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in question. In other words, the defervescence may be the result of two causes — slot machine poker gratis the failure of the world series of poker plastic playing cards supply of toxin and the action of an antitoxin. It will be urged against this view of what takes place in the pneumonic lung that there is no neces- sary relation between the amount of lung involved and the degree of toxaemia. This is emphatically true as a simple proposition; but in this, as in all other forms of toxic infection, different persons show re- markable differences in susceptibility to the poison, and at the same time the poison itself online poker us residents varies extremely in virulence. To this we may add that in all proba- bility there are comparatively few cases in which a single form of organism is responsible for the affec- tion, most exhibiting two or more varieties of micro- cocci with differing infective energy. Furthermore, accepting the theory of an antitoxin, the period at which the formation of this substance begins in a given case and the rate at which it progresses become at once factors in determining the general condition of the patient at a given time. Keeping these points in view, we may safely say that, other things being equal, the systemic impression will be closely proportioned to the extent of the local invasion. Occasionally in the progress of a pneumonia gan- grene of a portion of the lung takes place. We may assume that in these cases a branch of the bronchial artery becomes involved in the process, thus shutting off the nutrient circulation from the corresponding area of lung tissue. That this online poker us ipad does not occur more frequently shows how passive is the role played by the pulmonary parenchyma. A process of less intensity involving the nutrient vessels would account for the permanent changes which are found in chronic pneu- monia, which is a true inflammation of the lung. Suppuration with the formation of abscesses in the lung tissue is now and play poker for fun again observed. This is prob- ably ilue to a mixed infection, in which other patho- genic germs take put with the diplococcus and pro- duce a more intense degree of local irritation. The evolution of new poker player stats tracker free germs having ceased, and the system having recovered in a measure from the de- pression oi the toxaemia, the process o\ removal of the exudate from the air cells begins, This is ... plished chiefly by absorption. In the course of a few days, if all goes well, the cell is entirely relieved of its contents, its walls remaining intact and read] play poker machine games for free E01 an immediate resumption of function. I'hc sum of the argument, finally, is that from its nli. 11 construction the lung is enabled :.<' field toi bacterial culture and to supply a culture me- dium, and this without calling upon its own nutritive resources or directly compromising its own tissues. It January 2, 1897] MEDICAL RECORD. is the fact that in the lung there are empty spaces ac- cessible game poker offline android terbaik to bacteria, and separated from an unlimited blood supply by only the thinnest and most permeable wall, that makes the phenomena of pneumonia possi- ble. It is the further fact that the free download game online zynga poker framework between these spaces has its own separate blood supply apart from the vessels involved in the pneumonia process that prevents a sweeping destruction of lung tissue. In rare instances in the course of pneumonia there is a simultaneous infection of a number of serous or synovial membranes. Such a case was the subject of editorial comment in the New York Medical Record for September 5, 1896. In this example there was effusion poker freerolls usa into the pericardium, into both pleura, into the peritoneum, into the knee-joints. The fluid in each of these situations was found to contain an abundance of pneumococci. In seeking for game poker offline di android an explanation of such general infection, we should need to go no further than to assume a destructive process, however limited. by which the interior of an air cell should be made to communicate with an adjacent vessel, thus throwing the contents of the cell, teeming with bacteria, into online poker sites usa mac the general current of the circulation. In conclusion, I grant that much of what I have said is of the nature of pure speculation. The evidence is mostly circumstantial. To what extent it will bear examination will, I hope, be determined by the dis- cussion that is to follow. Should the theory be sustained, if only in outline, it would follow that the us online poker sites for ipad most natural direction for thera- peutic effort would be that of attempting to poker game theory book render the exudate inimical to the development of micrococci. This might be effected by acting through the blood, but better and more directly by inhalations. Stipp, Theodore Clemens,' and others have reported very re- markable successes from inhalations of chloroform. It is true that these were employed with a view to us online poker news 2013 the seda- tive and anodyne effects, but insomuch as chloroform is a very efficient germicide (a small fraction of one per cent, being sufficient to sterilize a culture medium), math essay by chris ferguson about game theory and poker it may well be that the hastening of the crisis so gen- erally observed was due to this action rather than to the one the observers had in view. If given before the air cells were completely occluded, the chloroform would come into immediate contact with the exudate. and sterilization of the latter and arrest of germ devel- opment would result. In the single instance in which I have employed this treatment, defervescence took place on the fourth day, forty hours after the inhalations were begun. The patient was a lady, seventy-five years of age, and the pneumonia occupied the lower half of the left lung. The chloroform was diluted with half its bulk of alcohol, and was given for ten minutes of each hour. So much air was admitted that the patient experienced nothing more than a decided drowsiness during the in- halations and lasting for a few minutes afterward. Possibly other agents of a character to be inhaled might be substituted poker machine strategy australia for chloroform with advantage, but thus far this has been the only agent employed. As, according to Sternberg, the pneumococcus lan- ceolatus will not grow in a medium that contains the slightest trace of a free acid, it may be that the addi- tion of a volatile acid — such, for example, as acetic — in online poker for us players 2013 quantity not sufficient to be irritating, would add to the efficiency of the inhalation. Intracranial Lesions of otic origin are diagnosti- cated in only two-thirds of the cases, according to post-mortem statistics gathered by Weichselbaum in Vienna, and based upon over forty thousand autopsies. Four and one-half per cent, of deaths were found to be due to this cerebral affection. 1 Allg. med. Central-Zeitung, Berlin, 15 THESCRGICAL TREATMENT OF TUBERCU- LOSIS By HOWARD LILIEXTHAL, M.D., ; SINAI HOSPITAL, NEW VOl Many years before the discovery of the tubercle bacil- lus, scientific men had come to the conclusion that tu- berculosis was not a uniformly incurable disease. Cicatrices and calcified foci were found in the free download game poker online for pc lungs post mortem in subjects dead from other diseases, while enlarged and "scrofulous" lymph nodes, with or without suppuration, as well as joints affected with "white swelling," were frequently cured under general treatment directed to body nutrition, together with lo- cal measures whose object was rest to the diseased

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