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Related post: I believe the chairman refers when lie says that he has fre-
quently seen them. What I referred to was a pure Buy Pletal Online gelatinous
growth, characterized by stellate fusiform cells, often anasto-
mosing, imbedded in a homogeneous or finely fibrilluted, soft,
gelatinous basement substance. The case mentioned by Dr.
Swain is undoubtedly analogous to the one I have reported.
Probably in most cases the diagnosis is made from the macro-
scopic appearances, and is not confirmed by microsco])ic exami-
nation. I think that originally the growth may be a hyaline
myxoma, but subsequently undergoes a change such as 1 have
referred to.
Sjjfcml ll^rticlfs.
LETTERS TO MY HOUSE PHYSICIANS.
By WILLIAM OSLER, M, D.,
BALTIMORE.
Lktteb IV.
Erlamoen and WOrzburo.
Dear S. ; The university is Erlungcn — prncticiilly there is nothing
else in the little Bavarian town, which forcibly illustrates the great
truth that men make a seat of learning, and, if given proper fauilities,
will altiact students. It is surprising, liowever, in Pletal 50 a place of tliis size
to find BO large a hospital ; but many patients come from the surround-
ing country, and there is ample teaching material Pletal Cilostazol in medicine and sur-
gery, and even in the Cilostazol Pletal special brandies.
Striiiupell, who lias charge of the meciical clinic (whose text-book,
edited by Shattuck, has made his name well known iu America), is one
of the most industrious and progressive of the younger generation of
German professoi-s. His contributions to neurology have been most
important. The medical wards are well arranged, and we were shown
a series of instructive cases, several of great rarity. One in particular,
of acromegalia, attracted our attention, as it Buy Pletal was a most typical in.
stance — a woman, aged twenty-eight, looking over fifty, with large,
coarse features, apathetic expression, and enormous hands and Pletal 50mg feet,
which had been, with the face, progressively enlarging for years. The
reinaikable affeition seems rare in Germany, as it is with us. Ever
since the publication of Marie's paper I have been on the lookout for
cases, and searched in vain the chronic wards Pletal Tablets at the Philadelphia Hos-
pital. I have known of one case in Toronto for several years, and saw
a second in the same town with Dr. Bunitt ; both of these have re.
cently been described by Dr. I. E. Graham. 1 see that a special mono-
graph has just been published in Paris on the disease. Pletal Price
A case of rhythmical spasm of the psoas muscles in a middle-aged
man, which came on after a sudden paraplegia two years ago, was
rather a puzzler for diagnosis. The thighs were lifted witb each con-
traction, and there was a slight spastic condition of the legs. There was
evidently organic disease, but the case simulated hysterical rhythmical
spasm, an instance of which I remember was shown by Dr. George
Ross at the Medico-chirurgical Society of Montreal. Speaking of hys-
teria, Professor Strumpell sent for photographs of a remarkable case
which had recently been under his care, in which the girl had produced
extensive lesions of the extremities by cauterization, leaving sloughs
resemliling somewhat those of symmetrical gangrene. In my last letter
I referred to the heart disease induced by the combination of heavy
drinking and heavy work, and we found here in one of the wards a
most characteristic example : A man, aged about thirty-six, employed
in a brewery and accustomed for years to drink from twenty to thirty
litres of beer daily, began to suffer with shortness of breath, then a?dema
of the feet, and liually anasarca of the lower part of the body ; in this
condition he was admitted to hospital. The heart was much dilated
and a loud apex systolic murmur was heard. Under treatment and
rest the dropsy was subsiding aud tlie heart's impulse was much more
distinct, about two inches outside the niiiple line. This, Striimpell said,
was a common Pletal Mg history in the workers in the large Erlangen breweries.
At about the age of forty the breakdowu occurred, and usually with
heart failure, which proved fatal after two or three attacks. We ques-
tioned this patient — a most intelligent fellow — as to the quantity of
beer consumed daily by the men, and the figures I mention above repre-
sent, he assured us, an average allowance. As might have been ex-
pected from the good work which has been done here, there was an ex-
cellent collection of cases of diseases of the cord, including one of
syringomyelia, and of cases of muscular atrophy, and iu the clinical
laboratory we were shown many beautiful microscojiical sections, par-
tiL'ularly of the combined scleroses of the cord. Unfortunately, it was
not a clinic day, and we did not hear riofcssor Striimpell lecture (I had
hid that pleasure in Leipsic in ISSt), but after the hospital Pletal 100 Mg visit we
spent a couple of delightful hours at his house.
One of the men I was most anxious to meet in Erlangen was Pro-
fessor Zenker, the descrihcr of trichinosis in man, the discoverer of fat
embolism, and Pletal Cost the industrious worker at anthracosis and siderosis. He
was busy at a Staats-Exanien and could not give us much time, but his
son and assistant showed us the Pathological Institute, which, though Purchase Pletal
small, is conveniently ariangel for teaching. In the post-mortem room
we saw n rare termination of meiliastinal sarcoma. A man of about
forty, with signs of intrathoracic pressure, had died suddenly in the
wards. The entire mediastinum was occupied by a large sarcoma, which
completely surrounded the great vessels, covered over the heart, aud
had perforated the Pletal 50 Mg superior vena cava, into which masses of the soft
tumor projected. Death was no doubt due to extensive pulmonary em-
bolism. As is common in these mediastinal growths, there was exten-

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