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brought in ; three punctures were made on each arm : vaccina- tion again failed ; but four weeks after the attempt a red swelling appeared on two generic zithromax no prescription of the spots where the punctures had been made ; these soon ulcerated, increased in size, and a greenish crust was formed ; the crust still remained, when I saw the child in November. The child was much emaciated, its body covered with generic zithromax z pack an {papulo-vesiGuleuse) eruption, generic zithromax price the axillary cheap zithromax and cervical ganglions obstructed. This child died. Such are some of the facts — the others were all similar. If any one has doubts, gentlemen, I regret he did not accompany me on this sad pilgrimage tlu-ough the homes thus visited safe order zithromax online by vaccinal syplwlis ; he would, I think, have been convinced. These two kinds or sorts of vaccinal syphilis have, therefore, entirely different characteristics. In the evoked or developed vaccinal syphilis, one single case may occur out of a large number of vaccinations generic zithromax z pak effected on the same day. Tlie first thing that takes place is the trans- 636 CLINICAL EECOKDS. formation on the s^ot, from the twelfth to the fifteenth day, of the vaccinal generic zithromax 250mg pustule into a pseudo-chancre, which is imme- diately followed zithromax-cheap.net by all the other symptoms of syphilis. If inquiries are made as to the origin (or source) of the vaccine, the child is said to be healthy ; but, should the investigation be followed up, it is found that one or the order zithromax over the counter other of the parents has been syphilitic, and sometimes also that the vaccinated child has had syphilitic s^miptoms at the time of its birth, but which have since disappeared. In inoculated YSiC,dixi2^. syphilis, on generic zithromax (azithromycin) the contrary, when sev- eral persons are vaccinated on the same day, all or almost all are affected at the same time ; the vaccine follows its regular course, and even reaches so far as cicatrization ; but on the twenty-fifth to the thirtieth day one or more of these cicatrices will break out into a pimple {papule), which is the starting- point of an indurated chancre. This specific ulceration heals but slowly, and is accompanied by an indolent ganglionary obstruction {engorgement ganglionnaire), and in about six weeks, that is to say, two or three months after vaccination, the secondary symptoms of syphilis will appear. Should the origin of this unfortunate operation be sought after, it will appear, like the above facts which took place at the Acad- emy, that the child from whom the vaccine was taken was evidently syphilitic, while those who were vaccinated were cheap zithromax online perfectly healthy before the operation, and belonged to healthy parents. For us, gentlemen, who are perfectly convinced of the ex- istence of real danger in Jennerian vaccination, we know of no certain and practical means of avoiding it ; every thing that has been proposed is uncertain and ineffectual. Animal vaccination alone gives us a logical and practical solution of the difficult problem. II. — Conservative Surgery in Minor Operations. By A. P. Grinnell, M. D. John Hunter believed that the surgeon who practised amputation of any part of the human body acknowledged his ignorance or want of skill, for he should have possessed the CONSERVATIVE SUEGERY IN MINOR OPERATIONS. 637 knowledge or power of saving the wliole, not destroying a part. It would, indeed, be gratifying to the surgeon who is called to amputate at the thigh for injury below the knee, if he possessed the ability of instituting a course of treatment which would result in perfect restoration of the whole limb. Con- servative sngery has accomplished much in checking the wholesale destruction of diseased or injured parts, order zithromax online no prescription and taught the surgeon to wait, withhold the knife, and order zithromax canada observe the power of Nature to eflfect a cure. Formerly, the universal treatment followed for inflammation of a joint was amputation above the afi'ected part ; now we know a limb is seldom, if ever, lost, even if the knee or ankle-joint has suffered severe injury. In proof of Nature's capability in effecting generic zithromax cheap restoration of injured, even mutilated joints, I would cite two cases which have re- cently come under my observation : Case I. — A lad, aged fourteen, of a vigorous, healthy con- stitution, received a severe wound on the right hand by a cir- cular saw. buy cheap zithromax online Upon examination of the injury, I found that the saw had entirely severed the third order zithromax for chlamydia finger, with the exception of a little cuticle which held the end suspended between the first and second articulation, had disarticulated the first and second phalanges at the second joint, and, besides, injured the soft parts in different portions of the hand. My first thought was, to finish the amputation generic zithromax 500mg of all dependent portions, but, upon reflection, I "determined to afford Nature an opportunity of showing her skill in establishing a union of these lacerated tissues. The subsequent treatment involved much care and attention, but the result was sufficiently gratifying to reward the effort of preserving the whole hand. "We have been taught that in all injuries of this character, where union has taken place, sensation was lost and the power of motion considerably impaired ; but in the above case bone united firmly with bone, tendon with tendon, nerve with nerve, and the circulation of blood was fully restored. Sensation is perfect beyond the point of injury, and, to have secured this result, nerve must have unit- ed with nerve, for the amputation of all sensitive portions was complete. The can you order zithromax online power o£ motion is order zithromax online uk also preserved, although not perfect in one finger, owing to anchylosis of a joint.

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