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more or less constitutional disturbances. Advanced stage. — Well marked areas of con- solidation, with cavity formation and lisinopril buy constitu- tional disturbances. 20 mg lisinopril Very advanced stage. — Marked increase of all the foregoing signs. In his lisinopril 10 fifth annual report of the same institu- tion, he, however, dropped the very adz'anced stage. Trudeau (32) divides phthisis into three stages only, without exactly defining the areal extent. Incipient stage. — With but slight local and con- stitutional involvement. Advanced stage. — Local disease more extensive, or in an advanced stage, or the local disease may be comparatively slight, with grave constitu- tional impairment or some complication. The far advanced stage. — Both phj^sical and rational lisinopril 20 signs order lisinopril warranting lisinopril 10 mg the term. H. P. Loomis (33), also Stubbert (34), in the reports of the Loomis Sanitarium, classify simi- larly, distinguishing between incipient, moder- ately advanced, and advanced online lisinopril stages, and Ashton (35) and Elliott (36) follow this classification in their reports. If one examines these various classifications, to which many more or less decided modifications by other authors could be added, one can see good points in all of them, be they based upon the clin- ical manifestations solely, upon a basis which is purely anatomical, or one that is a combination of both. When one, however, has a larger series of cases to dispose of and intends to classify in a man- ner in which the anatomical lesions (as shown by physical signs) are attached to certain clinical phases of the disease, then there lisinopril 20mg are cases left over which cannot be disposed of at all, while some of those which have been disposed of under March lisinopril hctz 20 ll, 1905.] VOX RUCK: CLASSIFICATION OF PCLMOXARV TUBERCULOSIS. 487 one or the other combination groups, purchase lisinopril are found to differ greatly in prognosis, which after all is the real object of all classifications, so far as we use them for statistical and comparative pur- poses. A careful study of the classificatipn of stages recommended by the committee of this association does not appear to me to lisinopril 5 have suffi- ciently remedied this serious defect, and I am well convinced that no classification can do this even approximately, so long as it attempts to combine the physical phenomena, especially in regard to extent of area, with the clinical aspect of cases, simply because they stand in no neces- sary relation, either in the prospect for lisinopril 5 mg duration of life, or in the prospect of a clinical cure. Under such circumstances, one lisinopril 40 mg lisinopril 12.5 mg is tempted lisinopril 10mg to resort to the old method of division into clinical stages only, the more so as the attainment of uni- formity on a physical sign basis implies, as Tur- ban himself admits, equal training and experience in examination of the chest. In the classification of my hctz 12.5 lisinopril own work, compris- ing reports of over 3,000 cases, I have therefore paid secondary attention to the physical signs, and have divided my cases into three classes, en- tirely upon a clinical aspect from my own stand- point of prognosis. By this method a case is classified regardless of the fact that one or two lobes are the seat of demonstrable alterations, while cases with acute or actively progressive changes, caseous pneu- monias, or such with more serious complications and of but limited or less acute local lung dis- ease, go where, from a prognostic standpoint, they really belong. A case recently examined lisinopril 12.5 by me, in which the greater part of an upper lobe was the seat of caseous pneumonia with coexisting parenchymatous nephritis and tuberculous ulcer- ation of the larynx, was naturally placed in the most unfavorable class, whereas lisinopril hctz 12.5 mg according to Turban the classification should cheap lisinopril have been in the first, and according to our committee's recom- mendation, in the second stage. While I have found room for improvement in my own classification, especially for making my reports with a view of their ready comparison with those of others, I have made no change in the past, because every one seemed to classify

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