attack. Botli times it felt as if the catheter met some obstruction within the bladder. The urine flowed from meatus along the sides of tube ; only a few drops came by mouth of catheter. On removing the catheter, the tip showed some mucus streaked with blood. Rectal examinations did not throw any light on the case. The boy was sent to the hos- pital, where he was cystoscoped. A loose fold of mucous membrane was found hanging from upper wall of bladder, forming an obstruction to the outflow of urine at internal orifice of the urethra. No calculi were found. This boy was instructed to keep bowels open and avoid overdisten- tion of the bladder. Almost five years passed and he had no more trouble. Case II. B., white, male, aged six months, American, breast fed. When three months old, his mother noticed at times a pink spot in centre of moist napkin. atarax price Baby cried a good deal whenever he had to move the bowels or to void urine. There was always a drop of urine at the meatus. He was treated for colic, but failed to improve in his disposition. When he was about six months old, mother once noticed some fecal buy atarax matter mixed with mucus and blood. The alarmed mother had a doctor to see the patient twice the same day ; calomel was described, but there was no improvement. Late in the evening I saw the patient, and found him moaning with rapid pulse, shallow respirations, and subnormal temperature. As soon as ther- mometer was removed, a mass composed of mucus and dark blood canie through anal orifice. The abdomen was distended. External heat and stimulants brought the tem- perature up atarax tablets to above normal. Within eight hours a more thorough examination was made, with the belief that it is a case of intussusception. The bladder was atarax 25 mg distended above the pubis purchase atarax and a tense tumorlike mass was felt at the anterior wall of the rectum. After the examining finger was removed, mucus mixed with blood and some fecal mat- ter came by rectum. The history and examination pointed toward the bladder as the oflfending organ. The parents were not satisfied with the grave prognosis of the case, and took the infant to a popular pediatrist in Manhattan. He promptly sent the baby to the hospital buy cheap atarax to be operated upon for intussusception, discarding the atarax mg idea of an anomal- ous bladder. The surgeon, after opening the abdominal cavity, did not find any trouble in the intestines ; but on furtlier search, found a mass within the bladder. He

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