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of polyvalent antistreptococcic serum is being tried. Cubicle isolation is essential to prevent the spread of the streptococci by droplet dissemination. Pneumonia at a Base Hospital. — Rufus Cole and W. G. MacCallum {Journal A. M. A., April 20, iyi8) studied a considerable number of cases of pneumonia, both clinically and pathologically and found that there were two very distinct types of the disease. The one was the usual lobar pneu- monia, similar to the disease as encountered in civil life, and was of low mortality. The other was a lobular or bronchopneumonia which occurred as a complication or sequel of measles, was of very high mortality, and was due to infection with a hemolytic streptococcus. In every case of this type of pneumonia examined post mortem this streptococcus was isolated, usually in pure culture, from the heart's blood, the lung lesions, pleural exudate, or other tissues. In many of the cases the same organism was present during life in the sputum and in a few also in the blood. The clini- cal picture of this form of pneumonia began with cough, fever, slight respiratory distress, and muco- purulent sputum. Sometimes there was an interval between the fall of the fever due to the measles and at others there was none. In all cases the onset of the pneumonia was gradual. The symptoms of the developed disease were moderate fever, seldom above 104° F. and often irregidar, especially when empyema was present ; moderate acceleration of the pulse ; and characteristic respiratory distress. The respiratory interference appeared to Cialis Tadalafil 20 Mg Tablets involve inspir- ation so that there was marked use of the accessory muscles and evident conscious efifort. The rate was not very rapid. Cyanosis of marked degree was always present, even in the early stages. Cough was troublesome and accompanied by sputum which varied in different cases, but never was like that of lobar ijneumonia. Restlessness and pain in the chest were also common. The physical signs, like those typical of bronchopneumonia in general, were not very distinctive. The commonest complication was empyema, which proved very fatal. Investiga- tion showed that the infection with the strepto- coccus was apparently acquired by the measles pa- tients during their stay in the hospital as the organ- ism was relatively infrequent in the throats of the patients at the time of their admission and in the throats of their camp associates. Bacilli and Spinal Fluid in Tuberculous Menin- gitis. — D. P. West {Virginia Medical Semi-Month- ly, February, 1918) describes a modified technique by which the chances of success in discovering the tubercle bacilli are increased. The aim is to get the film from the spinal fluid out and onto a cover glass without, as in the ordinary method, having to handle or tease it — procedures which merely knot the film together. Fluid is received in several tubes, five or six mils in each. All shaking of the fluid is avoided, as it reduces the chances of film forma- tion. The fluid is incubated or refrigerated for twelve to twenty- four hours, as necessary. In marked cases the film will often form in a very few hours. It is attached to the bottom Cialis Tadalafil 20 Mg Tablets of the tube, and also at the top of the fluid, assuming usually an hourglass formation. One quick Cialis Tadalafil 20 Mg Tablets turn of the tube between the palms of the hands is usually suffi- cient to detach Cialis Tadalafil 20 Mg Tablets the film and cause it to float free in the fluid. Half of a petri dish is now held slightly slanting, a cover glass placed in its depen- dent portion, and the fluid and fihn poured out into Cialis Tadalafil 20 Mg Tablets the dish and onto the cover glass. The cover glass is pushed with a laboratory' needle up toward the shallow part of the fluid until the film still floating free in the fluid engages one corner of the cover glass. The fluid is then drained oft' by tilting the dish still further, allowing the film to settle, fanlike, over the cover glass. Finally, the cover glass is picked up with forceps, stained, mounted on a blood slide, and examined. The Coin Test in Pleurisy. — P. LerebouUet [Paris medical, January 5, 1918) states that this test deserves more attention than it generally re- ceives, as it aft'ords one of the best presumptive in- dications of pleural eft'usion, and its simplicity com- mends it to the busy practitioner. The examiner's ear is applied at a point on the chest opposite to that at which the coins are being struck, and the Cialis Tadalafil 20 Mg Tablets ear not used in listening should be closed with the finger. Through healthy or normally aerated lung tissue the sound heard seems distant and dull, while over fluid or homogeneous solid tissue, a sharp, clear, silvery, metallic sound is noted. Generall\' there is a definite line of demarcation between the sound heard over lung tissue and that over fluid. Over the lower portion of the right lung the liver, being homogeneous and solid, may yield the metallic Cialis Tadalafil 20 Mg Tablets .sound even in the absence of effusion. This sound also occurs physiologically at the base of the left lung, where the coins are struck over the area of cardiac dullness. The sign is, therefore, not reliable below the point of intersection of the tenth Cialis Tadalafil 20 Mg Tablets rib with a vertical line midway between the' spinal column and the posterior axillary line. LerebouUet deems May i8, Cialis Tadalafil 20 Mg Tablets ipiS.] MISCELLANY I-ROM HOME AND FOREIGN JOURNALS. 955 it best to place the coin over the lower end of the sternum, Cialis Tadalafil 20 Mg Tablets or even in the supraxiphoid fossa, in or slightly to the left of the midline. Meanwhile, the examiner listens posteriorly over both lungs in alter- nation, at successive ])oints covering the entire length of the organs. Exceptionally in very large eftusions the sign may be absent. Again, a posi- tive test may be obtained where the lung is con- solidated in its entire thickness, and in rare cases of encysted pleurisy with old, firm adhesions bind- ing down the lung. Generally, however, the posi- tive test means a li(jui(! effusion, and tlie level at which it becomes negative shows the height of the fluid, especially upon listening Cialis Tadalafil 20 Mg Tablets within the inner mar- gin of the scapula. Often the test reveals fluid where the first or second ex]>loralory puncture has been negative. The author has lately found it very