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parasternal line. It was first described by Gueneau de Mussy and named by him the " bouton diaphragma- iique." The presence of tenderness and pain in this position is most important, and is almost pathogno- monic of diaphragmatic pleurisy, more especially of the localized suppurative form. De Mussy and most writers since him have considered tliis to be the tender point of the phrenic nerve, though von Ziemssen disputes this on the ground that the function of this nerve is entirely motor. Other peculiarities of this variety of pleurisy are: 1. The pain is abnormally violent and diffuse. 2. Movement is almost Huppres.scd in the hypochondrium and base of the thorax on the affected side. 3. Physi- cal signs may be absent, or consist in a limited tym- panitic resonnnct! at the extreme base, and minus breath pounds, owing to the compression of the buy cytotec lung liy the efTusion. 4. cytotec buy online Occasionally there is pain on swallowing cytotec 200 mcg as the food pn.sses the diaphragm. 5. Hiccough may bo present, eithiT from direot irritation of the dia- phragm, or possibly of the vagus or phrenic nerves. It is important to remember that these elTusions, when near the centre of the (liaphragm, are out of reach of the exploring cytotec 400 mg syringe. One of the oases seen by the writer gave a striking illustration of the value of de Mussy's point in diagnosis. A woman, aged thirty, fell ill with fever and pain in the breast. There were no abnormal |)hysical signs in the lurig>i. cytotec mg iiml an I'xploratory punctun- gave a negative result; tlii' |iliri'nic "••rve in the neck, lif)Wever, was tender and tlu' Imiilon hiiphrfKimtitiaiie extremely painful, and by these symp- tofiis alone Or. Hoiiverel, of Lyons, diagnosticated suppurative dinpliragmatic pleurisy, and immediately Imnrleil the cn(t(< over to the surgeon. An encapsulated eni[ivcmn wa8 found and evacuated. The woman n-cov- buying cytotec the brain by overwork, because, when a certain intensity of strain has been reached, cytotec on line the brain refuses to work any longer and the man is forced to rest. On the other hand, it is quite easy to cytotec 200 mg do seri- ous injury to the brain of a child by pressing him in regard to mental work, and this happens even more read- ily in neurasthenics than in healthy children. The re- verse is the case with regard to worry. This falls light- ly on a healthy child, and the most serious trouble may at cytotec order any time be dissipated by the administration of a sugar plum. In a man, on the other hand, cares and worries are not readily shaken off. The mind can not easily forget them, and sleep is interfered with. A neu- rotic child takes an intermediate position in this matter. Worries and anxieties are apt to fix themselves in his mind in a quite morbid fashion. In conclusion, a word may be said as to mental work and mental exhaustion in neurotic children. Even in the cytotec cheap perfectly healthy child we know from many observations that an hour or two of such work produces an exhaustion which is quite perceptible in order cytotec online that it blunts the tactile sense to a degree capable of being measured. In neu- rotics exhaustion of the cortex is. even more readily pro- duced, the visual field, for example, becoming distinctly smaller. This points to the necessity of making the periods of work of a neurotic youth short, and of inter- posing muscular exercise between each. It might be ])ossible in any individual case, by direct testing of the visual or tactile sense, to say purchase cytotec whether too much exhaus- tion was being occasioned, or, in other words, whether the mental work done was proving too much for the boy. The Micro-organism of Scarlet Fever. — .\t a recent meeting of the Chicago Medical Society Dr. W. J. cytotec 200mcg Class (Journal cytotec cost of the American Medical Association, April 8th) described a micro-organism which he believed to be the specific causative factor of this malady. Klein, in a large number of ea.«es, had isolated a streptococcus considered by him and by a number of French observers to be online cytotec the cause of scarlet fever. Crajkowski, in IS!*."), re- ))ortcd that he found, in fifteen cases in which online pharmacy cytotec he exam- ined the blood of scarlet-fever patients, a diplococcus present in comparatively small numbers, seldom more than one or two in a microscopic field. This diplococcus did not stain by tirani, and only feebly and then quickly losing its color by any method. Cultures were obtained in bouillon and ii]ion solid media, but not on gelatin. The development was said to be slow, and the colonies resembled small dro]is of dew, not more than one third to one half of a millimetre in diameter. It was cytotec price pathogenic for mice, but not for rabbits. Crajkowski, in consequeiu'c of the failure of the various careful scion- tista who took up this work to find a s])ccitic geru) either in the scales or in the seen'tions from the throats of scarlet-fever patients, did not a.'sert that the n'tiologicnl n'lalion of this diplococcus to scarlet fever had Invn demonstrateil. Dr. ('Ia.«s iK-lieved where to buy cytotec that the fault lay with the culture media employed, as it was a well-known fact that souu< giMius wen- very selective in this n's]x»<'t. After buy cheap cytotec numerous failun*s, he finally siicceded in tindinf; M culture ntediiim on whicli he had l>con able to almost invariably obtain. Iwith from the scale.* as well as from till' tliroatH of scarlet-fever jiatients. the growth of nn orcranism which pre'ient<'d such characteri«tic fenture*. ImiIIi in its morpbologv ns well an in it* growth, that ho ?94 PITH OF OURRENT LITERATURE. [N. Y. Med. Joub,, had little hesitancy in asserting it to be the specific germ of scarlet fever. Morphology. — The diplococcus as ordinarily seen on

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