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same environment. The disease was congenital but in some instances the child appeared to be normal until five months of a.ge and then began to show sjniiptoms. General Tuberculosis, Including the Skin, in a (.'hild.-— Dr. William P. Nurthrup of New York reported this case, which he stated was similar to three previously reported by him. At the age of four months the child was taken with diarrhea and wasting. It had a cough but no vomitin.g and no crying. The skin eruption and the .)--ray had enabled him to make the diagnosis of miliary tuberculosis. In a case of miliary tuberculosis a good a--ray, gave, next to buy viagra in india online an autopsy, the most in- timate knowledge of buy viagra in india online the lesion in the child's lungs. yellow viagra pills The skin eruntion in miliary tuberculosis furnished a pathognomonic sign for diagnosis, and such a lesion was almost always an indication that one was dealing with a fatal form of tuberculosis in young children. The characteristics of the lesions were that they were yellow viagra pills about the size of the rose spot in typhoid fever, were tipped by a tiny vesicle, surrounded sooner or later by a congested hemorrhagic zone with the form of a crust, which when removed, left a pit. In cases of acute tuberculosis these vesicles were the first revealed lesion. Macewen's Sign.— Dr. HERBERT B. WiLCOx of New York presented this paper which yellow viagra pills was based on ob- servations made in Dr. LaFetra's service at Bellevue Hospital. Macewen's sign was best determined by placing the stethoscope on the forehead just above the base of the nose. The skull was then tapped with the percussing finger or the hammer, over the parietal region, beginning just over the parietal boss from which the percussing finger should approach to the point at which the stethoscope was applied. This should be car- ried out on both sides of the head. A typical sign ob- served in this way consisted in a high pitched, sharp, short, cracked-pot note. It was most distinct when per- cussion was being yellow viagra pills done over, behind, or below the parie- tal boss on either side, was unchanged as the point per- cussed passed downward, and diminished in intensity and character as the point percussed approached the stethoscope. The latter point was important in differ- entiating between a false and a true Macewen's sign as the reverse obtained in percussing a normal skull. The author emphasized the fact that increased clear- ness of sound when percussion was done over the pos- terior portion of the skull rather than near the stetho- scope was diagnostic. The sign uniformly accompanied conditions of increased cranial tension and was not found unless this causative factor existed. It was equally applicable to infants and older children. It was presented in fifty of fifty-three cases of tuberculous meningitis; in seventeen of eighteen cases of menin- gitis of other types, and was found to vary directly with the development and recession of cerebral symp- toms as complications of disease not directly affecting the central nervous system. It was present in eleven of thirteen cases of pneumonia buy viagra in india online in five of which lumbar puncture showed increased cerebrospinal fluid under pressure. The sign was uniformly lacking in children normal as to the brain and its coverings. Dr. L. E. La Fetra said that Dr. Wilcox should be congratulated on the persistence with which he had worked on this sign. He also reiterated the points to which it was necessary to give special attention in or- der to distinguish between the true and false Mac- ewen's buy viagra in india online sign. This sign was important as indicating when one should draw off spinal fluid in cases other than meningitis. Dr. Koplik said he had used Macewen's sign and found it useful in indicating the presence of fluid in beginning tuberculous meningitis and in serous men- ingitis due to otitis. Much depended unon the indi- buy viagra in india online vidual's ability to apply the method. The older the child the more valuable was the sign. A Preliminary Report on Pneumonia in Children, with Special Reference buy viagra in india online to Its Epidemiology. — Dr. Godfrey R. Pisek of New York discussed the findings in 1,000 cases of pneumonia in children studied in the wards of the Post Graduate Hospital. A series of charts were presented showing the mortality and the results of plate culture of the sputum. After reviewing the work of Dr. Cole and that of Dr. Gillespie on the varie- ties of pneumococci and discussing the epidemiology Dr. Pisek summarized as follows: From a study of 1,000 cases a mortality of 43.3 per cent, was established. This was probably highei- than was obtained in pri- vate practice among well-to-do people, but was the average for the mass of city dwellers. Bronchopneu- monia yellow viagra pills was preeminently a disease of the first two years of life, and aftei- the third year was relatively uncommon. Lobar buy viagra in india online pneumonia was the buy viagra in india online type of the dis- ease which was present after the third year in prac- tically all cases of pneumonia if those cases which were frequently buy viagra in india online secondary to some other condition or those buy viagra in india online in which the pneumonia occurred as a terminal condition were omitted. Lobar pneumonia per .sc was a common condition yellow viagra pills in the first and second years of life, being much more frequent than was conimonlv supposed. The infection which was the etiological factor in lobar pneumonia was alwavs the pneumo- cocci, while a bronchopneumonia might be due to a number of organisms such as the streptococcus or the influenza bacilli, occurring alone or as a mixed infec- tion. If pneumococci were present in bronchopneu- 542 MEDICAL RECORD. [September 25, 1915 monia they were usually one of a group of organisms commonly found in the mouth. The pneumococci might be divided into four general groups, each being made up of many races which were closely related. By the method outlined a pure culture of pneuniococcus