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irregular in outline. Reactions to light and in accom- modation are present, but sluggish. All of the extrin- sic muscles of both eyes are paralyzed with the excep- tion of the external recti, and a very slight inward rotation of the right internal rectus. He can stand and walk, but methotrexate and ms is verj' weak and staggers. The Babin- sky reflex is present on both methotrexate sodium 2.5 mg sides. The temperature ranges from 99° F. to 100° F., pulse 50, respiration 20. During the night delirium and great restlessness is prevalent, the patient continually getting out of bed. November i, 1904. Periods of somnolence alternat- ing with great restlessness and low muttering delirium. He tosses from side to side, arms and legs are in con- stant movement, clawing the 6 mp methotrexate air, picking methotrexate injection cost at the bed clothes. Restraint is necessary. Periods of stupor with irregular stertorous respirations. Hutchinson's face is well marked; the ptosis is complete on the right and almost complete on the left. The sixth nerves are still intact, the only other movement of the eyeballs present is a slight inward rotation of the right eye. The pupils are unequal, moderately contracted and react sluggishly. The gross motor power of the methotrexate 7.5 mg extremities is well preserved; the tendon reflexes at the knee and pharmacology of methotrexate ankle are exaggerated. A coarse topical methotrexate tremor is present in both methotrexate pharmacology upper extremities. There methotrexate b12 is pseudo -ankle clonus on the left, which is not elicitable on the right, owing to an old anchylosis (osteomyelitis with operation). The abdominal and cremasteric re- flexes methotrexate generic name are present and the Babinsky reflex is elicitable on both sides. Reacts promptly to pain stimuli on the trunk and extremities. Professor Dana examined the patient at this time and confirmed the clinical diag- nosis of polioencephalitis acuta superior. To-day was noted for the first time a difficulty in swallowing, with choking and regurgitation after taking liquids. A paresis of the soft palate is quite apparent on volun- tary innervation. The fifth, sixth, seventh, and twelfth cranial nerves are unaffected. There is no gross de- fect of sight or hearing, finer ophthalmological tests methotrexate cream are impossible. The outline of the left disc is clear and distinct, the veins distended, no optic neuritis. The right disc could not be seen. Incontinence of urine and fjeces. Temperature rises from 98^ F. to 100° F. Pulse rate is 44, 54, 56, and 64 during the day, and full and methotrexate for ms soft ; respirations 18. Patient passes into a comatose state, dying quietly at 12.45 ^- r"- o^ respira- tory failure. Autopsy: Pathological diagnosis: Polioencephalitis acuta superior, pachymeningitis interna h?emorrhagica, chronic apical tuberculosis (healed) ; chronic inter- stitial nephritis; chronic splenitis and perisplenitis. The post mortem examination was made by Dr. Charles Norris, pathologist to methotrexate india Bellevue Hospital, fifty- seven hours after death. His notes read as follows : Rigor mortis has disappeared. Ribs are ossified. Heart: Pulmonary and tricuspid valves normal, like- wise mitral and aortic valves. No atheroma of the aorta or coronary artei ies. Lungs : A few adhesions at the apex of the right lung posteriorly. Firm adhe- sions over the upper left lobe ; bronchi contain some mucous pus, and are slightly reddened ; lungs are pos- teriorly cedematous ; the upper lobe of the right lung is firm and on cross section is smooth ; it contains whit- ish raised areas the size of a pinhead; the upper lobe of the left lung presents the same condition as the right; the lower lobes are reddish and dry; bronchial lymph glands are anthracotic and show no tubercles. Liver : Normal. Somewhat pale on cross section. The suprarenals are normal. Kidneys : Firm, surface granular, and the capsule adherent in places ; cortex is methotrexate usp thin and markings indistinct. The lymph nodes of mesentery are normal. Stomach and intestines are normal. The spleen is firm, capsule thickened. Brain: The dura mater is not adherent ; on turning it back the under surface on the right side is found to be the seat of an extensive pachymeningitis interna hremor- rhagica, with large fresh hemorrhages which have visibly compressed the Rolandic area. Fresh blood clots are also found in the anterior, middle and pos- terior fossa; of the skull on the right side, having fil- tered down from the cortex. The dura mater on the left side is free from any gross changes, but on very careful inspection there is visible in certain areas a very fine and delicate rusty membrane. There is no laceration of the cerebral cortex and no subpial ex- travasation of blood. No evidence of fracture of the skull, methotrexate 12.5 mg although the dura was carefully stripped from both, calcarium and the base of the skull. The ves- sels of the circle of Willis are methotrexate canada normal. The ventricles of the brain contain a moderate amount of clear fluid. The ependyma is normal. Brain Stem: After removal of the cerebral hemispheres and the cerebellum, the medulla, pons, and basal ganglia were divided at close methotrexate 17.5 mg intervals by a systematic series of transverse cuts. The methotrexate rxlist puncta vasculosa are prominent, especially in the pons Varolii, which is also soft and moist to the touch. The oedema is not so apparent in the medulla and basal gan- glia. In the pons a few minute red spots appear methotrexate 2.5 mg tablet to indi- cate an actual hsemorrhage, but these are small and few in number. No haemorrhagic foci were observed in the gray or white matter of the cerebral cortex, cere- bellum, or basal gai:glia. From the naked eye exam- ination alone the existence of hsemorrhagic encephalitis could not have been determined with certainty.

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