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monition made by many observers never to perform a lumbar puncture when the patient is moribund, if one fears the possible blame to be laid to the lumbar puncture, instead of to the disease which indicated the puncture. What are some of the indications of a lumbar puncture in price clomid australia a child? The indications might for practical purposes be divided into three general groups : 1. For the relief of pressure symptoms. 2. For the purpose of differential diagnosis. 3. For the purpose of administering therapeutic aid intraspinally. Under the first group come a large number of conditions, both in infancy and childhood. A. It is a well recognized fact that some cases of hydrocephalus are greatly improved by repeated lumbar punctures, according to Quincke (12). This is true both of the congenital type as well as of the one secondary to meningitis. This statement will bear modification, namely, that experience has taught us that a goodly number of cases of hydro- cephalus only refill much more rapidly after they have been tapped once or order clomid online can you order clomid online twice. I recall one case which refilled within a week after the first puncture when buy generic clomid cheap the head assumed such large proportions order clomid online no prescription that the patient could not be recognized on the next visit safe order clomid online to the clinic. On the other hand, I should order clomid online recall two other cases where the head circumference measured about price clomid twenty-three inches on the first visit and by the help of weekly punctures, both spinal and also of the lateral ventricles according to Kausch (13), I succeeded in arresting the get clomid cheap abnormal growth of their heads and they are now able to walk around and are happy. B. In types of meningitis due to some type of organism against which we have no specific antidote, the simple drawing off of the fluid accomplishes drainage as well as relieves pressure symptoms, temporarily perhaps, as in tuberculous meningitis. Convulsions may subside and the patient may get a temporary rest. In fact, there are on record some fourteen cases of tuberculous meningitis can i order clomid online reported cured b)' repeated lumbar puncture, and while we question the authenticity of the diagnosis, we must still bear in mind that it happened in the realm of medicine, hence why doubt it? C. In acute infectious diseases, pneumonia for example, complicated with serous meningitis or so- called meningismus, the headache, convulsions and opisthotonous are relieved almost immediately after puncture is done. Considering the second group, every purchase clomid cheap time one is called upon to make a differential diagnosis between an acute disease complicated with meningismus and purulent meningitis, or when one is confronted with the problem, is it a case of tuberculous meningitis or of poliomyelitis order clomid cheap ; or a given case may present some symptoms of cerebral lues and colloidal gold and Wassermann tests on the spinal fluid have to be done, then our mind immediately reverts to the name Quincke. We send the patient's spinal fluid to the laboratory price of clomid in the uk for a cell count and for the determina- tion of the predominating type of cells and type of organism. A lumbar puncture not only helps us in suggesting the proper order clomid online canada management of the case, but it also generic clomid cheap directs us with regard to the prognosis, from the viewpoint of the family, which must be taken into consideration. What may be learned from a careful where is the best place to order clomid online examination of the spinal fluid buy cheap clomid no rx may be answered by briefly quot- ing Dunn, as quoted by Rachford, who sums up the diagnostic importance of clomid cheap a carefully examined cerebrospinal fluid specimen in the following man- ner: "If the fluid is cloudy, some form of where to buy clomid cheap menin- gitis is present. If the fluid is clear, no form of APFEL: LUMBAR PUNCTURE. 1023 meningitis can be present except tuberculous." It the cell count is normal (under ten to the c.mm.), no meningitis is present. If the cell count is over ten to the c.mm., some form of meningitis is present. In tuberculous meningitis, the mononu- clear leucocytes predominate and the fluid is clear. If the predominating cell is of the polynuclear type, that points to a suppurative form of meningitis. In poliomyelitis or encephalitis the fluid is clear, no bacteria are fomid, and there is a preponderance of large mononuclear cells. In meningfismus, while the fluid is increased in quantity it is normal in character." (2). As for the third group of indications, one need

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