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668 MEDICAL RECORD. [Oct. 16, 1915 hopelessly advanced cases. 3. The ligation of both in- ternal iliacs viagra generico online sicuro and one ovarian possesses definite merit, and when combined with heat, furnishes the best means of converting the borderline cases into frankly operable ones. 4. It cannot be too strongly emphasized that the combined application of heat and ligation of vessels, on the one hand, and total extirpation, on the other, in all except clearly operable cases, should be done as a two-stage operation. 5. In the combination of heat with starvation, we have a valuable means of markedly increasing the operability and of viagra 150 mg pills decreasing the primary mortality of radical extirpation. 6. Heat com- bined with extensive arterial ligation, followed by radi- cal hysterectomy, offers the greatest possibilities for permanent cure. The Lancet. September 18, 1915. 1. On the Bacteriology of Septic Wounds. A. Fleming. 3. Rhinophyma : Its Etiology, viagra generico online sicuro Pathology, and Treatment. W. Milligan. 3. On Galyl, a Substitute for Salvarsan and Neosalvarsan. A. Foerster. 4. A Case of Temporary Motor Aphasia Developing in the Course of Tuberculosis. J. B. McDougall. it. Salvarsan in the Treatment of Taws. W. M. McDonald. -6. Observations upon 100 Consecutive Operations for Appen- dicitis. R. M. Glover. 1. Bacteriology of Septic Wounds. — A. Fleming, writing from the Research Laboratory attached to the General Hospital at Boulogne reports that the bac- teriology of wounds inflicted in this war has furnished a very interesting study because the flora of these wounds has been found to be very different from that met in civil practice. Nearly all the wounds were due to bullets or fragments of shells and they seldom re- mained sterile. Pieces of mud-covered clothing were usually carried deep into the wound. To determine the relationship between the infections found in wounds and the bacteria on the clothing the author examined samples of clothing taken from wounded men on their arrival at the base. Small pieces were cut off from portions of clothing remote from the wound, so that contamination viagra generico online sicuro of the clothing by discharges from the wound might be avoided. Pieces about half an inch square were planted into broth tubes and cultivated aerobically and viagra generico online sicuro anaerobically. Of twelve samples of clothing examined, B. aerogencs capsidatus was found in 10, B. tetani in 4, streptococcus in 5, and staphylo- coccus in 2 ; while other organisms which were not properly identified, but which were in all probability viagra generico online sicuro mainly non-pathogenic, were found in some of the sam- ples. These examinations were made in November last when there were many cases of tetanus, which is hardly surprising when it is considered that one sample in three of the clothes examined showed the presence of the tetanus bacillus. From a study of the bacterial flora it was noticed that these wounds pass through thi-ee phases, more or less distinct. The bacterial his- tory of a wound is much the same whether it is slight or severe, except that in the slight and per- fectly drained wounds the transition from one stage to another viagra 150 mg pills is much more rapid and healing occurs in a shorter time. Streptococci are found in practically all wounds, whether old or recently inflicted. The spore- bearing anaerobes, comprising chiefly B. acrogcnes cap- sidatus, B. teiani, and some putrefactive organisms, on the other hand, progressively diminish in relative fre- quency as the age of the wound increases. In the early stages these spore-bearers are present in much greater numbers than anything else, whereas later, although they may still be seen in the pus films, their numbers are relatively few. The most striking feature of the discharges from these wounds was the extraordinary .amount of pus — thus indicating that phagocytosis was very active and the resistance to the infection very great. This is in marked contrast to cases seen viagra 150 mg pills in civil practice where the infectious agent usually has enhanced virulence due to its viagra generico online sicuro passage from one indi- vidual to another, or where infections occur more or less spontaneously due to lowered resistance on the part of the individual. The author recommends the periodic administration of a vaccine to keep the pa- tient's resistance up to a high level. 2. Rhinophyma: Its Etiology, Pathology, and Treat- ment. — W. Milligan is of the opinion that chronic alco- holism or traumatism are not etiological factors in producing rhinophymata. It may conceivably be an end result of acne rosacea which is very often present on the nose and in other parts of the face at the same time. Histological examination of sections of the pathological tissue removed by viagra 150 mg pills operation shows marked thickening of the connective tissue of the corium with hyperplasia and cystic dilatation of its sebaceous glands and small deposits of fat between the various hyper- trophied areas. The outcome of these changes is an elevation of the papillary layer of the true skin into circumscribed projections of varying size and shape. Cystic dilatation of one or more of the sebaceous glands viagra generico online sicuro is, as a rule, a marked feature in many sections, and it would appear as if these glands were not only enor- mously increased in size, but were actually increased