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His morning temperatures were normal, the evening varying from 102° to 103-5°. Repeated examinations of his lungs failed to reveal any pulmonary difficulty. Early in September he began to have a muco-purulent expectoration, and slight dull- ness was discovered at the apex of his left lung, with infiltra- tion of bases of both sides. September Sth. — Rectal examination revealed the prostate larger than at previous examination, and studded how much does imitrex cost with small nodules; no softening. His cough had become distressing, and his expectoration profuse and purulent. By the end of the month be had sunk into a semi-comatose ctmdition, was ex- tremely emaciated, and died, exhausted and worn out by his sufferings, on the 29th of the following October, just a year from the supervention of his first symptoms. At the autopsy the lungs were found to be the seat of gen- eral tubercular deposit, and contained several cavities. The alimentary canal and mesenteric glands were norm.il. Both kidneys were tubercular, the left, however, containing only a few caseous foci, averaging about 1 cm. in diameter, while the right was one mass of disease. All the imitrex cost per pill pyramids had been converted into cheesy, tubercular masses. Only a few points of healthy tissue remained, and these were limited to the cortex. The pelvis and ureter of the right kidney were also tubercular and thickened, their mucous membrane being con- verted into a soft, cheesy layer. The bladder contained a green- ish muco-pns, and its membrane was thickened, degenerated, and studded with small nodules from 1 to 2 mm. in diameter. The prostate was also tubercular. This case undoubtedly began as a tubercular affection of the prostate or bladder, and ended with tubercular kidney and pulmonary phthisis. I quote it because it is so pure a type of its class, occurring in a perfectly healthy temperate man of middle life, and probably aggravated by the imitrex generic no prescription injury to his generative organs consequent on his fall. Had price imitrex nasal spray the original starting-point of his disease existed as a cheesy de- posit in his epididymis or testicle, the result would have undoubtedly been the same, and this buy cheap imitrex online is the point to which I am anxious to draw attention, because I believe that upon its rcc(>gnitii>n depends the imitrex cost canada safety of buy imitrex online uk many buy imitrex online canada patients afilicte.l with tubercular epididymitis or orchitis. Authorities all Si ROCKWELL: TUBERCULOSIS OF TEE OENITO-URINART TRACT. [N. Y. Med. Jocr., recognize the undoubted relation between the two diseases. Ebstein says: "Sometimes the caseous inflammation begins in the mucous membrane of the bladder, and thence ex- tends uninterruptedly through imitrex generic release date the ureters to the kidney. In exceptional cases the prostate may be the starting- point of the disease. By far the most frequently, however, the primary cheesy inflammation is seated in the testicle and epididymis, and the process is conducted to the kid- ney, either by direct continuity of tissue — the spermatic cord, prostate, bladder, and ureters being in turn involved — or discontinuously, one or all of these parts remaining unaffected." With this view Van Buren, Roberts, and other writers agree, and the pathological text-books are filled with clinical evidence supjsoiting not only this view, but that which re- gards caseous foci of the genito-urinary system as extremely liable to be followed by general or pulmonary tuberculosis, and yet the treatment of the primary lesion based upon this conclusion seems singularly inadequate from a surgical point of view. Iron, tonics, cod-liver oil, hygiene, price imitrex without insurance and fresh air imitrex cost us are universally recommended, with the hope that the patient may recover his general health, and so find a termination to his disease ; or that the formation of a capsule about the caseous masses, thus preventing absorption of infecting sub- stances, or the rarer termination in cretefaction of the in- flammatory products, is there a generic form of imitrex remove their power to injure. How little dependence can be placed upon these hopes in the great majority of cases so treated, experience amply testifies. Sooner or later buy imitrex nasal spray online the patient develops a progressive series of symptoms, whose beginning and end we are all familiar with : Inflammation of the organ involved, break- ing down of the cheesy masses, destruction of the surround- ing tissue, abscess, ulceration of the overlying integument, prolonged and exhausting suppuration, during which the patient retail price imitrex is in constant danger from the supervention of tuber- culosis best price imitrex of the kidney or lung, and terminating finally in the removal of the organ involved, when, perhaps, the other testicle is already affected, and the patient's shattered health renders him unable to withstand the inroads of a fresh dis- ease. Certainly, if good results are occasionally attained by, or rather in spite of, the treatment just mentioned, they are found among the wealthier class of patients, whose means enable them to secure all the benefits which may accrue from removal to fresh country air and abandonment of all depressing influences. In this buy imitrex injection online class, however, the disease is comparatively rare, and it is among the poorly nourished and badly housed patients who seek our charitable institutions that it is commonly found. To the latter neither time nor opportunity is afforded for " leading an easy out-door life in the country," or " fleeing to the sea-side or a Southern climate." They can not even, a.s one author recommends, " observe all the conditions of physical hygiene suitable to tubercular cases," and, as the same author fitly observes, "their cjute is sad indeed." All practical [iliyHicians know how Hmall a proportion of those suffering from pulmonary pbtliisiu receive any marked imitrex available generic form benefit from risideticc in a liOHpital ward ; indeed, in many cases the moment of admis- nion tnarkH a fresh invanion of the disease or exacerbation of iiymptomd already existing. What in yenerally true of these cases is especially so in regard to tuberculous disease of the imitrex generic form genito-urinary tract, and expectant or simply local treatment usually ends in disappointment. It is for this reason that I believe the treatment of tu- berculous testicle should be that of strumous disease of any other gland, and that early removal, either of the caseous masses or of the whole diseased organ, should be more gen- erally practiced than at present. The first indication — that of removal of the cheesy masses — may be easily accomplished by means of the blunt curette, used through an incision over the softened masses, and can be practiced at an early stage of the disease, and price imitrex

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