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February 10, moo.] BURNHAM: SANATORIUM REST OF PULMONARY TUBERCULOSIS. 295 of time in some cases, and on the possession of every fact that can be ehcited by careful history, taking careful note of the surroundings of the patient, knowledge of all symptoms, and lastly the physical examination of the case, — in other words, the case taken as a whole. In taking up the history there is no doubt but that a family history of tuberculosis is of value to the extent that there is a much greater liability of the patient in question having tuberculosis who has this antecedent history than the one who has none. I believe to-day that this is all that when will nexium become generic can be said. The question of heredity or of tendency I will not dis- cuss. The surroundings of the patient are found very valuable in nexium 40 mg generic giving us a suspicion of the pres- ence of tuberculosis, coming from a contagion known to be existing where the patient lives or works, and in many instances on close generic brand for nexium questioning this fact can be drawn out and is a positive factor to be order nexium samples considered when found. Though tuberculosis is a communicable disease only and not actively in- fectious, like the exanthemata for instance, the value of a known present source generic name for nexium of infection in a case is very great in helping us to make a provisional diagnosis, and we may obtain valuable help often limes in considering the question of the possibility of infection through this known source. The symptoms the early case ])resents are most varied, and even an enumeration what is generic for nexium would take up more time than I have to give to this part of the subject. Among the very first generic form of nexium symptoms in many instances, long before cough, fever, sweats, etc., come on, a mild degree of anaemia may be noticed even with no loss of weight or disability of any kind. Diminution of appetite below the patient's normal, and in many cases of tuberculosis it is noted that the normal r.ppetite may not 80 mg nexium be up to what it should be ; especially i« this found in the case of girls between generic equivalent of nexium the ages of 15 and 20. Loss when does nexium go generic of weight is exceedingly suspicious in a patient who cannot explain the same and who is not is there a generic for nexium feeling quite up to par. Indigestion of different forms, especially of is there a generic nexium the stomach variety, may be a cause perhaps, or may be the result of tuberculosis. The above symptoms of anaemia, loss of appetite, weight does nexium have a generic and strength, are in many cases the earliest mani- festations of a diseased process. In the presence of fever we now come to an im- portant and immediate symptom that demands the greatest carefulness in our consideration of a suspi- cious case. A temperature taken occasionally generic version of nexium will show nothing, perhaps, if slight ; and if so, as in many instances, it is neither constant nor regular in its appearance. To be of value the temperature should be obtained every two hours during the day until 10 in the what is the generic for nexium evening and recorded, and preferably temperature taken by rectum. If there is a rise to 99.5° or more or even to 99.2° or 99° at any time in the 24 hours which is persistent daily, it is very suspicious that there is some tuberculous process somewhere. Chills may accompany this mild de- gree of fever, but they are apt to be irregular and rather of the nature of chilly sensations than real chills. With the fever there may be an active car- diac action, which is also important in the considera- tion of the case. With the onset of fever, or before, or after ma\' be noted slight cough, so called hacking variety, in most instances in earliest generic for nexium 40 mg cases without sputum. This cough is described by the patient as that of tickling in nexium dosage 80 mg the throat. It is more apt to be noted early in the morning, and on lying down at night, and after meals. The presence of night sweats is not a characteristic early symptom, but may occur in cases that are not developed and with few signs buy generic nexium not otherwise explained it is a very valuable and fairly positive symptom. Ihemorriiage, if not proven of other origin than lungs, is one of the most positive of signs and oc- curring as is often the case in those who are in good health and without symptoms previously and with- out determinable signs in the lungs, as is also often the case, can usually be construed as caused by a tuberculous process in the lungs; practically it has almost the value of tubercle bacilli in the sputum, if we can bar out the few other conditions that might produce the haemorrhage and thereby mis- lead us. The presence of tubercle bacilli in the sputum is, of course, positive evidence of lung tuberculosis if we except the rare instances of reported cases where this what is the generic name for nexium is proven not to be the case. The failure to find tubercle bacilli is a point upon which much stress should be laid. A single examination of the

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