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tinued sufficient gas should be given to insure sepa- ration of the surfaces. The danger of repeated tapping lies in the chance of possible infection. Here we have an excellent culture medium, and a single virulent organism carried in on the needle would be sufficient to produce an army of workers in a short space of time. In the pleural effusions showing only tubercle bacilli it is our custom to aspirate as fast as a sufficient amount is formed, and if there is a ten- dency to thick pus we introduce a 2 per cent, forma- lin and glycerin solution. The number of aspira- tions varies in the different patients, so no hard and fast rule can be made, some forming very rapidly and other very slowly. In the mixed infection cases we have tried aspi- ration with the introduction of formalin and glyc- erin solution and pursued a policy of watchful waiting, only to find that ultimately it became nec- essary to put in drainage and to leave a discharging sinus. In the majority of all exudates the positive pressure causes more annoyance than the same pressure before exudations take place. Usually, however, this symptom as well as the fever inci- dent thereto can be controlled by keeping the pressure about neutral or slightly negative. The entire treatment can be summed up in the one word, conservatism, with the exception of the mixed infection where radical surgical interference is indicated. The ultimate outcome of all fluid cases, except mixed infection, I consider good even though show- ing a purulent exudate containing only the tubercle bacillus. Of course the length of time and behavior of the patient compra segura viagra generica differ. I have seen large exudates give absolutely no symptom and small ones cause great annoyance. I have seen pus develop to such an extent that the pleural cavity was half filled with a dirty green fluid, and the patient exhibited no fever or untoward symptoms of any kind. Then I have seen small amounts of pus call for frequent aspirations to relieve marked pressure symptoms and high fever. A certain percentage of patients after two or three aspirations develop no more fluid and have an uninterrupted recovery, while a few have been repeatedly aspirated for months with no apparent change in their condition. Some of our pus cases have recovered perfectly; others, although still under treatment, are giving no cause for apprehension, while the mixed infection cases have been drained, leaving a discharging sinus. One of these patients is running a normal tempera- ture and going to meals, having gained her former weight and looking perfectly well, while the other is still confined to bed after four months with what I consider a grave prognosis. In all the cases we have had no fatality. I believe it is levitra cialis viagra which is better the consensus of opinion that many of these patients may be subject to exudates for varous periods up to three years, and yet when the temperature returns to normal they can enjoy a compra segura viagra generica fair degree of health levitra cialis viagra which is better with the prospect of ultimate recovery. Serious as compra segura viagra generica this complication may be viewed from an unprejudiced standpoint we should not be de- terred from the use of artificial pneumothorax where it seems to be indicated. On the other hand, conservative men, and I like to consider myself one, will hesitate to induce a pneumothorax until they have given a patient a fair trial on the usual sana- torium routine. To use the procedure in early cases I believe to be a grave error, unless the disease shows a progressive tendency. On the other hand, the percentage of pus cases showing the tubercle bacilli is so small, and the percentage showing mixed infection pus so much smaller, that we can consider the complication a negligible quantity where artificial pneumothorax is indicated. I will now outline briefly in the following table the results of the work of Dr. A. G. Shortle and myself at the Albuquerque Sanatorium, covering a period from May, 1912, to May, 1915: Total number of patients operated upon, 110. Total number of fluids, 32. Percentage of fluids, 29.09. Total number of fluids becoming levitra cialis viagra which is better pus, 12. Total number of pus cases showing tubercle ba- cilli, 8. Total number of pus cases showing mixed infec- tion, 4. Percentage of pus cases, 10.9. compra segura viagra generica Percentage of pus showing tubercle alone, 7.27. Oct. 9, 1915] MEDICAL RECORD. 603 Percentage of pus showing mixed infection, 3.63. Now taking out the one patient that left for Colorado Springs, mentioned above, and the patient who returned home before a culture could be ob- tained, we have but two, or a known percentage of 1.81 mixed infection exudates in our series, one of these being the result of a spontaneous pneumo- thorax from which, of course, the mixed infection was produced.