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For this purpose you can use the corn sweat described under treatment of la grippe rhcp blood sugar zip quality actoplus met 500 mg. I had a patient sick with pleurisy; she did not get along fast enough to diabetes test during pregnancy symptoms buy actoplus met cheap online suit me diabetes insipidus medications cause generic 500 mg actoplus met, her color was a yellow-green diabetes mellitus type 1 symptoms buy actoplus met 500mg line. If you have a rubber water bottle, put hot water in that and place it near the sorest spot. It may hurt the patient by its weight; if so, use less water, at the same time you can give hot drinks freely. They must always be hot, and you must be careful not to get the night robes or covers wet. Commence at the backbone and cross directly over the ribs to the further side of the breastbone. In putting on the succeeding strips make them lap one-half inch over the next lower. After you have the strips on, place a piece at each end, part on the flesh and part on the plasters, to keep them from giving any. The patient should have his arms over his head when you are putting on the strips. Tincture of aconite in doses of one-tenth to one drop can be given everyone to three hours at the beginning, if there is much fever, dry hot skin, and full bounding pulse. A condition of the lungs characterized by a permanent dilation of the air cells of the lung with dwindling of the air cell walls and the blood vessels, resulting in a loss of the normal elasticity of the lung tissue. They usually occur when the fever drops in the early morning hours, or at any time of the day when the patient is sleeping. They may come on early in the disease, but are more persistent and frequent after cavities have formed in the lungs; some of the patients escape it altogether. Just before retiring take a cup of sage tea, and eat nourishing food," the salt acts as an astringent as it slightly closes up the pores, and the sage establishes a better circulation and at the same time helps the sweating. The patient should wear flannel night-dresses, as the cotton night-shirt, when soaked with perspiration, has a cold, clammy feeling. Bathe the patient in the morning with tepid water and afterwards rub gently with alcohol diluted one-half with water. They also occur when one is run down, but they are not so debilitating and constant. The parasite occupies the upper part of the small bowel and there is usually only one or two present, but sometimes they occur in enormous numbers. They may go up the eustachian tube and appear at the external meatus (opening of ear). There is a specimen in the Wister-Horner Museum of the University of Pennsylvania in which not only the common bile-duct, but also the main branches throughout the liver, are enormously distended, and packed with numerous round worms. The bowel may be blocked or in rare instances an ulcer may be perforated; even the healthy bowel may be perforated. Bad health, cross, peevish, irritable and dumpy, when the child is naturally the opposite. Its virtue may consist in being a laxative and an antiseptic which in themselves would add to the general health of the child. An infusion is highly recommended in irritability of the bladder, in sick stomach and in whooping cough. Osler, of Oxford, England, recommends as follows: Santonin in doses of two or three grains for an adult; one or two a day for three or four days, followed by salts or calomel; one-half to one grain for children in the same way. Before giving any of these remedies it is well to move the bowels freely and also after the medicine has been stopped. Douglass of Detroit, Michigan, recommends the following for a child five to ten years old: Santonin 12 grains Calomel 3 grains Divide into six powders, and give one night and morning while fasting. The following is from Professor Stille: Spigelia 1/2 ounce Senna 2 drams Fennel seed 2 drams Manna 1 ounce Boiling water 1 pint Mix and make into an infusion (tea). They produce great irritation and itching, particularly at night, symptoms which become intensely aggravated by the nightly migration (traveling) of the parasite. Occasionally abscesses are formed around the bowel (rectum) containing numbers of worms. The patient becomes extremely restless and irritable, for the sleep is very often disturbed, and there may be loss of appetite and also anemia. The infection takes place through the drinking of water and possibly through salads, such as lettuce and cresses, and various other means. A person who is the subject of worms passes ova (eggs) in large numbers in the feces, and the possibility of reinfection must be guarded against very scrupulously. They are usually very restless at night and pull at the rectum both day and night. This condition may be relieved by an injection, of powdered aloes,-five grains; hot water one-half pint. Give a teaspoonful three times a day for two days, following this up by a good dose of castor oil or cream of tartar to thoroughly cleanse the system. Finally the mother tried an injection made by steeping quassia chips for two or three hours slowly, then straining it and injecting about one pint (luke warm) once a day. Santonin in doses of one-tenth of a grain can be given for two days, three or four times a day, preceded by spiced syrup of rhubarb, one dram dose, and also followed by the rhubarb. The hips should be well elevated so that the injection can be retained for some time. Quassia chips 1 ounce Common salt 1/2 ounce Water 1 pint Soak over night and inject slowly all the bowels will hold. Tooker of Chicago, Illinois, recommends the following:-Give an injection of an infusion of fresh garlic for two or three nights in succession, using, to make the infusion, a small bunch of garlic in a pint of water, steeped down to one-quarter pint. Anoint the anus for several nights in succession with sweet oil, using the little finger to insert the oil as far into the rectum as the fingers will reach. Inject cod-liver oil (pure) into the bowel or make into an emulsion with the yolk of an egg and then inject. The head is small, round, not so large as the head of a pin and provided with four sucking ducts and a double row of hooklets. By these hooklets and disks, the parasite attaches itself to the mucous membrane of the small intestine in man. Below the head is a constricted neck, which is followed by a large number of segments, increasing in size from the neck onward. Each ovum (egg) contains a single embryo, armed with six hooklets and contained in a thick shell. When swallowed by a pig or man these shells are digested and the embryos migrate (travel) to various parts of the body, where they change to Cysticerci or "Measles. When meat, improperly cooked and containing "measles," is eaten, the cyst is dissolved in the human stomach and the free scolex or head attaches itself to the intestinal mucous membrane and grows into a tapeworm. It may grow fifteen to twenty feet or more and possesses a large head in comparison with the Taenia Solium. The ripe segments are larger and they are passed as in the Taemia Solium, and are eaten by cattle, in the flesh or organs of which the eggs develop into the Cysticerci. The knowledge of the presence of this worm may cause great nervousness or depression. Careful attention should be given to three points: First, all tapeworm segments should be burned. They should never be thrown into the water-closet or outside; secondly, special inspection of all meat; and, thirdly, cooking the meat sufficiently to kill the parasites. My mother helped prepare the seeds and saw the tapeworm which came from a woman as a result of this dose. During this time a little milk can be given, and after a night of fasting, before breakfast, the worm medicine (anthelmintic) must be swallowed. In addition, nearly all the drugs must be followed by purges in order to dislodge the intruder while he is paralyzed and has lost his hold; and in many it is well to have a basin of salt and water ready so that when a passage occurs a rectal injection may be given to wash out the segments of the worm which remain in the rectum. For two days prior to the administration of the remedies the patient should take a very light, diet and have the bowels moved by a saline (salts) cathartic. The etheral extract of male fern in two dram doses may be given; fast, and follow in the course of a couple of hours by a brisk purgative; that is, calomel followed by salts.
The athlete must be made to diabetes in dogs giving insulin buy 500mg actoplus met understand that this behavior is unacceptable: it draws the athletic train er’s attention away from the other athletes who may really need it diabetes you magazine discount actoplus met line, and makes it dif ficult for the athletic trainer to diabetes early signs and symptoms 500 mg actoplus met take that athlete seriously when an injury does occur blood glucose kit in philippines 500 mg actoplus met amex. Regardless of whether an athlete is playing up (exaggerating) an injury or playing it down (minimizing), the athletic trainer is not there to cast judgement, but to facil itate the athlete’s needs. When an athlete has been restricted or removed from play, or has been advised coping mechanisms of a permanent disability, the athlete may have a mental battle to overcome as well as a physical one (see Figure 22-10). If competitive activity is restricted for only defense m echanism s; the a short time (the duration of a play or a single event), the athlete’s confidence or psychological or physical motivation to resume activity is not likely to change significantly. These athletes are m ethods by w hich an indi generally ready and excited to get back to the game as soon as they can perform the vidual adjusts or adapts to a necessary physical and mental maneuvers. But when an athlete is out of com challenge or stressful petition for an extended time, psychological coping mechanisms often emerge situation. Kubler-Ross describes the stages of adjust ment typically experienced by those faced with the stress of death or great loss. Restriction or loss of ability to participate in that sport repre sents a significant loss to them. An athletic trainer can more effectively address the psychological needs of an athlete’s rehabilitation by becoming familiar with these stages. Plan for and work toward the athlete’s psychological recovery as well as the physical rehabilitation. If an athlete is physically fit but not mentally ready, a return to full potential is unlikely. More than likely the athlete will experience denial when told of the severity of the injury. While the physician will provide the refusal to believe that athlete with a diagnosis and prognosis, other vital information may be left for the w hich is true or real. Such information may include a description of the anatomy involved in the injury and the importance of the athlete’s role in the diagnosis rehabilitation process. This may begin with the athlete realizing the possibility of not being up and identification of the moving tomorrow—maybe not for the rest of the season. Help direct the athlete’s natureof a disease or focus away from the injury by pointing out opportunities for increasing attention to condition based on other significant areas of life, such as more study time or more family time. An athletic trainer can enhance this motivation by reassuring injured athletes that they prognosis are still a part of the team and finding or creating opportunities for involvement that an estim ate of a chance for are suited to the injury. Helping other players understand game plans, assisting with recovery; a prediction of equipment inventory or maintenance, and providing moral support to their team the likely outcom e of a mates are all excellent ways of keeping injured athletes active and involved while they disease or injury. It is the ath letic trainer’s responsibility to reassure that the athlete will survive the pain and sense of loss, and that the athletic trainer will be there to help. Be aware of anyone else with whom the athlete may be angry and help minimize this response by explaining to the athlete that the injury is not anyone’s fault. Help the athlete work through this anger in positive ways such as increasing repetitions of exercises or simply allowing the athlete to “shout it out, then put it away. The athlete may need to be reminded not to jeopardize these relationships with misdirected or inappropriate anger. Reassure these athletes that support will be there even when they blow up, but remind them that support and recovery are a lot easier when hostility is kept under control. Try to avoid cliches like, “this hurts me as much as it hurts you” unless willing to truly experience some of the athlete’s pain firsthand. Also, even if the same type of injury has been experienced, saying, “I know how you feel” may only increase an athlete’s anger. Although the physical pain may have been similar, keep in mind that the personal and/or psy chological situations may be polar opposites. Try supportive statements like, “I can see this is difficult for you,” or “I’ve seen you play. They will play one person against the other using half-truths and bargaining to accomplish their goals. At this bargaining stage athletes may go from doctor to doctor until they find one who will say what the attem pting to m ake a deal athlete wants to hear. In some cases an athlete may find someone who will say exactly w ith an authority figure in that but who will not then bear the responsibility for complications or further (some an attem pt to change the times permanent) injury that often results from returning to play too soon. Tell an athlete how long an average injury might take to heal, but avoid giving the athlete specific recovery estimates. When a physician is involved with the case, the physician will tell the athlete how long rehabilitation is expected to last. However, for minor to moderate soft tissue injuries in which a physician’s care was not required, the athletic trainer may have to provide this information. When providing general estimates to an athlete, always give the most conservative estimate possible for rehabilitation time. Do not allow the athlete to try to persuade you to grant permission to return to play too soon. In other words, when the athlete is told “three to six weeks,” “three weeks” is all the athlete will hear. Other indications of the bargaining stage include the athlete’s realization that some of the attention gotten as an active part of the team may decline. This realiza tion often intensifies the bargaining process, yet remember to stay consistent and not give the athlete information that might backfire later. Better to not say the ath lete will be ready to return to play after three weeks, because this statement cannot be guaranteed. Frequently, when bargaining fails, the athlete will experience or return to the anger stage. It is the athletic trainer’s job to recognize these stages of psychological recovery and help the athlete work toward the final stage, acceptance. Mild cases, known as “the blues,” may resolve themselves on their own, but such cases extrem e feelings of sad may also lead to more-serious emotional distress. Be alert to intense changes in the athlete’s moods, such as increased sadness or unrealistic cheerfulness. Never hesi tate to discuss concerns with more-experienced professionals—an athlete’s life may depend on gut instincts. Some rehabilitation programs are long and tedious, often reaching plateau plateaus that can last for weeks. These plateaus may consist of extended periods during which no increase in strength or range of motion is noted. All kinds of a period in the process of setbacks can occur during these periods, including weight gain, loss of self rehabilitation in w hich no esteem, apathy, or trouble at home or school because the athlete feels that no significant im provem ent or one understands. As compassionately as possible, without dismissing or generalizing the sense of loss or despair, let the athlete know that many people have gone through similar self-esteem tragedies and that others will experience tragedy in the future. As a professional, pride in oneself; keep in mind that, in many cases, injured athletes have too much time to think and self-respect. This is one of the main reasons to change the workout rou tine frequently and add excitement to long rehabilitation programs. Stay ahead of the athletes; if self-pity apathy or boredom is sensed make an extra effort to work together with those around the lack of interest or concern. Keep in mind the influence of your positive attitude, as the injured athlete’s time with you will be dra matically increased throughout the recovery period. Acceptance acceptance Acceptance is the stage in which athletes are able to fully understand and appro priately deal with the extent of their injuries, as well as their responsibilities in the com ing to term s w ith recovery process. This understanding includes coming to grips with the time frame theoutcom e of one’s of restricted participation, or even the possibility they may never return to their par prognosis. This stage often signals the beginning of the athlete’s recovery from a psychological standpoint. Remember, in order to be ready for competition, and everyday life, one must be physically and psychologically fit. If the athlete is going to return to the sport, confidence and determination must be addressed and emphasized during the acceptance stage. The athletic trainer must provide and encourage as many activities as possible to bring the injured ath lete closer to a competitive setting. An unexpected play, crowd noise, teammates asking the injured athlete’s opinion on strategies, and post-game celebrations can all contribute to rebuilding an injured athlete’s confidence and desire to return to play. Some athletes whose injuries require an extended recovery period do not experi ence any of the stages described above; others may experience only some of the stages; still others may experience each stage but not necessarily in the order listed. Sometimes even athletes with short-term restrictions experience some of these stages. Furthermore, in a long rehabilitation program, the athlete may go from one stage to another and back again.
In the United States blood sugar elevated cheap 500 mg actoplus met otc, over 6 million persons are visually impaired but not 1 classified as legally blind diabetes mellitus may lead to cheap actoplus met 500 mg with amex. Other common causes of low vision are glaucoma diabetes type 2 abbreviation actoplus met 500 mg for sale, diabetic retinopathy diabetes type 1 birthday cake recipes purchase online actoplus met, cataract, optic atrophy, corneal disease, cerebral damage, degenerative myopia, and retinitis pigmentosa. Approximately 9% of the low-vision population is pediatric, with visual loss from congenital eye disorders or trauma. A treatment plan should consider the level of function, realistic goals for intervention, and the varieties of devices that could be helpful. The sooner they adapt to low-vision devices, the sooner they can adjust to the new techniques of using their vision. Low-vision evaluation should never be delayed unless the person is in an active phase of medical or surgical treatment. Does the person understand the limitations of what can be achieved with low-vision rehabilitation? It is helpful to refer to a list of common daily activities the patient may not be able to perform efficiently (Table 24–1). From this list, it is possible to arrive at realistic treatment objectives for that person. Refractive status should be confirmed to rule out a significant change, particularly after surgical intervention such as cataract or glaucoma surgery. A patient may have become myopic from a nuclear cataract or astigmatic from corneal warping after glaucoma drainage surgery. A 4-meter test distance is used when acuity is 20/20 to 20/200; a 2-meter distance for acuities less than 20/200 but 20/400 or better; and a 1-meter distance for acuities less than 20/400. Projector charts are not recommended for testing subnormal vision because of low contrast and insufficient letter choice at low acuities. Although relatively insensitive, it can be used to advantage in low vision, particularly to identify the dominant eye. If the dot is seen, the patient is using either a viable macula or an eccentric viewing area. Then check the grid monocularly and again ask the patient to report seeing the center fixation dot and any distortion or scotoma. If the grid is presented in this manner, the patient understands what is expected and the test can provide helpful data. For example, if a large scotoma in the dominant eye overrides the better nondominant eye, the patient probably will require occlusion of the dominant eye. If the dominant eye is the better eye, it will override the poorer nondominant eye, and the patient can benefit from binocular correction. Tests of contrast express the functional level of retinal sensitivity more accurately than any other test, including acuity. Of the available tests for contrast sensitivity, the Mars test using letters arranged on three 14 × 19 charts in 8 rows 999 2 of 6 letters each is rapid and accurate (Figure 24–2). Regardless of acuity, if contrast is subthreshold or in the severe loss category, the patient is less likely to respond to optical magnification. Simple color identification tests are done if the patient’s complaints include difficulty with color cues. Graded text is then presented to establish reading skills with the selected optical devices. Near-vision test charts, including the Lighthouse Continuous Text Cards for children and adults. A rule of thumb for the starting power is to calculate the reciprocal of visual acuity—for example, an acuity of 20/160 suggests a starting lens of 8 diopters (160/20). Keep in mind that visual acuity is not a particularly sensitive measure of function. Scotomas within the reading field and the contrast sensitivity of the paramacular retina have a greater influence on ability to read magnified print through an optical lens. After the dioptric range has been agreed upon, the three major categories of devices are presented in sequence in the selected power. Lenses in a spectacle mounting are presented and evaluated first, followed by hand-held magnifiers and, third, stand-mounted magnifiers. Telescopes and television or computer designed devices are increasingly prescribed as the population becomes more sophisticated in the use of advanced technology. Attention should be paid to daily living activities, which can be complemented by low-vision lenses but may also require referral to an agency for the visually impaired. The patient uses the various devices under the supervision of an instructor until proficiency is achieved. The patient is allowed ample time to learn correct techniques in one or more sessions and possibly provided a loaner lens for home or job trial. Older patients usually need more adaptation time and reinforcement than younger or congenitally impaired persons. Practitioners and staff benefit from training programs to learn how to manage a low-vision patient in the office. Basic setups for incorporating low vision into a practice are reviewed in a number of publications. If minor problems arise within the first few days after the appointment, they can usually be resolved by telephone. C: High-power reading spectacles with prisms to reduce the requirement for convergence. A: Reading and writing guides, marking devices, pill organizer, and liquid level indicator. The main advantage of spectacle (Figure 24–4A) and spectacle-mounted magnifiers (Figure 24–4B) is that both hands remain free to hold the reading material. They require the reading material to be held at the focal distance of the lens, for example, 10 cm for a 10-diopter lens. Increasing lens strength shortens the reading distance and increases the tendency to obstruct light. Patients with binocular function may use 4 to 14-diopter spectacles with base-in prisms to reduce the requirement for convergence (Figure 24–4C). Dome magnifiers (Figure 24–4D and E), which are placed directly on the reading material, also allow both hands to be free, always provide a focused image, and maximize illumination, but the amount of magnification is limited, and there may be problems with distortion and light reflection. Hand magnifiers (Figure 24–4F–L) that can have colored illumination are convenient for shopping, reading dials and labels, identifying money, etc. They are often used by older people in conjunction with their reading glasses to enlarge print. The advantage is a greater working space between the eye and lens, but holding a lens may be a disadvantage for a trembling hand or stiff joints. Stand magnifiers 1009 (Figure 24–4M) are convex lenses mounted on a rigid base whose height is related to the power of the lens, for example, a 10-diopter lens is just under 10 cm from the page, writing on the material being read being possible with the lower magnification devices. Because the lens mounting may block light, a battery-powered light may be helpful. All telescopes share the disadvantage of a small field diameter and shallow depth of field. The simplest device is the hand-held monocular telescope (Figure 24–5A) used for short-term viewing, particularly of signs. For close tasks and vocational or hobby interests, telescopes mounted in (Figure 24–5B–D) or clipped on (Figure 24–5E) a spectacle frame are practical but difficult to use above 6×. They are traditionally called “nonoptical devices,” although “adaptive aids” is probably a better term. In daily life, difficulty in reading is not the only frustrating experience for the low-vision person. Cooking, setting thermostats and stove dials, measuring, reading a scale, putting on makeup, selecting the correct illumination, identifying banknotes, and playing cards are only a few things that sighted people take for granted. Many devices are available for the visually impaired to assist in performing these tasks. The field is expanding rapidly, and it is important to keep up to date with available aids and resources. Light or medium gray lenses are prescribed to reduce light intensity, and amber or yellow lenses improve contrast and reduce the effect of short-wave light rays (Figure 24–7). Devices designed specifically for low-vision patients offer nonchangeable filters and photochromic (variable intensity tint) lenses. An additional antireflective coating should be considered for glare-sensitive patients.
Child says diabetes 11 buy 500mg actoplus met overnight delivery, "Syphilis exerts its usual baneful influence diabetes test generic 500 mg actoplus met, but gonorrhoea is responsible for more pathological (diseased) lesions (conditions) in the female pelvis than any other one factor diabetes symptoms itching purchase actoplus met uk. Its attack diabetes test when your pregnant purchase actoplus met master card, if not resulting in ultimate loss of life, always leaves the tissue in an impaired condition, from which resolution (returning to natural condition) is rare. It is doubtful if a woman once infected with gonorrhoea ever recovers from its ravages. Foul, putrid discharges from neglected supports (pessaries) and tampons in the vagina; sloughings from cancer may act as exciting causes. Mothers often allow soiled, foul smelling diapers to remain for a long time on the baby. The glands of Bartholin and those around the urethra may become infected and fill with pus. The fatty glands of the labia majora are also sometimes affected and then appears the disease called Follicular Vulvitis (in the chronic stage secretion is abundant). When the disease is caused by gonorrhoea it is more extensive and involves the vagina, urethra, the glands around the urethra and glands of Bartholin. The parts should be kept constantly moist with a wet antiseptic dressing, listerine, hot water, etc. If there is much pain the following solution may be used: Acetate of lead 1 dram Laudanum 1/2 ounce Water enough for six ounces. Child says, "The vulva should be shaved, thoroughly cleansed and a mild ointment applied daily thereafter," such as: Salicylic acid 20 grains Oxide of zinc 2 drams Petrolatum enough for 1 ounce Mix and make an ointment and apply daily. If it is due to irritating discharges that cannot be checked, cleanse the parts thoroughly and use the Zinc ointment to protect. With the itching there is more or less swelling of the parts and extreme nervous irritability. Diabetes, gout, irritating discharges from the vagina and rectum should be removed. Internally the bromides to quiet the nerves and arsenic to build up the system should be given. The duct (canal) of the gland of Bartholin, situated in the labia majora, sometimes closes and the secretions of the gland are not cast out, thus forming the cyst. These cysts may be attacked with an acute inflammation and finally pus is formed in them, and a very painful abscess is the result, Symptoms. Then there is an acute local pain, quite tender on pressure, and often high fever. If it goes on to an abscess, a free cut should be made, the abscess scraped and good drainage given. This form is hardest to cure and may continue for years or life, the infection may extend to the womb, fallopian tubes and peritoneal cavity and produce inflammation of the womb (endometritis) pus in the tubes, (pyosalpinx) and peritoneal cavity. There is a feeling of heat and burning in the vagina, and a copious discharge of mucus and pus. In gonorrheal variety the symptoms date from a distinct onset, last longer, do not yield so rapidly to treatment, and complications, such as enlarged glands in the groin and in the vulva and vagina, inflammation of the lining of the womb and fallopian tubes, inflammation of the bladder, often make their appearance early. If the gonorrheal poison is present in the pus, the walls of the vagina, cervix and cervical canal should be dried and thoroughly painted with a twenty per cent solution of nitrate of silver. In chronic cases the gonorrhea poison (gonococcus) is found most frequently just behind the posterior lip of the cervix and here the silver solution should be applied very thoroughly. If there is no local irritation, the opening should be dilated under an anesthetic. Very hurried, quick labors cause it sometimes, but the greatest injuries are due to the various operations for delivering the child through a cervix that is not fully dilated. When the tear has extended through the internal opening the woman win not be able to carry the child to full term, even if she becomes pregnant. If not then, and if it does not heal, it should be repaired later when the tear extends through the internal (opening) or in case of extensive raw surface on the cervix. The acute form is seen most often as a part of a general infection involving both womb and cervix, and will be described later. On examination a string of thick mucus is seen at the external opening (os) of the cervix; and of women who have borne children there are usually signs of tear and rawness of the cervix present; (Endometritis usually produces a thin watery discharge, while gonorrhea produces a thick, pus-like discharge). White oakbark tea used as an injection once a day for this trouble; also good for vaginitis. The most frequent exciting causes are the microorganisms, like the gonorrhea poison, etc. In severe cases the whole mucous lining is destroyed and the deeper muscular tissues of the womb are invaded. A purulent (pus) discharge appears early from the cervix, usually about the second day, and difficult and burning passing of urine are early symptoms. There is inflammation of the vagina accompanying it in about fifteen per cent of the cases, while inflammation of the fallopian tubes, pus in the tubes, and local peritonitis are common results. In case of hemorrhage this bath is invaluable, and will relieve when all other means have failed. Dose:-Two drops in a half glass of water, tablespoonful doses every ten to thirty minutes according to the severity of the case. Child advises that the cervix be dilated, and the interior of the womb, cervical canal and vagina swabbed out with a ten per cent silver nitrate solution. Subsequently vaginal douches (1 to 5000) corrosive sublimate solution followed by a salt solution, one dram of salt to a pint of water, should be given for at least one week. The face looks flushed at first, but it soon becomes pale and the patient has an anxious look, as the disease goes on. The discharge that always follows labor is diminished or stops and has no odor, if there is any discharge. The womb should be washed out with a hot salt solution, one teaspoonful of salt to one pint of water, and then packed with ten per cent iodoform gauze. The bowels should move freely, and if necessary injections may be given for that purpose. Milk, brandy and strychnine, if necessary; 1/100 of a grain of strychnine can be given every four hours. Milk should be given every half hour, about two ounces at one time: or more if it agrees well. The gauze should be removed gradually, beginning on the third day and ending on the ninth day. In this disease the interior of the womb is smooth and contains no broken down or foreign tissue. In the next disease, Putrid Endometritis, it is far different, for this is caused by the presence of dead material, such as parts of the after-birth, left in after labor, or sloughing tumors. This material becomes putrid (rotten), and thus causes the disease called "Putrid Endometritis. The fever is high, pulse bounds and feels hard and strong, the face is flushed but there is little or no pain. This must be done carefully and with perfectly clean tools and liquids of every kind. After this pack the womb with ten per cent iodoform gauze, which may be bought in this strength. The patient can be given whisky or brandy and 1/60 grain of strychnine every four hours if needed. Tears and erosions (scraping off and making raw) are supposed to act as direct causes. After the change of life (menopause) is over if bleeding occurs and continues it is a very bad sign and the womb should be examined immediately. Later, a watery bloody discharge appears, with pain, loss of weight and general weakness. If the case is too far advanced, the only thing to do is to make the patient as comfortable as possible. For the discharge, hot water and corrosive sublimate (1 to 2000) is the strength to be used. Cancer of the Body of the Womb is found in only about two per cent of womb cancers. The chances of obtaining a cure if operation is done is better even than in cancer of the neck of the womb. There is less chance for the adjoining structures to be affected so early and readily. Few blood vessels appear in the tumor, nourishment being received from the surrounding tissues.
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