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fiillnwing diagnoses liadJicen previously made: Sprain from a fall at inception of disease, transverse myelitis, fracture al the hip. infectio\is arthritis of the knee. On examination there was Kit l.dipes ei|uinovarus, with relative shortening of about half an inch. The posterior tibial and posterior thigh muscles were in a condition of flaccid paridysis. There was hypotonus, ihe knee being thrown backward in walking and the foot mtated ontwanl. The left knee jerk had been much exaggerated since the onset of the disease. TIktc was no nor ankle cloiuis. The alTected leg was cooler to the touch. .Ml sensation was intact. There was reaction of degeneration in the posterior thigh and posterior tibial groups; no lexapro discount program joint pain. Meas- urements were as follows: Right calf. ii>4 inches; thigh, izyi inches; groin, 19^ inches. Left calf. discount lexapro coupons 11 inches; thigh, 12 inches; groin. 1854 inches. The case is interesting, on account of lexapro price the increase of knee jerk and the various diagnoses made from lexapro price per pill time to time by surgeons, orthopaedists, and neu- rologists. A Case of Polioiii\clitis zvitli Exaggerated Knee Jerk. average cost generic lexapro Case \'II.— Girl, age three, no faulty hered'ty or' history of previous disease. As a child she walked well at the generic lexapro price drop age of two years. One month later (in June), or six months ago. she had a fever of two days' "duration. On the third day she could not stand or walk: on the fourth day she walked, but dragged the right heel, and this condition continued since. On examinaton. in December, the muscles cheap lexapro canada perma- FiG. n. — .V scniltliagnimiiialic ri'pit'sentiition of tlio nrtorii'S of the spinal cord. cheap lexapro no prescription The tliromliotir lesion of poliom.volitis Is a>^snined to oocrir discount lexapro card at .\ in Ihe niiiicoinnal arter.v. in. c The cross liaulu'ii area I> indioalcs llie region In the pra.v and white mat- iiT. supplied by the mideoiniial branch of Ihe anterior central artery, and the area of the lesion caused buy discount lexapro by a thrombosis at -V. The lexapro price comparison collaterals from the lateral pyramidal tracts (Bl are inter- rupted in tltelr passage through the lateral limiting layer, and the gray m.itter by discount lexapro online the Icslop P. and thus fait to terminate on anterior horn cells at get discount lexapro r and E. Therefore in lesions of thi» character the normal knee ierk. which is dependent upon cell groups C and K. Is uninhibited. The exaggerated knee Jerk Is the consequence In thesi' rare types of poliomyelitis. nently alTected were found to be the right posterior tibial group (see Fig. 10), and in these muscles there was reaction of degeneration. The knee jerk of the ati'ected leg had been exaggerated since the onset of the disease: that of the other leg normal. There was no clonus or l^abinski and no sen.sor change. The meiual condititm was gooil : there had been no fits, and the child was bright ami active. The anterior tibial and (|nadriceps groups were intact in prescription discount lexapro volittuary power and electrically. It might l)e suggested that the lesion in these two cases is a raiulom one in otlier striielures at tiie level of the cellular lesion in the gray substance (nivelitis), but in the alisence of any distinct lexapro price generic evi- dence, sensor\- or motor, such contention seems un- warranted, ' two eases are really lateral polio- mxelitis. It is not diflicult to understand that a nottinvoive- metit of tlie quadriceps extensor group mii^bi le;;ve I04 RECTENIVALD: PERFORATIVE APPENDICITIS [Nhw Yokk Medical Joubnal US an intact knee jerk, hut that a lesion such as poIioinyeHtis. ordinarily iniderstood, should give an exaggerated knee jerk is impossible of such expla- nation. Nor is it at all likely that such a lesion in- duces irritation in adjacent areas not involved discount lexapro no prescription in the destructive process sufficient to induce the exag- gerated reflex. It has occurred to one of us (Clark) that there is a very simple explanation for the exaggeration of the knee jerk in those cases of poliomyelitis affect- 'ing the posterior group of muscles of the leg and thigh. It is well known that these muscles are rep- cheap lexapro online resented in the lower lumbar and first sacral seg- cheap lexapro alternative ment of the discount lexapro cord. The grouping of motor ceils which supply these muscles in the gray substance of the cord at this level is in the anterolateral and

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