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mals were injected with a mixture of pure cultures of Loeffler bacilli, streptococci, and staphylococci and the effect was extremely virulent and fatal. From these and other similar experiments the following conclu- sions are warranted : i. Streptococci with Loeffler bacilli and with or without other cocci are the bacteriological cause of the pneumonia complicating diphtheria. 2. That mixed infection not only causes this and other complications, but increases markedly the viru- lence of the action of the diphtheria bacillus. Even in cases in which the pneumonia is the result of the extension of the diphtheritic process into the finer bronchioles, the active factor in reviews for viagra professional the production of the pneumonia is probably not the Loeffler bacillus, but the pneumonia is the result of the action of the strepto- cocci upon the diseased respiratory mucous membrane. Platini viagra horror stories found that when he subjected animals to in- halation of pure cultures of diplococci, pneumonia did not result unless the mucous surface of the air passages was abraded. Such minute lesions of con- tinuity are produced by the diphtheritic exudate and become the point of entry for the streptococci reviews for viagra professional into the lymphatics and blood. Symptoms which Characterize the Occurrence of this Complication in a Case of Diphtheria. The clinical picture of pneumonia is so classical that it would scarcely be in place here to do more than to call attention to such points of interest in the symp- tomatology of this affection as appear to be of espe- cial diagnostic importance. It is well known that severe and even fatal cases of diphtheria and espe- cially of diphtheritic laryngitis run their course with very little or no rise of temperature. But it may be laid down as an axiom that the reviews for viagra professional occurrence of broncho- pneumonia as a complication of diphtheria is always ushered in by a rise of temperature which remains to a greater or less figure above the normal while the complication lasts. So universally is this true that whenever viagra horror stories in a case of diphtheria a sudden rise of temperature occurs, and when a careful examination shows no complication in the kidneys, in the ears, or inflammation of glands, I am led, even before absolute physical signs show the lungs to be involved, to sus- pect very strongly the occurrence of pneumonia as a complication. If the rise in temperature be accom- panied by relatively excessively increased rapidity of nation and slight cough, I would feel warranted in making a diagnosis of pneumonia long before the physical signs gave any proof of such a condition. 1 Zeitschrift fur Hygiene und Infections-Krankheiten. lid. xvii.. II. iii. ! reviews for viagra professional XI. Internat. Cong., Rome. Section for Dis. of Child. March 14, 1896] viagra horror stories MEDICAL RECORD. 569 Indeed, the two most important symptoms of pneu- monia complicating diphtheria, outside of those ob- tained by auscultation and percussion, are the rise of temperature and rapidity of respiration greater than would be called for by the increased action of the heart. Of the physical auscultatory signs, those which show the presence of a local capillary bron- chitis are extremely important, particularly when this bronchitis is found at the base of the lungs poste- riorly. Crepitant and subcrepitant rales in this situ- ation with rapid breathing and rise of temperature indicate when occurring with diphtheria the presence of a broncho-pneumonia. I say this in viagra horror stories spite reviews for viagra professional of the fact that I persistently look for bronchial breathing and the percussion note of consolidation. Where the pneumonia begins in the deeper portions of the lungs, signs of consolidation cannot be obtained before the third or fourth day and frequently we do not get them at all, and he who seeks confirmation of his diagnosis by this means will often not find it con- firmed until the signs of resolution, moist and sub- crepitant rales, defervescence of reviews for viagra professional the fever, etc., show where the lungs have been involved or, in the case of death, the autopsy proves it even more positively. The most important and, if heard, absolutely pathog- nomonic physical sign in the early stages of a broncho- pneumonia is one obtained by auscultation. It con- sists of fine crepitant rales heard on deep inspiration over the inflamed lung tissue. It can be heard reviews for viagra professional in crying infants during the deep inspiration between the cries. Heard once it is so characteristic that a diagnosis of pneumonia can be positively made. The viagra horror stories ear of the auscultator should be firmly pressed against the chest, care being taken to exclude the crepitant sound made by the hair of the auscultator rubbing against the chest of the patient. Even if the incipi- ent inflammation be in the deepest part of the lungs and no bronchial breathing or dulness is heard, owing to reviews for viagra professional the overlying healthy lung tissue, this crepitation will be heard on very deep inspiration. It is, of course when certified to by reviews for viagra professional a competent auscultator, absolutely pathognomonic. This crepitation is prob- ably due to the entrance of air through the viscid in- flammatory products which partially till the finest bronchi and air cells in the early viagra horror stories stages of pneumonia. Especially difficult will it be to obtain the classical physical signs in cases of disseminated reviews for viagra professional broncho-pneu- monia, for here comparatively healthy lobules sur- round diseased areas of lung tissue and mask the physical signs, but if one will be guided by the symp- toms already given, r.amely, rise of temperature, in- creased rapidity of respiration, and the presence of capillary bronchitis, and, best of all, the crepitant rales heard on deep inspiration, he will rarely be deceived in his diagnosis. It is of the utmost importance from a prognostic point of view to attempt to make the dif-