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[New York Medical Journal. followed by enlargement of the liver. In a certain proportion of cases possibly what is celebrex in all which remain untreated — contraction of the liver, with ascites, re- sults. The condition of the average patient when he comes to the hospital is somewhat as follows : (jeneral ill health ; earthy complexion without defi- nite jaundice, possibly some coloring of the conjunc- tiva ; muscles coupons for celebrex wasted and flabby ; skin dry and in- elastic. I'atient generally denies having fever, but is often found to have a temperature of 100° F., or over. This loss of febrile sense is noteworthy be- cause it celebrex price is extremely common, and must be borne in mind when considering the history of a patient, who states that his illness has been afebrile after an initial attack of ague. The chest is wasted, and in strong contrast to the distended abdomen ; on ex- amination, celebrex celebrex both the 200mg celebrex spleen and celebrex coupon liver are greatly en- larged. The legs 200 mg celebrex are slightly edematous. Epi- staxis celebrex 100mg is common, but hematemesis rare. The urine is quite free from albumin, and does not give the tests for bile. Dysenteric symptoms (probably only a complication) are relatively common, and the stools contain ancylostoma eggs in many cases. The blood picture shows marked reduction of erythro- cytes, while the leucocytes are variable — never in- creased to any extent, and often decidedly reduced in number. Mononuclear cells are relatively nu- merous. In the early stages, the disease may pos- sibly be amenable to medical treatment ; it is cer- tainly curable by splenectomy. When contraction of the liver with ascites has occurred, the progno- sis after operation is very doubtful ; but without operation, and in cases beyond the reach coupon for celebrex of opera- tion, the disease is always fatal. In suitable cases splenectomy, if careful attention is paid to detail, is not very dangerous; the result, if successful, is well worth the risk. There is urgent need for sys- tematic investigation into the etiology, diagnosis, and prognosis of this disease. Sandflies (Phlebotomus) in China, and Their Relation to Disease, by R. A. Bolt. — Sandflies make their appearance at the beginning of summer in Peking and vicinity, and remain throughout the hot months. Four years ago, when the autlior was at Petaiho, a seaside resort, the experience cost of celebrex of his own family, and the untoward symptoms which seemed to be associated with the bites of the flies in a number of in.«tances, led him finally to the belief that there was more than a chance coincidence be- tween the bites and the unpleasant symptoms which followed. cost celebrex A large number of infants were bitten so badly as to make their condition bear a super- ficial resemblance to measles. The children not only suffered intensely from the local irritation of the bites, but many of them exhibited a sudden short febrile reaction, injected conjunctivae, and great restlessness, while some had diarrhea. In adults similar symptoms, together with severe celebrex purchase frontal headache, were noted. Occasionally a long period celebrex online of depression followed the attack, but all the pa- tients recovered. At that time the symptoms ob- served were attributed to other causes, such as the heat, but celebrex buy his observations since have convinced him that this peculiar symptom coniplcx after sandfly bites was really an instance of so called three days' fever, now better classified as phlebotomus or pap- oataci fever. BOSTON MEDICAL AND SURGICAL JOURNAL. celebrex 100 May 6, 1915. Epididymotomy for Acute Epididymitis as an Outpatient Procedure, by A. H. Crosbie and A. Kiley. — When a patient with acute epididymitis is unable to enter a hospital for operation, he must in many cases either do without an operation or have it performed under local anesthesia as an ambulant patient, and the writers have had excellent results from the latter procedure. Local anesthesia is produced by the subcutaneous injection of twenty to thirty c. c. of a one per cent, solution of novo- caine to which has been added from three to six drops of adrenaline solution, one in 1,000. A lat- eral incision is made into the timica vaginalis near the epididymis, through which the testicle and epi- didymis are brought out. The epididymis is then carefully examined. It is hard and indurated where the inflammation is worst and occasionally minute 200 celebrex abscesses may be seen as yellowish white dots. It is very rare that there is a single abscess large enough to give definite fluctuation. Multiple punctures are made with a tenotome deeply into the celebrex mg indurated area whether there is visible pus or not. Frequently a drop of thick yellow pus wells up, and when a pus cavity is found the incision is enlarged a little to allow free drainage. When an artery is struck, the bleeding is stopped by a fine catgut stitch. The testicle and epididymis are then washed off with warm salt solution, a drain of gauze or rubber tissue is placed lengthwise along the epi- didymis, brought out at the lower end of the in- cision and the testicle is pushed back into the tunica. The wound is closed loosely with silkworm gut sutures passed through all the layers so that any hydrocele fluid may work out. A large dressing is a])plied and secured with a T bandage, the patient is told to go home, take a cathartic, and remain in bed for a couple of days if possible, but in some cases the patients have not quit work at all. The next day he is apt to have a little fever, but usually without much pain, and at the end of celecoxib celebrex thirty-six hours the temperature becomes and remains nor- mal. The advantages maintained are : This oper- ation invariably gives immediate and permanent re- lief from pain ; there are no recurrences unless there is a fresh infection ; the course celebrex coupons of both the epididymitis and urethritis is shortened ; the pa- tients are less likely to be sterile ; the treatment of the urethritis can be begun much earlier ; the opera- tion can be done safely and successfully in an out- ])atient clinic. Myxedema Simulating Nephritis, by William

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