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Prognosis. — In the earlier stages great improve- ment may how long does viagra last 50 mg be effected by proper antisyphilitie treatment, but after stenosis and dilatation, fibrosis, excavation, and permanent changes of this character have occurred, it is not to be expected that they will disappear. Treatment. — Most how long does viagra last 50 mg of the older authors pinned their faith on the mercury and iodide treatment and had some measure of success. My own case showed a very good improvement on sodium cacody- late treatment, as mentioned before. I believe that salvarsan in these cases would be indicated, unless the patient were in an extremely weak physical con- dition, when it would seem that some other means might be preferable. Conclusions. — 1. Syphilis of the lung, while a rare condition, does occasionally occur. 2. All cases of suspicious lung involvements, espe- cially those resembling tuberculosis, and repeatedly showing absence of tubercle bacilli on careful micro- scopical examinations, should be regarded as pos- sibly syphilitic. 3. Especial care should be taken in cases showing the above mentioned signs and in which no physical findings occur in the apex, but only the base of the lungs. These cases should be regarded as sphilitic. 4. In cases in which syphilis is suspected treat- ment should always be instituted at the earliest possible moment in order to prevent the permanent changes of fibrosis and stenosis of the bronchi. 5. In a known syphilitic, who is also known by microscopical examination to be afflicted with tuber- culosis, I believe it always advisable to administer some appropriate form of antisyphilitic treatment along with the treatment for the other condition. BIBLIOGRAPHY. Dieulafoy: Text-Book of Medicine, Vol. 1, p. 230. Fowler and Goodlee: Diseases of the Lungs, London, 1898. Osier: Modern Medicine, Vol. 3, p. 407. Teixara: Jour, of A. M. A., Vol. 59, No. 21; Jour. A. M. A., Vol. 56, p. 540. Stanley: British Midical Jour., Vol. 2, 1911, p. 806. Councilman: Johns Hopkins Medical Bulletin, No. 11, p. 35. Nothnagel's Encyclopedia of Practical Medicine (Lungs) Edition 1904, p. 652. A. Robertson: Jour, of Pathology and Bactcrioloyy, Vol. 15, p. 45. Reference Handbook of the Medical Sciences, Vol. VII. 216 Cooper Street. THE MATERNAL INSTINCT A FACTOR IN THE PRENATAL DEVELOPMENT OF THE EPILEPTIC TYPE OF NERVOUS CONSTITUTION. Bv RUSSELL G. MacROBERT, M.D., NEW YORK. RESIDR.N'T FHYSIC1.\N. .'SECOND DIVISION, NEUROLOGICAL INSTI- TUTE. Although the epileptic type of nervous constitu- tion' is fully how long does viagra last 50 mg determined before birth, the direct inheritance of epileptic attacks in the children of epileptic parents is rare (17 cases in 2000, Starr). Neuropathic stock predisposes only in a general way. Cousins are more frequently affected than brothers or sisters. Specific factors must determine the epileptic child of the family which did not enter into the development of his non-epileptic brother or sister who may however reflect the general neurotic heredity in various other ways, as in hysteria, neurasthenia, psychasthenia, or tic. The epileptic occurs with a frequency not gen- erally suspected. There is one pronounced epileptic for every 400 of our population (Church and Peter- son ) but many are known only to their families. No race under the sun escapes. The specific factors that determine their development are therefore of a fairly frequent and ordinary nature. The absence of all pathognomic physical signs of epilepsy should earlier have directed our search more confidently towards a psychogenic origin of this disease. Gowers,' from a consideration of the pathological anatomy of epilepsy, made state- ments as far back as 1888, which implied the pre- diction that our explanation of epilepsy must come from the realms of psychic occurrences, whose only changes are of a functional nature. Some of his words in speaking of this point are "The changes in the nerve centers are probably of that fine kind which is revealed only by altered function and eludes the most minute search." The epileptic manifestations are reactions to dis- turbances in the psychic sphere where our instincts and emotions have their foundation and play. Stoddard' of London in 1909 summed up some existing views by writing, "Broadly expressed, one how long does viagra last 50 mg would say that the essential feature of the epileptic is that there is a periodic loss of volitional control of the instincts and emotions." He quotes Aschaffenburg as asserting that, "The specific fea-