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DELAVAN: TERTIARY ULCERATION OF THE TONHIL. 769 16th.— Tofranil Price Until last week the eruption had been grad- ually disappearing on the body as she has had the attacks of epistaxis, the last attack being three days ago. She now feels very miserable, and has six well-marked petechial patches on the limbs. Examination of the fauces disclosed the first appearance of the petechial rash on the mucous membrane of the palate and poste- rior pharyngeal wall — this, so far as ascertainable, be- ing the first time the blood has extravasated into the m\icous membranes. The pharyngeal vibices were two in number, situated almost in the median line, dark red in color, and long and narrow. On the right side of the fauces and directly over the anterior pillar was the most conspicuous spot, being a quarter of an inch long and about a millimetre and a half in width. These vibices followed the usual course, as Cheap Tofranil observed when they appeared on the cutaneous surface, and while they ex- isted nasal hfemorrhage was in abeyance. February 9th. — Have not seen the case since the last date, as she was feeling much better; her general condi- tion is excellent; Tofranil Online no htemorrhages into the skin or mucous membranes, but has Tofranil Cost had two severe Tofranil 50 Mg attacks of epistaxis. The thyreoid gland is diminishing in size, but the exophthalmia remains Tofranil Tablets the same. 18th. — Has had nasal bleeding since the 16th, the blood dripping from both nasal apertures. Purchase Tofranil She has done nothing to arrest the flow of it, and it has con- tinued for two Tofranil Uses days; it would apparently cease for a short time, then continue for several hours. Tannic- acid tampons were applied to control it. 23d. — Has had no epistaxis and but few small pur- puric spots since last Tofranil Mg report, and is much better in all respects. 25th. — No epistaxis until this morning at eight o'clock; it occurred while she was sweeping, lasting until 1 p. M., when the bleeding was controlled with tannic acid. March 2d. — -Bleeding now only occurs when she blows her Buy Tofranil Online nose with much violence, and then lasts but a short time, gradually lessening in amount, but still very difficult to control. 18th. — But one slight attack since last date; no pur- pura; thyreoid gland reduced at least one half; general condition excellent. 25th. — Says she is nearly well, and has had no spots or nasal hfemorrhage since last date. April 2Sth. — Thyreoid nearly normal, and no other trouble. She considers herself cured. Since last date she has been in very good health and can not be in- duced to continue treatment. As before mentioned, the diagnosis of the case was extremely difticult, the choice lying between exoph- thalmic goitre, purpura hemorrhagica, peliosis rheu- matica, and hemophilia. Peliosis rheumatica could readily be Purchase Tofranil Online eliminated by the Generic Tofranil character of the cutaneous lesions, the absence of multiple Tofranil Pm arthritis, and its acute course, as in our patient there was no rise of tempera- ture at any time, and the disease ran more or less of a subacute or chronic course, and, although weakening the patient from excessive nasal bleedings, did not confine her to bed. The symptom complex of exophthalmic goitre, of course, was present, but that had existed before the pa- tient came under our observation, and we are not di- rectly concerned with that aspect of the case in this Order Tofranil Online arti- cle. Practically, we are narrowed down in our diagnosis between hsemophilia and purpura hsemorrhagica. That the case was one of the latter disease, superadded upon a woman the victim of hereditary hieniopiiilia, must be received with a proper amount of respect. Order Tofranil In favor of the former disease was the history of the case in regard to hereditary bleeders being in the family, her brother being a marked case, while her own case showed- the subcutaneous and submucous collections of hismic material. I also ascertained that several years previous to the present illness she lost considerable blood from having a tooth extracted, the dentist having great diffi- culty in controlling the bleeding. Add to this her previous (indefinite, it is true) history of rheumatism, and we have considerable evidence in favor of hienio- philia. In purpura hemorrhagica, or the morbus maculosus of Werlhof, the bleeding from the mucous Buy Imipramine Online membranes is Buy Tofranil usually very severe, and the disease is seen in young and delicate persons. Buy Cheap Tofranil In this case the patient was a strong and well-developed Buy Imipramine woman. In purpura there is weakness and other evidence of systemic involvement

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