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tender. The patient was ill nourished. The chest was long and bony, and scattered over the arms, legs, and back were some bright red maculopapules ; but expansion was fair. Anteriorly there was impaired resonance with blowing breath sounds at hoodia buy both apices. Posteriorly there was dulness at both apices, more marked on the right. Vocal resonance was increased at the riglu apex, where loud blowing breathing was heard with a to and fro grating sound, the latter extending as far down as the angle of the scapula. The heart was nor- mal. The abdomen was soft and the liver slightly en- larged. The examination purchase hoodia online of the urine was practically nega- tive. Differential count of the leucocytes showed poly- nuclear, 88 per cent. ; lymphocytes, 8 per cent. ; hyalin. 4 per cent. The blood was examined on several occa- sions, but the malarial organism was never found. No pathogenic organisms were found on blood culture. Tubercle bacilli were found in the ffcccs. While in the hospital the patient had several chills, followed by a rise of temperature. The patient did not cough or cx- (KJCtorate while in the hospital. After being in six weeks he developed cerebrospinal meningitis. In the cerebrospinal fluid obtained by lumbar puncture there were 86 per cent, polynuclear leucocytes, 9 per cent, hyalin, and 5 per cent, lymphocytes. There was. a ' A XIplioHti'niiil CriirKliIng Soiind, with a Koport of Six (lanCH. Amiylmii .lnutnal nf the ll'illral HHrncca, cxxvl, pngc ];(1, llllCi. scanty growth of cheap hoodia diplococci, morphologically and tinc- torially resembling meningococci. .Subsequent exam- ination showed undoubted meningococci. Tubercle bacilli were not demonstrable buy hoodia online in the spinal fluid. At this time the lungs showed consolidation of the right apex and infiltration of the left. The temperature was remittent from the day of admission. The patient was removed to the Municipal Hospital. At both hospitals the disease ran a rather mild course, the order hoodia patient at no time seeming very ill. He was discharged from the hospital on May ist. On that day he stated he no longer experienced pains in his legs and chilliness.^ Case VI. — H. O., white, aged fourteen years, was admitted to the hospital on February 12, 1907, suffering from typhoid fever. He gave a negative family and previous medical history. The patient was thin and anaemic looking. His chest was long and emaciated. Percussion showed tympany at the left apex and in both axills, and hvperresonance at the sides ; but dulness at the right apex and impaired resonance at the right base. At the right apex whis- pered voice sounds were heard. The breath sounds were harsh and prolonged, the respiratory sounds in both axillas suggesting the cavernous type. A few rales were heard at the right base. The heart sounds were loud, but lacking in muscle tone. The second pulmonic was accentuated. The abdomen was dis- tended and rather tense and tympanitic, the spleen was palpable. The Widal reaction was positive. Convalescence was so protracted that the faces were examined, tubercle bacilli being found. purchase hoodia The boy de- veloped an acute parenchymatous nephritis, but no tubercle bacilli were found in the urine. About two weeks after admission the patient coughed for a week, but had not coughed or expectorated since. Examina- tion six weeks after admission showed slight infiltration nf the upper right lobe of the lung. The temperature finally became normal. A number of important facts are brought out and some very interesting questions are raised by these cases. The diagnosis of tuberculosis can often be made by bacteriological examination of the patient's fsces. By this means diagnosis may sometimes be made in the absence of clinical symptoms and even of physical signs. This will therefore be an im- portant aid in the studv of cases of early tubercu- losis and in all cases in which the nature of the dis- ease is obscure. The fajces of tuberculous patients must be re- garded as hoodia 57 a source of contagion and must always 1)0 thoroughly disinfected. The same precautions in regard to the disinfection of hands, clothing, bed covers, etc., soiled by fascal evacuations, that are taken in cases of typhoid fever, should be observed in the hoodia p 57 management of patients with tuberculosis. So called closed tuberculosis may not be closed at all, as the tubercle bacilli may escape in the faeces. Cases of pulmonary tuberculosis without expecto- ration consequently must be regarded as dangerous. It is also possible that the so called cases of latent tuberculosis may permit tubercle bacilli to escape in the bowel and thus be a menace to the jMibiic health. Can tubercle bacilli be eliminated by the bowel with- out the latter being involved, just as they are be- lieved to be excreted by the kidneys in the absence

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