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would account for the trouble. The illness contin- ued benignantly, with a mucopurulent discharge, for about four weeks. No history of contagion could be obtained, although the patient was in almost con- stant contact with a brother. A clinical diagnosis of rhinitis fibrinosa was made, and treatment insti- tuted as in the former case. The following day the patient returned for a bacteriologic examination. The membrane in this case was fortunately very readily removed with very slight hemorrhage, and cultures were made. The culture on agar-agar showed a staphylococcus and a species of saccharo- myces. The growth on gelatin did not cause lique- faction. Of the membrane obtained in this case, part was at lisinopril 40 mg once transferred to absolute alcohol; another part, without being subjected to any other treatment, was exposed to the action of dilute acetic acid, and a third portion, to that of artificial gastric juice. Dilute acetic acid caused the membrane to become almost perfectly transparent; at the same time there occurred on carefully shaking the test-tube without breaking up the membrane a very slight turbidity in the fluid. The result of this experiment showed that the mem- brane largely consisted of fibrin mixed in some way with a small amount of mucus. lisinopril 5 mg Exposed to the ac- tion of lisinopril buy artificial gastric juice, the membrane within a few hours was almost completely digested. There remained only a very small, hardly appreciable, amount of undigested residue. This likewise proved the fibrinous nature of the exudate. The piece of membrane hardened 20 mg lisinopril in alcohol was subsequently em- bedded in paraffin and sectioned. lisinopril 10 mg The sections were studied with Gramm's, Weigert's, Altmann's, and a hematoxylin stain. The mass of the exudate, as shown by the study of the sections, consisted of numerous, mostly polymorphonuclear leucocytes, a few epithelial cells, some cocci, and some indefinable debris; lisinopril hctz 12.5 mg all of hctz 12.5 lisinopril these elements were embedded in a dense fibrillar network. This network stained violet with hematoxylin, a beautiful blue with Weigert's- fibrin stain, and red with Altmann's acid-fuchsin- picric-acid stain. Case III. — T. C, order lisinopril male, ten years, presented him- self for treatment, November 26, 1897; temperature normal. On examination a dirty-white membrane was found covering the septum and turbinate body of the right nasal cavity only; there was also present a deflection of the septum to the right. The patient's mother stated that he complained of some nausea and had a slight fever three days before, and was also greatly distressed because of the limited amount of nasal respiration permitted, which made him restless- at night. Pieces of the membrane were removed, leaving the characteristic raw and bleeding surface. online lisinopril There was no history of contagion and no further symptoms of importance developed except a more or less mucopurulent discharge, the case continuing be- cheap lisinopril nignantly. A clinical diagnosis of rhinitis fibrinosa was made in this case, and similar treatment applied as lisinopril 12.5 mg in the previous cases. From the membrane re- moved cultures were made and a staphylococcus found. The lisinopril 20 growth of the staphylococcus on agar- agar was moist and somewhat yellow. On gelatin, an extensive liquefaction was produced. Only small pieces of lisinopril 10 the membrane could be obtained in this case, but enough was secured to make the chemic tests, and a small part was hardened for sectioning as in the preceding case. Dilute acetic acid caused the membrane to become almost transparent. Arti- ficial gastric juice caused an lisinopril 12.5 almost complete diges- tion purchase lisinopril within a few hours, with only a small amount of lisinopril 20mg residue. The mass of the exudate was again proved to consist of numerous polymorphonuclear leuco- cytes, lisinopril 10mg a few epithelial cells, cocci, and some inde- finable debris, all embedded in a dense fibrillar net- work. This network stained blue with Weigert's and red with Altmann's stain. The stains employed, as well as the chemic tests, proved beyond a doubt that the great bulk of the exudate, as in the previous case, consisted of fibrin. In conclusion, it is my agreeable duty to sincerely thank Dr. M. R. Brown for permission to publish these cases from his clinic, and also to thank Dr.. Maximilian Herzog, director of the Pathologic Laboratory of the Polyclinic, for his assistance and direction in the examinations. OROPHARYNGEAL MYCOSIS. 1 By R. P. LINCOLN, M.D., OF HBW YORK. Oropharyngeal mycosis is a parasitic disease which is not infrequently found in the deep parts of the oronasopharyngeal cavity, and was first de- scribed by B. Frankel of Berlin in 1873, under the name "mycosis tonsillaris benigna," and later by Hening lisinopril 5 as "pharyngomycosis leptothrica." I lisinopril hctz 20 have selected this subject for discussion be- 1 Read at a meeting; of the Harvard Medical Society of New York, March 26, 1898. Digitized by Google April 30, 1898] OROPHARYNGEAL MYCOSIS. 557

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