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cilli are growing, it seems fair to assume that the bacilli are uppermost. Tubercle bacilli probably do not grow much in sputum. The growth would be either in the tissues or on the ulcerating surface of cavities. Growth in cavities has been presumed by A. Cop- pen Jones. My experience with three autopsies also gave this impression. It is an open question, how- ever, whether anafranil online or not the bacilli could grow in cavi- ties without being influenced by the body fluids, as many bacteria apparently do in the buccal cavity. The persistence of tubercle bacilli in sputum is no evidence of growth ; it may indicate a gradual re- moval from some old focus. a. Clumps of Parallels. — Tubercle bacilli are sup- posed to multiply by longitudinal fission. Clumps of parallels are believed to indicate growth. Paral- lels have been observed in tubercle bacilli growing on the anafranil price heart valves and on the inner surface of the thoracic duct. Clumps of parallels were not ob- served in tissues by A. Coppen Jones. Of fifty-four cases showing parallels forty pa- tients (74 per cent.) improved. Of anafranil buy nineteen 'cases not showing parallels fifteen patients (79 per purchase anafranil cent.) improved. This presence of parallels in the sputum proba- bly is of little value in prognosis, but suggests an unfavorable course. b. Variations in Depth of Stain. — Marmorek al- leges that old tubercle bacilli retain the stain more strongly than the young. Of fifty-two cases showing variation in depth of stain thirty-seven patients (71 per cent.) improved. Of eleven clomipramine anafranil cases not showing variation in depth of stain nine patients (82 per cent.) improved. This would tend to show that variation of stain pointed to an unfavorable prognosis. In a series of anafranil buy online sixteen specimens anafranil for ocd where both points were observed, variation in stain and clumps of parallels were present together in fourteen cases. In one case one was present ; in the other clomipramine hydrochloride case nei- ther was present. Thus there is almost absolute correlation between the two. This should be ex- pected if both are evidences of growth. c. Disintegrated Tubercle Bacilli. — If the bacilli are all dead, as possibly evidenced by their disinte- gration, then the balance would seem in the patient's favor. Of forty-one cases with disintegrated tubercle ba- cilli thirty-two patients (78 per cent.) improved. anafranil 150 mg Of twenty-five cases without disintegrated tubercle bacilli eighteen patients (72 per cent.) improved. From this the appearance of disintegration in tu- bercle bacilli appears to be of little value in progno- sis, but suggests a more favorable condition of the patient. The splittersputa (fragments of tubercle bacilli) asserted by cheap anafranil Spangler and confirmed by Pottengcr to be found in sputum in the absence of intact tuber- cle bacilli, would also seem to be evidences of the balance in the patient's favor, if splitter represent a flisintegration form rather than a developmental. ()i fifty-two cases in ocd anafranil my series, four (8 ])cr cent.) jjaficnts showed splittersputa. In all four, intact tubercle bacilli were found. In all fifty-two cases intact tubercle bacilli had at some time been found. I wish to express my thanks to Dr. Trudeau and Dr. Baldwin for many helpful facts, to Dr. Brown for his helpfulness clomipramine 20mg in the work, and to Mr. E. G. Pope, who kindly computed the statistics. ConclH\sions. 1. Fifty-nine per cent, of the cases showed phag- ocytosis when our phagocytic index was applied. Eighty-two per cent, of the cases showed phagocy- tosis when all cases showing phagocytosis at any time were included. 2. Phagocytosis in ordinary sputum examination clomipramine hydrochloride tablets seems of little practical value in prognosis. In large groups of cases certain features may be ob- served : e. g., phagocytosis was much less in anafranil 50 mg my tuberculin cases. 3. From three autopsies and from the variation observed, whether of sputum taken at intervals of clomipramine 50mg minutes or months, it would seem that a specimen from the homogenized daily output clomipramine 50 mg is necessary for much accurac)'. 4. Tuberculin reactions failed to produce posi- tive and negative phases. 5. Phagocytosis anafranil 150 seemed not to vary with the order anafranil presence of bad clomipramine tablets symptoms.

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