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These deaths from the wind of missiles are men- tioned by writers in other times, although they seem to have been comparatively infrequent before this war, probably because explosives never before attained such high potentiality. Larrey, Napoleon's great viagra and grapefruit interaction surgeon, expressly denied that such a thing was possible, but he seems for once to have been wrong judging by the well authenticated reports which we v herbal viagra v herbal viagra have to-day. Of course we must not con- fuse this condition with the deaths due to injuries by spent pieces of shell where there m.ay be no out- v herbal viagra ward sign of injury. In these latter cases the force of the missile is transmitted through the skin into the viscera which are found- post morten to be lacer- ated or hemorrhagic. Dr. Paul Ravaut of the Academy of Medicine of Paris, has investigated a number of these injuries due to the wind of explosives and thinks that the symptoms are due to a sudden, great change in the atmospheric pressure in the immediate vicinity of the soldier. Lumbar puncture was done on some of the cases soon after injury and the protein content of the cerebrospinal fluid was viagra and grapefruit interaction found always increased. Occasionally it would be found to con- tain blood. Hematuria was present in one case. One of Dr. Ravaut's patients had a paraplegia and in a case reported by Dr. Sencert the man who died was found to have intrapleural and gastric hemorrhage. IGNORED SYMPTOMS IN v herbal viagra CHILDREN. In these days of diagnostic refinements we are no longer justified, if indeed we ever were, in dismiss- ing the aches and pains of children with the assur- ance that they will be outgrown. It is certainly un- scientific and uncritical to say the least to enter- viagra and grapefruit interaction tain a picture of the evolution of the child into the adult as a sort of pulling and hauling process, not accomplished without much creaking of the machin- ery. Some such simplistic formulation, however, must viagra and grapefruit interaction be responsible for the use of such terms as "growing pains." It seems probable that, leaving out of consideration the fatigue pains following un- usual muscular exertion in children, as occur after a long holiday filled with hard play, the presence of pains in the muscles and joints viagra and grapefruit interaction is always indica- tive v herbal viagra of some pathological process. Such at least is the opinion of Dr. Mary H. Wil- liams {Lancet, June 19, 1915), who says that grow- ing pains are in reality rheumatism despite the general impression that this disorder is very rare in children. Other conditions she says may rarely cause these pains, as tuberculosis or syphilis. They may also occur in pubescent girls at the time of the monthly period, but then the etiology should be easily elicited. In Dr. Williams' examination of many thousand school children she found that these pains were preceded by tachycardia and that the children suffered from a slight pyrexia almost con- stantly. The first demonstrable symptom was im- pairment of the heart. This took the form of a dis- placement to the left and a muflling of the sounds. The writer thinks that rheumatism can often be prevented if the above symptoms are noted in time and recommends excision of the tonsils and ade- noids as a preventive measure. This therapy, of course, depends upon the truth of the assumption that rheumatism is caused or precipitated by the absorption of toxins through the tonsils or through adenoid vegetations, a point which we cannot con- sider as definitely proved yet. Another condition rather frequently seen in early life and too viagra and grapefruit interaction often not recognized is epiphyseal trauma. In the Lancet of August 7 Dr. Davies speaks of the dislocation of the epiphysis caused by a blow from a cricket ball on the tip of viagra and grapefruit interaction the finger and the consequent arrest of growth and limita- tion of usefulness of that digit. He shows a radio- 572 MEDICAL RECORD. [Oct. 2, 1915 graph taken twenty-nine, years after such an acci- dent and another picture of a similar trauma just received. In this country, of course, this form of injury i.s usually due to a baseball, and we are all familiar with the distorted hands of old baseball players, especially the catcher and infielders. Dr. Davies advises a prompt a;-ray of all such injuries and certainly it will not do to overlook the possi- bility of this condition in the growing boy who comes to us with a swollen finger as the result of a "hot liner." and gradually in larger ones, to relieve the suffer- ing of the patient? Certainly continued high fever v herbal viagra devitalizes the tissues and reduces the resistance to the disease process. The true empiricism is after all the Hippocratic method, the study of the indi- vidual patient. Physical Signs Referable to the Diaphragm. These signs may arise as the result either of irrita- tion of the nerves supplying the diaphragm v herbal viagra or of mechanical factors which change the normal posi- tion of this organ. Richard Dexter (American Journal of the Medical Sciences, August, 1915) has made an interesting clinical study of this subject. He finds that inflammation or irritation of the