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cause it is more likely to be observed by the general practitioner than by the specialist. The now well-known nature of the maxalt rpd 10 disease proves it is not of recent origin. That it has so long been over- looked is evidence that its consequences are not often serious, that it has been confounded with another -affection, and that it must frequently disappear spon- taneously. That it is not very uncommon is evi- denced by three cases which came under my care about three months ago. Of these cases, two were in males and one in a female. The patients were in middle life, in excel- lent general health, without constitutional taint, and free from other disease, being neither dyspeptics nor having rheumatic or gouty diatheses, and being free from catarrhal troubles. Two of the patients were residents of this city. In neither of these, so far as I could determine, had a correct diagnosis been previously made. The female patient had been treated in Paris last summer for cheap maxalt what she was told was follicular tonsillitis, maxalt melts but without relief of her trouble, which she first noticed when in Italy last June. One of the male patients had been treated locally with sprays and gargles, and had himself used them six months without result; the other had de- pended upon internal medication and gargles irreg- ularly for a year and a half, having spent a greater part of that time in Asheville and the Adirondacks, maxalt mlt tablets caring for order maxalt online an invalid wife, and thus under favorable climatic conditions. I know of no definite statistics of the duration of this disease, but we must accept in one of these pa- tients a period of a year and a half. Dr. Wright cites a case of two -and-a-half years' duration, and Dr. Mulhall had one under observation six years. There were certain objective appearances common in all the cases and characteristic of maxalt mlt price the affection. These are included in the following description: The disease involved maxalt 5 mg the tonsils and the base maxalt melt 10mg of the tongue, the latter buy maxalt online being the site price of maxalt of many tufts of the growth, at least thirty or forty. In one case, the growth was present on the soft palate and the post- pharyngeal wall, with maxalt rpd 10mg two or three tufts in the in- ter-arytenoid space, and on the epiglottis. On in- spection there were observed, apparently covering or protruding from the orifices of the mucous follicles, yellowish-white patches or plugs, fungoid in appear- ance, which are literally a collection of growths. They vary in size from a thread in diameter to per- haps a line, and sometimes, by coalescing, form patches as large as one's finger-nail. They are moist and soft to the touch, and usually removed or broken off on a level with the mucous membrane by moderate friction, to be reproduced during the follow- ing twenty-four or forty-eight hours. When the superficial or protruding mycotic growths are thus re- moved, there is not left behind that clean, smooth surface which we find when we express a cheesy, cretaceous mass from a mucous crypt; on the contrary they are more or less maxalt mlt coupon adherent, and it is frequently necessary to seize the projecting fimbriate mass with forceps and exert considerable force, as evidenced cost of maxalt by a few maxalt tablets specks of blood at the seat of implantation. The study of a single case, even without the micro- scope, ought to convince one that the growth is im- planted, not upon the maxalt mlt generic superficial mucous membrane, but upon the lining of the canicular and mucous fol- licles and in the depressions between the folds of nasopharyngeal lymphoid tissue. Often where the point is favorable for examinatian a lacuna can be seen distended with the growth beyond its normal caliber. There is not yet a uniformly accepted opinion as to the etiology of mycosis; its origin and specific na- ture are sub judice. Different fungi are found in the extruded maxalt cost masses, but leptothrix buccalis is acknowl- edged to be always present. Besides this leptothrix, we also find oidium albicans, the micro-organism of nigrities linguae, a sarcina, and the aspergillus fumi- gatus, and others. Among predisposing causes the fol- lowing have been claimed by almost as many different investigators: catarrhal inflammations; mouth-breath- ing; rheumatic diatheses manifested by tonsil- litis, dyspepsia, acidity of the saliva; damp habita- tions; unhealthy skin; dental caries; neglect of mouth cleanliness thus favoring calcification in the pres- ence of alga leptothrix — leptothrix buccalis seems is there a generic for maxalt to be always present in the mouth. Considering that leptothrix buccalis predominates in the morbid product, it may be not irrational to conclude that as the soil has become favorable by a certain degree of inflammation, the spores of the leptothrix find lodg- ment in the mucous crypts and develop more rapidly than under ordinary circumstances; and that these bundles with their products, though other fungi may be associated with them, constitute the disease. The subjective symptoms are almost never pro- nounced. They consist of a tickling or rough feel- ing, sometimes causing a cough or choking, which in turn results in an unavailing effort to clear the throat. There also may be a sense of dryness or burning. Pain, from a consequent inflammation is said to be sometimes present. I have never seen an instance. The affection is more often annoying than dangerous, through E. Frankel claims the fungus may be destructive to the tissue upon which it grows, and reports maxalt melt a case of penetration of the tonsil to a depth maxalt canada of several millimeters. If there is any doubt in diagnosis, the microscope should be used. My friend, Dr. Jonathan Wright, Digitized by VjOOQLC 558 OROPHARYNGEAL MYCOSIS.

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