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mann has shown at the Academy of Medicine. Tri- felletti's case was that of a man who had a marked his- tory of previous syphilitic lesions. In his larynx he pre- sented a condition which the reporter declares bore every clinical appearance of tertiary syphilis, and he gave no definite signs of pulmonary involvement. He received antisyphilitic treatment, and the laryngeal lesion im- proved markedly iip to a certain Valtrex Purchase point, when it remained stationary for a time, and then slowly became worse. Ex- amination of the sputum did not show tubercle bacilli. Examination of the tissues also failed to reveal them, but showed small round-celled infiltration with a number of giant cells. Some of the tissue was used to inoculate a rabbit, but the results were negative. Surgical treat- ment of the laryngeal Buying Valtrex lesiombrought about cicatrization and cure. Although, as said above, the presence of the tubercle bacillus was not demonstrated, although the clinical evidence Order Valtrex of syphilis was perfectly clear, yet, How To Order Valtrex on the strength of the finding of giant cells and the incom- plete results of antisyphilitic medication, the diagnosis of a primary Valtrex On Line tuberculosis was made and the cure of laryngeal tuberculosis was attributed to surgical treat- ment. Valacyclovir Valtrex The actual occurrence of Valtrex Mg either of these events is one of Valtrex Buy the rarest phenomena kno^^Ti to medical sci- ence. Purchase Valtrex As a matter of fact, on the other hand, it is not an uncommon tiling at all, as Manasse has pointed out for the nose, to find large Jiumbers of giant colls in the syphilitic lesions of the upper air-passages. So far, then, as the report of this case of primary tuberculosis of ilie larynx and of its cure by surgical means can bo * Architiii Ual. di larinijuloi/ia, No. 1, 1898. June 24. 1899.] WARTHm: POLYMORPHOUS-CELL Valtrex Order SARCOMA OF THE SOSF. 877 judged, the casual reader is warranted in regarding the writer's views of its nature as mistaken. With such a history, the demonstration of the tubercle bacillus is posi- tively essential to the diagnosis of tuberculosis. One can not even admit 500 Mg Valtrex the probability of a mixed infection or of the possibility of a tuberculous infection of a syphilitic lesion. Hansemann, in the Berliner klinische Wochenschrift, No. 2, 1898, has written a very good paper on secondar}' infection by the tubercle bacillus. In his well-kno\vn opposition to the contentions of the high contagionists, he goes to what would appear to them e.xtreme limits. He states that many Online Valtrex cases of cheesy degeneration of the Get Valtrex pulmonary parenchyma oc- cur following repeated attacks of pneumonia, and that these Valtrex Online areas of degeneration in many cases become only secondarily infected by the tubercle bacillus — that Valtrex To Buy fre- quently many syphilitic lesions become secondarily in- fected by the tubercle bacillus. There have been many recent publications which tend to show that the general consensus of opinion is veering toward these conclu- sions, although many of us who Valtrex 500mg have always been, even in the era of the furore of bacteriomania, low contagion- ists, will hesitate to believe that this is the usual sequence of events. A I'RIMAUV I'OI.VMORPIiOUS-CELL SARCO.M.\ OF THE NOSE, WITii IMVEI(S.\I, META8T.\S1S AND FORMATION OK A FUEE SAHCO.MATOUS MASS IN TIIK HUaiT VENTRICILAK CAVITV'. Bv ALDKKI) SCOTT W.XKTIIIX, M. D., Ph.D., inhtki'ctoii in rATiiiii.ouT, I'MvitiiiiiTT or MiciiKiAN, ANN AKnon, Mini. The reports of surcoinu of tlie nasal passages have multiplied to so great an extent during the last several years Cheap Valtrex that the condition Valtrex Buy Online can no longer be looked upon as one of very rare occurrence. Bosworth, in 1889, had colli'clcd from the literature previous to that year Buy Valtrex re- porLs of forly-one cases. In 180C twenty-one cases were addid to this list by Boylrfn, and I have been alile to find in the literature since the hitters paper reports of twenty-seven additional cases. It is evident from this rapid increase of reported cases that sarcoma of the noH(! must occur with some degree of fretpieni'V. The sarconuitous tumors described im bd and nasal bone.M, the ]M>riosteum of tlicHc Ikmk'h, the na-al cartilages, the sa-ptum, the inuHcles of the nose, the blood-vessels and connective tissue of the inueo»n of the nose and nasopharynx have all given rise to sarcomata. In n nuiiilH>r of cases an attempt has iM-en made t" prove their origin from non- malignant polypi. The evidence upon this point, how- ever, is very slight, and there is no proof of any close relation between a benign polyp and sarcoma. From the cases reported they would seem to be of independent origin. The nasal sarcoma, because of its location and the conditions of its growth, often presents a polypoid form, and in those cases in wliich a myxoma was thought to have become sarcomatous it is more probable that the so-called polyp was malignant from the begin- ning. The possibility of the development of a sarcoma in a benign polyp need not be denied, but in those cases where this change was thought to have taken place the microscopic evidence is either entirely wanting or in- sufficient. The opinion is quite generally held in the older lit- erature that sarcoma of the nasal passages is not so ma- lignant as sarcoma occurring in other regions of the

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