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dency to distention. A small rectal how much does amitriptyline cost tube introduced and allowed to remain in severe cases also affords pronounced relief. As a quick pickup for the heart and for relief where there is an asthmatic tendency, adrenalin has seemed to aid, but its action is more transient. Hot mustard pastes applied early over the entire chest are a great help. Intravenous administration of glucose is destined to be of elavil generic amitriptyline great assistance in patients not annoyed or upset by it, especially those with a tendency to amitriptyline hydrochloride generic amitriptyline online acidosis. Purpura and amitriptyline cost in uk Meningococcic Septicemia. — P. Lereboullet and J- Cathala (Paris medical, October 30, 1920) point out that meningococcic septicemia is by no means a rare condition. In recent years cerebrospinal meningitis amitriptyline online purchase seems to have assumed purpuric and septicemic characteristics more* fre- quently than before. The disorder may appear as a generic drug amitriptyline simple infectious purpura which continues clinic- ally mild until the terminal meningeal symptoms supervene. Any case of rheumatoid purpura of obscure origin should lead at once to the suspicion of meningococcic septicemia. For the early detec- tion of this type of purpura consideration should be given to the question whether the purpura appeared in a locality in which cerebrospinal meningitis had previously occurred. In one of Netter's cases the coexistence of cerebrospinal meningitis in the sister of a little girl of six years exhibiting purpura led to the discovery of the meningococcic origin of thi- latter. On lumbar puncture, cloudy fluid points definitely to meningococcic infection. A clear fluid does not, however, average cost amitriptyline exclude such infection. A blood culture .should be made on bouillon anfl ascitic fluid, but is often negative. Under exceptional conditions meningococci may be found by staining tissue sec- tions of a purpuric spot, or the organism found in smears of amitriptyline online no prescription bloody fluid from such a spot cost of amitriptyline 25mg ; or, again, it may be demonstrated in the fluid contained in the seropurulent vesicles sometimes formed on the sur- face of a petechia. The meningococcus may like- wise be sought in the pus from definite foci of infection accompanying the septicemia, as in sup- purative arthritis or iridochoroiditis. In severe cases, even where the meningococcus cannot be identified, antimeningococcic serum should be given by intramuscular injection- If a polyvalent serum J December 18, 1920.] PRACTICAL THERAPEUTICS AXD PREVENTIVE MEDICINE. 1005 is unavailable, amitriptyline cost canada B meningococcus serum should be amitriptyline online uk chiefly used, as the B organism has been found in nearly all the cases of this type so far reported. The serum should be administered as soon as the suspicion of meningococcic infection arises. These cases are more frequently fatal than the ordinary forms of cerebrospinal meningitis. Presence of the Tubercle Bacillus in the Blood Stream. — Sabathe and Buquet {Frcssc nicdicalc. October 27, 1920), to demonstrate the tubercle bacillus in the circulating blood, collect six mils of blood in a test tube and allow it to coagulate. After the clot has contracted, some of the fluid is buy cheap amitriptyline withdrawn amitriptyline cost without insurance by means of a pipette placed in contact with the clot and smears made and stained by the Ziehl method. Tubercle bacilli will l^e found in the blood of amitriptyline hcl generic elavil tuberculous patients b}^ this procedure. Sodium Citrate in the Treatment of Pneumonia. — L. Cheinisse (Prcssc nicdicalc. February 14, 1920), commenting on Weaver's pneumonia treat- ment with large doses of sodium citrate, notes that observations with the viscosimetre on pneumonia cases would appear to justify the citrate treatment. The viscosity of the cheap amitriptyline online blood has almost invariably been found high in pneumonia, especially in com- parison with the hemoglobin values. Hence the seeming advantage of acting remedially upon the viscosity and restoring it to normal. Sodium citrate may also be held to act by reducing the coagulability of the blood and by increasing its alkalinity, which is lowered in pneumonia. The Bacteriology of Colitis. — H. L. Lyon- amitriptyline costochondritis Smith (Lancet, June 12, 1920) considers that the usual methods of investigating the stool in colitis for the purpose of identifying the chief organism buy generic amitriptyline producing the inflammation are unsatisfactory. He points out that we are anxious to learn what generic amitriptyline hcl bac- teria is present in the mucosa rather than in the feces. In order to get as accurately as possible this inf(jrmation, he first gives a Plombiere douche of a pint of warm water. Then a second injection of two or three pints is given and retained for six

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