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the abundant saliva, and the physician hastens to re- lieve the symptoms with every means at his com- mand. An examination readily reveals the condi- tion. The uvula is usually intensely swollen and edematous, and, covering the whole of buy cipro the soft palate, the faucial pillars, and the tonsils buy cipro online are grayish cipro 250 mg sloughs in separate patches. The surrounding local Digitized by Google 6i6 TUBERCULOSIS OF THE UPPER AIR-PASSAGES. [Medical News anemia aids in differentiating it from price of cipro syphilis, as does the absence of great destruction. It is more difficult to differentiate from lupus, however, but here the microscope will show abundant tubercle ba- cilli in the tuberculous cases, only a very few being found in lupus. The treatment must be heroic. There is no chance cipro 250 for recovery, buy cheap cipro and the physician must be sufficiently humane to liberally administer one of the more powerful anodynes, irrespective of the fear of the patient's becoming addicted to drug-habits. Morphin, in combination with cocain, freely given every hour, with cocain sprays cipro cost used before deglutition, the ap- plication of lactic-acid (fifty -per- cent.) solution to the affected parts, incision of the edematous uvula, all these measures will relieve and call forth expressions of sincerest gratitude from the sufferer. One of the most practical suggestions for the treatment of these affections was made by Delavan. This consists in giving the patient nutritious enemata for several days and no medicine nor food by the mouth, rest- ing the muscles of deglutition. By this short rest cipro 500mg much relief is occasioned and deglutition becomes no longer painful, or very slightly so. Tubercular Laryngitis. — Perhaps every writer on this subject mentions the case of a child aged four and one-half years, reported by Demme, who died of tuberculous meningitis, in which the tuberculous deposits were found in the larynx at the autopsy, while cost of cipro the pulmonary tissues were normal. Primary tuberculosis of the larynx does occur, but the vast majority cipro online of cases occur either simultaneously with pul- monary tuberculosis or as a sequel thereof. The latter forms are by far the most frequent. The following is a brief history of a case of simul- taneous pulmonary and laryngeal tuberculosis: JT A girl of seventeen was referred to me by her family physician in July, 1897. She gave a history of having had a short cough with slight expectora- tion, and accompanied by huskiness for the past two months. Her voice was hoarse at the outset, and finally became less and less clear, and at the time of presentation the aphonia was almost complete, she was only able to whisper. Her family history was good, her purchase cipro father and mother being of strong phy- sique. Her general condition was very good. There had been no cipro price attacks of hemoptysis, nor had cipro order there been any night-sweats. There was no perceptible loss of flesh. A laryngoscopic examination showed that both arytenoids were greatly infiltrated, so much so that it was only by repeated examina- tions that the vocal cords could be seen. There was no visible destruction of tissues, nor any evi- dences of acute inflammation. The swollen aryte- noids met in the center, did not decrease on appli- cation of cocain, and the mucous membrane over them presented a perfectly normal appearance. It was apparent then that the aphonia was due to the mechanical presence of these arytenoids, which pre- vented action of the vocal cords. There was marked consolidation at both apices, and the sputum was full of tubercle bacilli. No improvement of the voice has occurred as the result of treatment. The latter has been non -surgical because of buying cipro online the extreme sensi- tiveness of the patient. The patient is still under observation, and in addition to other forms of treat- ment, is receiving Maragliano's serum hypodermic- ally. This treatment was instituted by the parents on their own responsibility. No marked benefit has been noted from it; on the contrary, the pulmonary destruction is advancing. cipro 250mg In that most frequent form of tuberculosis of the larynx, secondary to pulmonary tuberculosis, the arytenoids are most often involved, next the ary-epi- glottic fold, and the purchase cipro online true vocal cords. The hyper- trophy rapidly gives place to ulceration, which soon cipro cheap extends to other parts. An examination of the larynx shows the epiglottis greatly swollen in its cipro online pharmacy upper and anterior border, assuming a crescentic or turban-like shape. The arytenoids are also swollen, and the narrow chink left for breathing is usually filled with mucus. Ulceration occurs in the inter- arytenoid space, and also in all parts of the larynx. A point in diagnosis ot this affection is the ex- treme pallor of the soft palate. Practically every case of tuberculous laryngitis shows this anemia to a marked degree. The symptoms present are huskiness or complete aphonia, more or less pain on swallowing, severe cough, and occasionally dyspnea has been observed. The latter may become severe enough to require in- tubation or tracheotomy. Tuberculous laryngitis cipro hc may be differentiated from all other affections by a mi-

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