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We now no longer attribute to the gas- tric juice the high bactericidal power it was for- merly supposed to possess. The mucus of the spu- tum and the food surrounds the organisms and pro- tects them against the action of the acid. More- prescription retin a canada retin a order on line over, during the presence of food most of the acid exists in combination and is thus rendered inert It is possible, also, that some bacteria might find their way from the blood into the feces through the in- testinal mucosa. Be all this as it may, by careful bacteriological examination I have found the pneu- mococcus present in the feces online retin a micro of patients suffering from acute lobar pneumonia. At first, on account of the large number and variety of bacteria in the in- testine, this might seem a very difficult task. That only ten per cent, of intestinal bacteria grow on ordinary culture media, and that only very few of these are Gram positive simplifies the work con- siderably. The method employed for the detection of the pneumococcus was rather simple. First, cultures of normal feces were made to determine whether pneumococci or Gram positive organisms resem- bling them were present. Examinations of such I N RUTZ: PN1 retin a order uk I . nil in (s were negative in this respect.. In the bac- teriological examination in the pneumonia cases smears and cultures of the sputum were first made willi the usual precautions, in order to ascertain the presence and variety of the pneumococcus. This was not always possible, especially online retin a in children wh i invariably swallow the sputum. For the examina- tion of the feces a specimen was obtained on the second or third day of the disease with all possible precautions. When possible, a particle from the inner part of the solid feces was examined. Liquid broth and peptone cultures in one half of one per cent, salt solution, rendered slightly alkaline to lit- mus online pharmacy retin-a micro paper with a saturated solution of sodium bi- carbonate, were used. These were kept at body temperature for twenty-four hours. Then cover- glass preparations were made and stained, some with water methylene blue, others by Gram's meth- od with gentian violet. These examined micro- scopically showed Gram positive diplococci corre- sponding in retin-a micro order online morphology to some variety of online retin-a prescription the pneumococcus. On two occasions it was found as- sociated with the streptococcus. In one specimen the pneumobacillus of Friedlander was found. Still further to prove the identity of these organ- isms, several drops of such cultures were injected subcutaneously into white mice. 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It is inter- esting to state that in this disease, just as in typhoid fever, meteorism is less marked in young children, although, apart from retin a mail order the reflex pain in the upper part of the abdomen, they have other evidence of intestinal disturbance, such as rectal tenesmus, pain in the lower part of the abdomen, and the expulsion retin a buy in mexico of large amounts of gas from the rectum. This tympanites is not a mere occasional symptom, such as might occur temporarily during the course of any disease, but is retin-a buy uk as constant as the pleurisy ac- companying the pneumonia, appearing at the end of the first or second day, continuing during the active stage of the disease, and disappearing from one to five days after defervescence. This symp- tom is of more than ordinary significance. No im- paired digestion, prescription retin a brands increased putrefaction, or intes- tinal elimination of carbon dioxide from the online retin a canada blood will adequately explain such constant and marked tympanites. I believe, and clinical experience seems to support this theory, that this meteorism is main- ly due to a paresis of the intestinal wall, produced by the action of the toxines during the process of their excretion by the intestine. To a less extent this retin-a cream order online symptom is due retin a micro order to the production of gas by the action of the acids generated by the pneumo- cocci in the feces, on the sodium carbonate derived from the pancreatic secretion. Proof of this latter cause I have seen in several of my cases. The re- cently evacuated semisolid feces of children were found, upon examination, to be full of bubbles of gas.

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