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The normal cerebrospinal fluid is perfectly clear. Sicard, Widal, and others have shown that Buy Cheap Lopid in health it contains scarcely any cellular ele- ments; there is an entire absence of polymorpho- nuclear leucocytes and the small mononuclear Gemfibrozil Mg * Read at the meeting of the Illinois State Medical Society, Bloomington, IlL, May 18. Lopid 600mg 1904. cells or lymphocytes are very scanty if present at all. Albumin is present as a faint trace (0.02 per cent to 0.04 per cent.), and there is no fibrin. Sugar is normally present, but, according to Pf-uindler, sugar disappears in acute inflammatory disease of the meninges. This observation, how- ever, lacks sufficient confirmation to be of diag- nostic weight. The amount of fluid Lopid 60 Mg allows of no definite conclusions, except that a great amount of fluid as shown by very high pressure is most frequently met with in tuberculous meningitis. An increase in the albumin (more than 0.05 per cent.) in the absence of blood, points to tumors or inflammatory Gemfibrozil Price disease, and a considerable excess of albumin in a clear fluid, according to Pfaundler, is Buy Lopid almost a certain sign of tuberculous menin- gitis. Wentworth states that in meningitis the with- drawn fluid is Lopid Cost invariably cloudy. The degree of cloudiness, however, depends on the number and character of the cells in the meningeal exudate. It is sometimes so slight as to be detected with difficulty. While, therefore, marked changes in the gross appearance of the fluid are of sugges- tive value, reliance should be placed only on a complete microscopical and bacteriological exam- ination. The necessity of thorough examination is emphasized by the experience of Barr, who Buy Lopid Online re- ported cases of purulent meningitis in which punc- ture showed a clear fluid. A cardinal rule in esti- mating the results of lumbar puncture has been insisted on by Hand, who declares that positive results only are of diagnostic value ; it is unsafe to draw any conclusions from -negative findings. For example, although the demonstration of tuber- cle bacilli in the fluid constitutes a positive diag- nosis of tuberculous meningitis, failure to prove their presence does not necessarily exclude the disease. Occasionally fluid may not be obtained. This failure is Lopid Tablets usually due to a faulty technique, but rarely it may result from the Generic Lopid thick, wax like character of the exudate, as in a case mentioned by Packard, in which the diagnosis was proved by post mortem examination. An admixture of blood in the spinal fluid may be accidental from Gemfibrozil 600 the operation. Such an ex- planation is excluded when repeated punctures show persistence of the same amount of blood. The stage Gemfibrozil 600 Mg of the disease in which the puncture is resorted to must always be considered. Puncture made late in the attack may fail to show changes which were pronounced at an earlier period. The bacteria most Lopid Price frequently found in the cere- brospinal fluid are the tubercle bacillus, the men- ingococcus intracellularis of Weichselbaum, the pneumoccus, and the streptococcus and staphy- 384 COOK: LUMBAR PUNCTURE. lococcus. The tubercle bacillus Gemfibrozil 600mg can usually be demonstrated in the sediment by the ordinary staining methods. By direct examination of the cover slips in this way, Pfaundler found tubercle bacilli in 91 per cent, of the cases where they were present. Rarely, inoculation experiments may be required to make a diagnosis in tuberculous men- ingitis on account of the scarcity of the micro- organisms. Cultures are usually necessary for the proper identification of the Order Lopid meningococcus, pneumococcus, Cheap Lopid and ordinary pus cocci. As pointed out by Councilman, the meningococcus may vary greatly in numbers. Usually it is read- ily found and in abundance. When present in small number it may be missed on the cover slips, and even when present in large number the cul- ture tubes may show only one or two colonies. The Gemfibrozil Cost demonstration of the meningococcus is posi- tive proof of the existence of cerebrospinal men- ingitis of the epidemic type. In fifty-five cases of meningitis in which lumbar puncture was Lopid Mg made. Councilman found the meningococcus in thirty- eight cases. He states that the cocci are most constantly present early in the disease, i. e., at Order Lopid Online a time when the diagnosis is most difficult from the symptoms alone. The identification of the meningococcus is also important from a prognos- tic standpoint, as these are the only cases in which recovery is likely to occur. Osier states that the pneumococcus cases are invariably fatal.

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