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42 127 38 suprax 100 II 93; Deaths 159 25 27 6 5 225 antibiotic suprax The Cerebrospinal Fluid in Pernicious Malaria.— Nicola Pende has made a study of the cerebrospinal fluid in five cases of pernicious malarial fever of grave type, with reference to cytodiagnosis and physico- chemical characteristics. The amount of fluid drawn was never more than twenty cubic centimeters. In normal cases there is a great deal of difference in the pressure of the fluid, which in some cases comes out drop by drop, while in others it flows continuously. In the five cases examined the cerebrospinal fluid was altered in its physicochemical properties as well as in its cytodiagnostic phenomena. The osmotic tension is diminished. There is hypotonia in cerebrospinal men- ingitis, and the same suprax antibiotics condition is found in the nervous conditions of grave cases of malarial infection. There is also in some cases lymphocytosis, which makes the diagnosis from meningitis extremely difficult. The percentage of chlorides is diminished in malaria. To understand these changes we must consider the serious alterations of the endothelium of the capillaries that has taken place suprax cefixime and the suprax 400mg obstruction of many of them by parasitic thromboses which interfere with the nor- mal vascular circulation. There is a diminished mole- cular concentration of the fluid, lymphocytosis, and the presence of pigment and other poisons in the cir- culation.^ — /; PolicUnico. Treatment of Valvular Diseases of the Heart. — George Alurray Waters declares that in fully compen- sated conditions no medicinal treatment is needed ex- cept keeping the bowels well regulated. The patient must lead a quiet, orderly life, free from mental excite- ment and bodily strain. Tobacco and stimulants must be used purchase suprax in severe moderation if at all; and the skin should be kept active by daily sponge and weekly tub baths of short duration. Moderate exercise, though never to the extent of fatigue or embarrassed breath- ing, is indicated, but even this should be supervised by suprax cefixime 400 mg the physician in charge. Especial care should be taken in the management of the aortic heart defect, and the patient repeatedly warned against excesses of all kinds and especially sexual indulgence. In the condition of lost compensation, absolute rest is of the first import- ance. The clogged venous system must be relieved by depletion. This is best accomplished by the use of cathartics such as calomel, blue mass, or compound jalap powder. Digitalis alone or combined with strych- nia in moderate doses will strengthen, the heart force, regulat.e the rhythm, and add tone to the organ gener- ally. The writer adds that special symptoms, such as dyspnea, cardiac distress, gastric disturbances, cough, insomnia, and renal inactivity are relieved chiefly by means of the general rules set forth. Special treatment may be required in each according to the condition of the individual case. — The Columbus Medical Journal. Medical Record Vol. 70, No. J9. Whole No. 1879. A Weekly Journal of Medicine and Surgery New York, November io, 1906. $5.00 Per Annum. Single Copies, lOc. ©ngtnal ArtirlpH. A PLEA FOR A MORE RATIONAL THERAPY IN TUBERCULOSIS.* By F. M. POTTENGER, A.M.. M.D., MONROVIA, CALIPOKNIA. As long as tuberculosis was looked upon as heredi- tary, little or no headway could be made in its pre- vention. It was considered to be a matter of fate, and consequently surrounded by an air of hopeless- ness. The discovery of the specific cause not only paved the way for the overthrow of the heredity theory, but also made it possible for the disease to be discovered earlier than before, thus bringing it before tlie medical practitioner at a time when many cases are curable. Pathologists had seen evidence of healed tubercu- losis postmortem ; but now the profe.ssion is able buy suprax online to find the bacilli in the sputum and then see the patient get well. The evidence of the curability of tubercu- losis has been accumulating so ra])idly that we know the disease which was considered to be one of the most hopeless a quarter of a century ago is now recognized, not only as the most suprax 400 mg tablet curable of all chronic diseases, but the proof is overwhelming that. if diagnosed early and treated intelligently, it will afford a mortality even lower than pneumonia and typhoid fever. In spite of ali this evidence, we not infrequently hear jihysicians say that they never saw a genuine case of consumption get well. Such state- ments reveal not only a limited e.\i)erience with tu- berculosis, "for genuine cases of consumption do get well." but they also show a lamentable lack of appreciation of the most valuable lessons connected with this disease, viz., that tuberculosis can be diag- nosed early before breaking down occurs, and before the advent of that complex condition known as suprax antibiotic for children con- sumption, and that the earlier the fliagnosis the more favorable the case for treatment. That most cases of far advanced consumption die is suprax injections not evidence against the curability of tuberculosis, simply a rebuke to the carelessness of the i)atient in not seek- ing medical aid soon enough or to the medical attendant for not exercising sufficient skill to detect it when the disease presented. To-day the curability of tuberculosis is established. No one conversant with facts will deny it. P)Ut the question which will bear discussion is. are we curing as many of the cases as we should ? Are we curing as many as we can ? Are suprax cefixime tablets we doing as much in the suprax mg way of treatment of this disease as is possible, or are we falling into a dangerous rut ? .Are we wor- shiping at the shrine of fresh air. good food, and hygiene, and closing our eyes to many other impor- tant and helpful measures? Have we advanced only a degree bevond the fetiches of cod-liver oil and creosote to fail worshipers at the altar of fresh air? True, the advance is welcome. It is a wonderful *Read before the Arizona Medical Societv at its meeting in Phoenix, Arizona, April 24 and 25. 1906. improvement, but whoever would treat a disease so serious as tuberculosis should worship at no shrine except results. He should endeavor to use all rem- edies and measures which will aid in producing a cure. As a basis for such a discussion as this, it is well to inquire into the causes which lead up to a cure in tuberculosis. What is it that makes it possible for the organism to overcome the tubercle suprax injection bacillus and the results of its activity ? Osier is quoted as saying, "Make the patient fat and the local disease will take care of itself," thus making the cure a matter of nutrition. Great stress is laid upon nutrition by all phthisiotherapists, yet all who have had a wide experience know that it is not all. There are many exceptions to (Jsler's state- ment. ( )ften we see patients who are thoroughly nourished, and ^\\o are progressing favorably toward recovery, begin, through no indiscretion of their own, to go down. The disease does not "take care of itself." Nature cures most of her cases of infectious disease, in spite of a low grade of nutri- tion. The cure of tuberculosis is more than nutri- tion. If it were not, we would noX. see men in robust health become tuberculous ; yet every one of us has seen this occur. True, a well-nourished man does not stand in much danger, comparatively speaking, of becoming infected. The inoculation, 'if of a few germs only, will suprax tablets not produce the disease ; however, if there be a great number of germs of a low virility, or generic suprax fewer of a very virile strain, even well-nourished individuals will not be able to overcome the germs. Where tuberculosis has made anv considerable advance in the system, we have a tendency for it to spread. So many bacilli may invade new tissue at one time that no matter what the nutrition of the patient, the bacilli will gajn the dav. We, who fol- low these cases carefully, see this thing happen very often. So, if we can administer anv remedies which will increase the natural resisting power of the body and keep the healthy parts bathed in .scrum rich in antibodies, we are doing more than we can bv nutri- buy suprax tion alone. Modern studies in immunity show that bacterial diseases produce toxic elements, which stimulate the cells of the organism to the formation of defensive bodies, which thus tend to cure the disease. To this tuberculosis is no exception : however, for certain reasons, the discussion of which we cannot enter into here, the toxins in this do not seem to be set free in the proper manner to be efTective, so the disease does not limit itself when it has become well started. If this failure on the part of nature to furnish the natural stimuli for the cells can be supplied artificially, or if the defensive bodies them- .selves can be .supplied, then another aid to cure has been found. That the of certain culture products will sup- ply this want has been thoroughly established. The original tuberculin of Koch, his' later preparations, as well as numerous preparations made by other men, when used properly, will stimulate the cells of /^u the individual suffering from tuberculosis to the formation of defensive bodies, as is shown by the increase of the agglutinating and opsonic power of the blood. Further proof of their value is shown in certain cases of tuberculosis which fail to respond to ordinary open air, dietetic, and hygienic treatment, but improve at once when tuberculin is added to order suprax the treatment. There are also certain sera which seem to furnish the antibodies already formed which are of some value, the best known of which are the Fisch, Maragliano, and Marmorek. Aside from the matter of nutrition and culture products, we suprax generation can do much for those suffering from

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