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widely spread, striking at once a great many persons who in no possible way could have come in contact with each other. This is like the la grippe epidemics, showing that avoidance of those who are ill with the disease will not at all prevent an attack of it. In a very few instances in this two year epi- demic of cerebrospinal meningitis, in Connecticut and Vibramycin 50mg elsewhere, have cases of apparently direct communicability been reported, and, as already stated, no more frequently than will occur in ty- phoid fever and pneumonia. The report of the Children's Hospital, in Boston, of the admission of no patients with this disease in eight years, all treated in open wards, without a single case originating in the hospital is to me absolutely positive proof of its noninfectiousness. In all of the above hospital cases the diplococcus intra- cellularis was found, and the only precaution against contagion was ordinary careful cleanliness of the patient and the nurse's hands. We have heard discussed the aetiology of Vibramycin Suspension the disease. I will only refer to some recent Vibramycin Mg investi- gations under the auspices of the German gov- ernment. Twenty-nine autopsies on patients dead of this disease were carefully made, twenty-two were children under ten years of age, and seven were adults. This report shows that the infec- tion started in the pharyngeal tonsil, entered Order Vibramycin Online the cranium through the Vibramycin Tablets sphenoid bone, travelling along the vessels which run from the pharynx into the sella turcica through the Vibramycin Indications sphenoid fora- mina. The part of the brain first affected was the hypophysis, or pituitary body. There was no evidence in these twentj-nine autopsies of the infection passing through the cribriform plate of the ethmoid, and the infection seemed to travel by l_ymph channels rather than by blood channels. The bacteriological studies in these investiga- tions show that the Vibramycin Syrup Vibramycin Hyclate meningococcus •(vas not nec- essarily the only germ to produce the disease, and the investigators state that " the real cause seems to be as unknown as that Buy Vibramycin Online of scarlet fever." In a recent bacteriological report in New York of 150 cases the pneumococcus Purchase Vibramycin Online infection of the brain was found to be of much worse prognosis than the meningococcus infection. To briefly refer to the pathology of the dis- Vibramycin Doxycycline Hyclate ease that is of interest to the clinician, it may CoPYiiiGiiT, 1906, BY A. R. Elliott Pobhshino Co. 326 OSBORNE: CEREBROSPINAL MENINGITIS. [New Yoek Medical Journal. fitst be noted that during an acute Vibramycin For Acne attack the only organs of the system involved are the brain and spinal cord. All grades of Vibramycin Cost Vibramycin Antibiotic congestion, inflamma- tion, Vibramycin Antibiotics and pus formation can occur on the surface of these organs, and I am convinced that many cases abort with only the primary first conges- tion. The first symptoms will denote the part of the brain or spinal cord first congested, and the symptoms will of course denote the amount of pressure exerted by the exudation. In my per- sonal experience last winter Order Vibramycin there were many more cases of spinal irritation and congestion than of cerebral inflammation. In typical advanced cases the brain is covered by a thin, yellowish pus which lies over the pia mater, and little petechial hemorrhages may be found on the surface of the brain. Vibramycin Acne The rapidity with which this exudate may form and cause pres- sure symptoms is unfortunately known to us all. This fulminating variety of cerebrospinal fever Generic Vibramycin was, fortunately, in the last two years, in Con- necticut, not very frequent. The pus formation and even the simple exu- Buy Cheap Vibramycin date may not be equally distributed ; one portion of the exudate may be clear, and in another part of the brain there may be pus deposits. The ven- tricles of course are generally filled with exudate. Although primarily the inflammation is limited to the cerebrospinal system, there is no disease that can have as many complications and sequelae as cerebrospinal meningitis. Besides deafness, blindness, neuritis, and paralysis, we may have pneumonia, pleurisy, endocarditis, pericarditis, nephritis, and arthritis. This disease is not a sep- tica:mic process, and I believe we rarely or never have metastic abscesses. Neither do the lymph glands nor the spleen ordinarily enlarge.

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