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Related post: that he thinks it would be of great interest to record the follow-
ing case, as in the present incomplete state of our knowledge of
this and allied conditions the period has not yet arrived when
such records are superfluous :
The patient, Propecia Sale Online a mule infant aged five weeks, was brought to
the ont-patient department of the Hospital for Sick Children at
Great Ormond Street on November 5, 1894. The mother, a
healthy looking woman, stated that this was her third child.
Of the other two the elder was strong and well, but the second
died in consequence of a fall at the time of its Ordering Propecia No Prescription birth. The last
pregnancy was preceded by a miscarriage at the third month.
The father was said to be healthy. The family occupies three
rooms on a first floor and no history of privation was obtained.
The infant was born at full term, the head presented, and there
was no particular difficulty at the birth except that the ha?mor-
rhage was somewhat excessive. He was a well-nourished and.
except in one respect, a healthy child. There was not, and had
not been, any rash upon the buttocks or snuffles. The child
was being nursed by his mother, who had an abundant supply
of milk, which he took reguhirly and well. The back of the
infant Order Propecia Generic presented a remarkable induration, which extended, like
a kind of carapace, Propecia Sale Uk over almost the entire dorsal aspect of the
body, involving the deltoid regions and upper arms, the but-
tocks, and the thighs down to and including the popliteal
spaces. The skin of the face, of the front of the trunk, and of
the limbs was perfectly soft and natural. The edges of the in-
durated area were sharply defined, irregular, and maplike, and
there was nowhere any tendency for the hardened parts to
merge into the healthy parts. The skin over the affected parts
was stretched, but not shiny, and in places exhibited a pink
mottling; it could not be pinched up between the fingers; pres-
sure produced no pitting, but merely rendered the surface pale
for a time. The distribution of the induration was remarkably
symmetrical. The legs could not be fully extended either at the
hips or knees, and when extension was attempted the skin in
the popliteal spaces became very tense and shiny. There was
no swelling, oedeuiatous or other, of the hands or feet. The
child was good-tempered, and the examination did not appear
to cause it any pain or discomfort. There were no signs of any
disease of the heart, lungs, or other viscera, and there was no
intestinal disturbance. The urine was not examined. It was
stated that the induration upon the buttocks was noticed im-
mediately after birth, and the places were at first of a deep pink
color. During the first nine days of life the hardness spread
down the Buy Propecia Online Canada thighs, but as Propecia Sale Canada far as could be ascertained the exten-
sion to the back and arms only took place during the fifth week.
Just before the infant was brought to the hospital, by which
time the color of the affected parts had Propecia Canada become much paler
than formerly. Xo history of any surface exposure to cold air
or water could be obtained. Inunction of a drachm of cod-liver
oil night and morning was prescribed. On November 12th, a
week later, the induration in the dorsal and Propecia Cost lumbar regions
was ratlier less marked, but there was no noticeable change in
other parts, except that the redness had practically disappeared.
The general health continued good, the infant sleeping and tak-
ing his food well. There was no coldness of the skin or ex-
tremities, and the temperature taken in the rectum was it8"2°
F. On this date inunction of blue ointment was ordered in
place of the cod-liver oil. By November 19th there was de-
cided improvement in the local condition. The skin of the
back, although it appeared stiffer than that of the normal parts,
no longer exhibited marked induration ; the hardness in the
deltoid regions had disappeared, Ordering Propecia Online but a small patch Cheap Propecia Online remained
upon each upper arm. The hardness of the buttocks and backs
of the thighs — /. «., of the parts first affected — was as distinct
as ever, but had somewhat diminished in extent, and the hide-
bound condition in the popliteal spaces was less marked. Propecia Sales It
was a noteworthy fact that as the induration cleared Ordering Propecia From Canada Online up it did
not merely shrink at its borders, but isolated patches were left
which had become detached from the main area. Moreover, no
pitting could be elicited in the regions in which the affection
was clearing up. On November Stith further improvement was
evident. A very small patch of induration was noticed in the
left parotid region, which bad probably been previously over-
looked. On November 29th the rectal temperature was 99°,
and the induration had still further diminished in extent. On
December 13th there were still isolated patches upon the upper
arms and extensive induration over the buttocks. On this date
the inunction of mercurial ointment was stopped, and that of
cod-liver oil was ordered to be resumed. On January 31, 1895,
there was only a small patch of induration upon the outer sur-
face of each thigh and the child could extend its legs well.
June 8, 1895.]
MISCELLANY.
733
The arms and back were entirely free. By March 14th the in-
-duration had completely disaiipeared ; there was a slight coufrli-
but no abnormal signs were detected in the chest. The infant
was good-tempered, well nourished, and slept and took the
breast well. On April 18th the child weighed fifteen pounds
and three quarters. The temperature in the rectum was 99-4°.
From the typical eases of sclerema neonatorum, upon which
the descriptions contained in the text-books are mainly based,
says the author, this case presents certain well-marked ditFer-
«nces, which, after all, are differences of degree rather than of
kind, and which may be briefly Propecia Coupon summed up as follows: 1. The
ohild, instead of being weakly at birth, was, with the exception
of the local condition, in excellent health ; and he had not suf-
fered at any period of his brief existence from any pulmonary
or intestinal disorder. 2. The temperature Propecia For Sale as taken in the rec-
tum was at no time exceptionally low, whereas in severe cases
the depression of temperature is one of the most conspicuous
phenomena of the disease. The rectal temperature of 98'2'' in
the earlier stages probably indicated some depression, for it is
stated that in young infants the temperature is as a rule over
99°, and on later dates the temperature was always somewhat
higher in this case. 3. The induration after spreading in the
earliest weeks of life became arrested, and instead of succnmb-
ing to the disease the patient made a steady and complete re-
covery. Ifow the only recognized condition with which scle-
rema is apt to be confounded is the oedema sometimes observed
in newly born infants. There is no doubt that these two phe-
nomena have frequently been confounded, and such confusion
permeated the earlier literature of the Ordering Propecia subject until Parrot
clearly distinguished between them, pointing out that Cheap Propecia Uk Andry and
other French authors had applied Underwood's name of scle-
rema to a quite different condition from that which he in-
tended it to designate. Those who are interested in this ques-
tion, says Dr. Garrod, will find the differences between scle-
rema and oedema neonatorum clearly set out in Henoch's work
on the diseases Buy Propecia Canada of children, and in a paper by Dr. Ballantyne.
In their general condition infants which are the subjects of
sclerema and of Buy Propecia Online Usa cedema are apt to resemble each other some-
what closely, but the integuments of oedematous infants usually
pit on pressure, although when there is great tension of fluid
this character may be to a great extent wanting. Again,
whereas sclerema tends to begin upon the dorsal aspect of the
body and legs, and thence to spread to the remainder of the
surface, oedema is apt to appear in the hands and feet, and at
an early period involves the abdominal walls and the scrotum
or the labia. The author does not think that this case was one
of oedema, for the Generic Propecia For Sale following reasons: 1. There was no evidence
of syphilitic taint in the child, and the history of a miscarriage
preceding the pregnancy hardly suffices as evidence of this dis-
ease. There was no evidence of erysipelatous inflammation, of
visceral lesions, or of any recognized cause of oedema, i. The
distribution of the liardness and the manner in which it cleared
up, leaving isolated patches which persisted for a long time,
seemed strongly opposed to the diagnosis Ordering Propecia Canada of oedema. 3. The
absence of pitting on pressure, even in parts in which the in-

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