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nels Trimox Online — whichever of these methods of invasion we believe to be the usual one, the problem which confronts us is, why the lungs are invaded so much more frequently than the larynx. If the infection enters at the fauces, or if it is carried in the inspired air, surely the larynx is more exposed to contagion than the pulmonary paren- ch3'ma. Moreover, when the latter has become affected, Trimox 500 tuberculous sputum from a melting lung is dashed over the laryngeal mucous membrane by a rasping cough, and yet a very .small percentage of cases of pulmonary phthi- sis acquire a laryngeal lesion before they die, and this small percentage is still further reduced if we rule out the cases in which the larynx breaks down in the last stages of the disease. Kricg has lately * analyzed seven hundred cases of tuberculous laryngitis Buy Trimox coming under his observation, with the view of discovering the bear- ing such an analysis may have upon the question of the method of the tuberculous Amoxil Trimox infection of the larynx. The results of his observations are summed up as follows: " 1 . Among the .seven hundred cases of tuberculous laryngitis are two Where Can I Buy Amoxicillin hundred and seventy-five, or Buy Trimox Online 39.3 per cent., unilateral, and four hundred and twenty-five, or GO. 7 per cent., not iniilateral. Trimox Dosage The unilateral cases ap- pear then not to be at all uniisiial — as, Amoxicillin 500 for instance, Ilcinzo assumes. ♦ Arch'iK fur hmfngolojiir, nnnd viii, Heft .'I. June 24, 1899.] WRIOHT: RECENT LARYNGOLOGICAL LITERATURE. 875 " 2. Of the two hundred and seventy-five unilateral cases, two hundred and fifty-two correspond with the affected lung, or 91.6 per cent., while only twenty-three, or 8.4 per cent., do not correspond. Those that do corre- spond are therefore the vast majority of the cases. " 3. Of the seven hundred cases of lar}Tigeal tuber- culosis there are, therefore, two hundred and fifty-two, or thirtj'-si.x per cent., both unilateral and correspond- ing to the lung lesion." As Krieg says, these and similar statistics, if reliable, are hard to explain on any hypothesis but that of propagation through the lymph channels. There should be no preponderance of infection on one side or the other if the infection occurred either primarily through the inspired air, or secondarily through the sputum coughed up from below. If, on the other hand, the bacillus enters beneath the epithelium of the fauces and finds its way into the cervical lymph channels, or if it enters by the gastro-intestinal tract primarily, and so gets into the lymphatics, or if it starts from the already infected lung by the way of the lymph channels, then we should Trimox 500 Mg naturally expect the pulmonary and laryngeal lesion to be on the Amoxicillin 500 Mg same side. Buy Amoxicillin It is evident also that the blood- vessels would not be expected to produce this coinci- dence. It will be seen also that these statistics have a wider bearing than that which applies simply to the method of tiic secondary laryngeal involvement, for they affect the wliole question both from the purely pathologi- cal standpoint and. from tiie much more important stand |)oint of personal hygiene Order Trimox and general sanitation. But are the facts on which such statistics are based to be unhesitatingly accepted? What laryngologist is so exjxjrt tiiat he can be sure from the picture in his mirror that tiie lesion is confined to one side of the larynx, or even that tlie surface manifestations Trimox Antibiotic of tuberculosis are confined to one side? The laryngoscope, even in the most skilled hnnd.i, is far from being an instrument of BiU'h prtx;iaion. Even direct ins[)ection of the Where To Buy Amoxicillin surface aflor death furnishes no criterion of where the tuber- cle U'gan or how far tiie microscope will show it has o.xtcnAmoxicillin Amoxil condition of tlu- bronchial glands at the liasi' of till- lungs? Anatomixts may Iw able to tell iia why the lymph channelfl prefer to deposit the germ nt the level of I lie vorni eonln, for at tiiis situation tulM-reiilous dis- f'lino of the larynx usually first manifests itself, rather than nt the bifiirention r)f tin? trachea or in the phar- ynx, btif Hueh nn explanation nt lea.tt has never oinx- nn;li nutnlxT of olmnrvntionH, if nnliin.<*ed, to exriufle enxunl orrorx. It is, moreover, HU|)porteil liy the (lilTlciillv we have in undrmlnncling liow tubercle bacilli get into the lungs themselves in Trimox Side Effects any other way. The in- spired air by the time it reaches even Trimox Indications the larynx has had nearly all the germs filtered out of Trimox 500mg it, while Generic Trimox it is only the residual air and not the tidal air at all which ever comes in contact with the peripheral twigs and leaves of the respiratory tree. Furthermore, primary tuber- culous larjTigitis is so rare that it has been confidently though wronglj-, asserted never to exist. Were infection brought about by the germs in the tidal air in the larynx, it is hard to see why tuberculosis of the larynx should be so rarely observed without a well-marked lung lesion. If we have long been in doubt as to tubercle bacilli reaching the lungs in the tidal air, post-mortem exami- nations have cast considerable doubts upon infection being frequent from the alimentary canal below the esophagus. Of late, various investigations have gone to show that in infants, contrary to former belief, thoracic tuberculosis is more common than abdominal, and that even children dying of pulmonary consumption, al- though they almost constantly swallow their sputum, do not by any means always present on autopsy evidence of lesions in the abdominal viscera. This is especially the ease in infants under one year of age — the very age at which they are nourished by milk. Clinicians are beginning to declare that many cases diagnosticated as tuberculosis of the bowels among the children of the poor are really only cases of marasmus from malnutri-

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