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type the cocci his and hers viagra fulfilled all requirements save that they would not form colonies in fermenting maltose. While believing that isolation furnishes no certain prophylaxis the authors would not abandon it, for the moral effect is good. The public would not understand why those at- tacked by any dread infectious disease should be spared this precaution. If it is omitted the public would clam- or against isolation for the less deadly diseases. Indicanemia. — Haas refers to the original di-scovery of indican in the blood of uremic patients by Ober- mayer and Popper. Their observations were promptly confirmed and soon afterward it was learned that in- dican could be present in the blood in both acute and chronic nephritis when there were no evidences of impending uremia. It is now acknowledged that indicanemia is rather an unfavorable prognostic in chronic nephritis, or, in other words, is evidence of a certain degree of renal insufficiency. The author de- cided to study the subject of indicanemia anew on two cases of chronic nephritis. One patient had cirrhotic kidneys with high blood pressure, how much does generic viagra cost while the other had ordinary chronic parenchymatous nephritis with blood pressure normal and much albumin in the urine. Both patients had indicanemia and in both the residual nitro- gen was still normal. It therefore became evident that the presence of indican in the blood antedates azotemia as evidence of future mischief, and the more delicate and trustworthy the test for indican in the blood the greater the promise for a prognostic resource. Also of great importance is the ratio between residual N and indican in the blood. The amount of the aminoacid frac- tion of residual N may also be looked on as representa- tive of the degree of renal insufficiency, and the ratio of aminoacids and indican in the blood should furnish an- other criterion of that condition. The rest of the paper is devoted to a study of Jolles's indican reaction. Tangential Shots of the Thoracic Cage. — Burckhardt and Landois go into this subject at great length. While these injuries do his and hers viagra not constitute an entity they differ in a number of respects from penetrating wounds. Almost invariably more than one rib is involved in the tangen- tial form. From the course of the wound through frac- tured ribs and muscles infection also occurs more readily in the latter, as does likewise open pneumothora>: with resulting empyema. The respiratory mechanism is badly damaged and bilateral his and hers viagra affections of the lungs often result. The projectiles cause contusions of the viscera, not only the lungs but the liver and kidneys; some of these are accompanied by lacerations, and hemorrhage and necrosis occur. Naturally, tangential shots of the lower ribs have more of these complications. These injuries will in time lead his and hers viagra to new viewpoints in regard to diagnosis and indications for treatment, notably surgical. Deutsche medizinische Wochenschrift. Auriust 5. 1915, Percussion in the Diagnosis of Apical Tuberculosis with Special Reference to Kronig's Apex Field. — Schnei- der refers to Kronig's original claim that percussion is of much more value than auscultation in the earliest rec- ognition of tuberculosis of the apex. The former may be so carried out as to reveal the existence of a true focus of disease while auscultation discloses only the presence of a catarrhal process, not necessarily tuber- culous. In true apical tuberculosis the apex has become more narrowed how much does generic viagra cost and smaller. Percussion shows this both in vivo and on the cadaver. Cadaver control is of course out of the question in routine work, but .r-ray control is fairly useful. The how much does generic viagra cost author now relates his own experience with Kronig's alleged apical field in which narrowing and general diminution are recognized by percussion and comes to the conclusion that auscul- tation is of more value in early diagnosis while per- cussion a la Kronig is to be used with great caution with reference to shortened resonance and slight nar- rowing (both in the right apex). Again, absence of these finds cannot exclude the presence of tuberculosis. Cases of the latter may present moist rales on auscul- tation and nothing at all on percussion. It may be laid down that as soon as percussion finds are obtainable, .c-ray finds are simultaneously obtainable. Veronal-Bromine Synthetics. — Serejski describes a new synthetic which consists of a veronal with a side chain of dibi'omopropyl. The bromine content is over 40 per cent. his and hers viagra As is usually the case no reasons are adduced to show the superiority of the synthetic over a simple com- bination of veronal and bromides. It is a nerve sedative and mild hypnotic, and has given excellent results in psychoses and psychoneuroses attended with excitement. It appears his and hers viagra to be readily taken and without the devel- opment of untoward collateral and after effects. Thus far, when administered daily no cumulative effects or habit-forming tendency has been noted. The cost per diem is about one mark or about twenty-five cents in Germany. When the excitation his and hers viagra is of the crescendo type the remedy has been powerless to check it. In cases in which failure occurs, opiates may also fail to obtain the desired results. Whether it can his and hers viagra rival opium in depres- sive cases has not yet been decided. Any remedy which is a nerve sedative is incidentally a hypnotic his and hers viagra when- ever the wakefulness is due to motor unrest. From this viewpoint the new synthetic is not an essential hypnotic. Sedatives of this type often render the use of the lat- ter unnecessary. The drug was sufficiently powerful in one case to quiet a depressive with impulsive ideas. Hot-Air Therapy in Gynecology. — Professor Walther of Giessen sums up this subject as follows: The diag- nosis must be how much does generic viagra cost beyond doubt and exact and patients must have been interned — they should never be treated in dispensaries. If the physician cannot give complete supervision to the case he must detail a competent per- son to represent him by constant attendance. No com- plications must be present, as fever, suppuration, hemorrhage, etc. The principle involved in this form of treatment is active hyperemia and the indications include all chronic inflammations and congestions. 538