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handicap of the resident physicians in handling pa- tients, and has nothing but praise for their indi- vidual efforts to systematize their work on a scien- tific basis; and it is to be hoped that their effoHs Vv'ill be expressed in constructive creations. No attempt is made to give the analysis of the waters used in the several bath houses, for they are essentially Order Nortriptyline Online similar in composition and vary but little in saturation. They are obtained from wells ranging from 800 to 1,300 feet in depth. They are strongly impregnated with salines, chiefly with the chlorides of calcium, sodium, and magnesium, Nortriptyline 25 and with Nortriptyline Mg hydrogen sulphide and carbonic acid gas. The degree of saturation averages from 11,000 to 12,000 grains per gallon. They are classified as sulpho- saline and are used for what may be called the Mount Nortriptyline 10mg Clemens bath. This is a hot tub bath of ten or fifteen minutes' duration, rubbing being practised during its pro- gress in suitable cases. This usually is followed by a pack and in some cases with fomentations to local parts, and then a spray, brisk rubbing, and drying. The patient then is allowed to cool in a rest room. The actual time spent in administering this treat- ment averages about thirty minutes. I'he physiological action of the baths is brought about by the salts and gases in solution. The skin reactions are local and reflex — a soothing effect upon the epidermis and a promotion of peripheral Buy Nortriptyline Online circulation because of the dilatation of the super- ficial capillaries and arterioles. Because of the thermic effect, a profuse diaphoresis is brought about and prolonged by the use of the pack and fomentations. The chief action of the baths being eliminative and as a promoter of elimination through the cnuinctories, it follows that their greatest value is in conditions due to faulty elimination where the tox- ins, of either endogenous Generic Nortriptyline or exogenous origin, have. =0 to speak, mobilized, overwhelmed the organism because of the neutralization of the enzymes, an- tibodies, and what not, and precipitated disease entities, such as the rheumatisms, gout, skin dis- eases, the so called autotoxic conditions, alcohol- ism, the neuritides, and Buy Nortriptyline industrial or occupational diseases. Accessory measures are too few and inadequate in number and variety. Additional apparatus for electrotherapy, mechanotherapy, and control tables for the various douches and showers are needed. On the whole, Mount Clemens may be said to be primitive and not to have been developed in keeping with its advantages. The waters are particularly useful and. with the aid of the proper accessory measures, their efficacy could be improved consider- ably. Facilities for the accommodation of several Nortriptyline 10 Mg hundred guests are available and the bath capacity is adequate for the number accommodated. It is ac- cessible, via Detroit, from the probable Nortriptyline 25mg ports of de- barkation. Climatic conditions may be a little se- vere in winter, but do not detract materially from the advantages. The elevation is 602 feet. {To be concluded.) Nitrous Oxide in Childbirth. — Moses Salzer (Ohio State Medical Journal, July 1918) draws tliese conclusions: Nitrons oxide can be safely used for hours without fear of any immediate or remote danger to mother or child. 2. Its effects are under absolute control at nil times. 3. The mother re- Cheap Nortriptyline covers from the confinement with a clear mental state and without any unpleasant recollections. 4. The babies when born are of good color. 5. It is successful in the elimination of pain when properly administered in practically every case. 6. It does Nortriptyline 25 Mg not retard labor and cannot therefore be a cause of uterine inertia. 7. Cyanosis must be carefully avoided. 466 MEDICINE AND SURGERY IN THE ARMY AND NAVY. SOME NOTES ON DRUGS AND TREATMENT. A Review of Recenl Progress in Therapeutics. By Mark S.'Ujler, M. D., Montreux, Switzerland. IV. THTi TREATMENT OF INFECTED WOUNDS.

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