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form. The variations are apparently as great in young individuals as in old, and in cases showing healthy arterial walls as in cases in which there is arterio- sclerosis. The location of the artery, especially in its relation to other structures such as bone and muscle, is probably of much greater importance in determining the blood-pressure reading than is thickness of the over- lying tissues. A difference between the right and left brachial pressures is by no means diagnostic of aortic aneurysm. The presence of a higher pressure in the leg than in the arm is not diagnostic of aortic insuffi- ciency, although this has been stated by previous viagra alternatives reviews ob- servers. Blood-pressure in the vessels of the leg and that in the vessels of the arm are by no means "practi- callv the same." 620 MEDICAL RECORD. [Oct. 9, 1915 New York Medical Journal. September 25, 1915. 1. Microorganismal Cardiovascular Toxins. Robert N. Wil'l- son. 2. Prostatic Calculus. Francis Huber. 3. High Blood Pressure ; Treatment by Means of Muscular Rela.xation. M. Grossman. 4. An Improved Method tor the Repair of the Lacerated Perineum. H. A. Bernstein. 5. A Two Way Stopcock for Intravenous and Intraspinal Injections and as an viagra alternatives reviews Aspirating Syringe. J. Roby. 6. Recent Progress in Ether Administration. W. O. Weis- kotten. 7. viagra alternatives reviews Gallbladder Disease. M. C. Wohl. 8. Erythremia. R. R. Mellon. 9. Blood Urea in Renal Conditions. A. J. Underbill. 10. Cancrum Oris Treated with Neosalvarsan. A. C. De Sanctis. 11. Harrison and Boylan Laws. M. Zagat. 1. Cardiovascular Toxins. — R. N. Willson describes the lesions recogriized in the hearts of patients dying during the course of or from the acute infectious diseases. Each represents a type. Cloudy swelling; edema; vacuolization of the nuclei and cells; atrophy of the fibers; pigmentary, fibroid, and fatty degener- ation; and fragmentation, are the important muscle lesions, common at some time to all. Typhoid fever presents Zenker's hyaline degeneration of the fibers. The cardiac nerve lesions, noticed so little and their significance even less clearly understood (as in in- fluenza, diphtheria, etc.), may all be comprehended in the different phases of fatty degeneration. The nerve changes viagra alternatives reviews begin usually in the myelin sheath, and the axis cylinder often takes on a swollen and beaded ap- pearance. The degenerative lesions in the cardiac ganglia have not, as yet, been thoroughly studied. The point given special emphasis is the fact that viagra alternatives reviews in every case of infectious disease all the cardiac structures are injured. Some require time viagra alternatives reviews and rest for their re- habilitation. The greater portion of the cardiac damage can never be repaired. 3. Muscular Relaxation in Treatment of High Blood Pressure. — M. Grossman describes a system of relaxa- tion exercises which he finds of considerable value in the treatment of high blood pressure. viagra alternatives reviews He finds that one does not by relaxation remove the primary causes, such as nephritis, arteriosclerosis, etc., but one does markedly influence the mental state viagra alternatives reviews accompanying these conditions, thereby reducing the viagra alternatives reviews increased ten- sion in the blood vessels due to this factor, and also minimizing the dangers which accompany this state. In employing this method of maintaining blood pres- sure at a lower level, there is provided not only a constant safeguard but also a greater control of the blood-pressure regulating mechanism. The results ob- tained in the cases of high blood pressure treated by muscular relaxation are said to be better and more permanent than those obtained by medicinal or any other measures. 6. Ether Administration. — W. O. Weiskotten in de- tailing the advantages of this type of anesthesia states that ether inhalation should be used unless contra- indicated or unless the administrator has had sufficient experience with the other methods viagra alternatives reviews of administration. The open drop method is in common use and is prefer- able to the closed douche method. .Artificially warmed vapor with a precio viagra mexico suitable inhaler is preferable to cold vapor for all inhalation anesthesias. Nasal, pharyngeal, or endotracheal insufllation of warmed ether vapor possesses great advantages and should be used when specially indicated. Rectal etherization when indicated is comparatively simple and a safe method when the proper technique is precio viagra mexico employed. 8. Erythremia. — R. R. Mellon reports a ease which he regards as typically one of erythremia, and clinically as the well known cardio-vascular nephritic complex, plus the polycythemia and mild splenomegaly. Benzol in the usual doses given did not produce any change in