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6. To protect tlie perineum: The patient should be restrained from bearing down unduly; extension of the head must be retarded, and the central part of the occiput must be allowed to be born first; pressure must be made with the hand between the coccyx and the anus; when the perineum has had time to stretch, extension and expulsion are allowed; after the birth of the head gratis viagra probe care must be taken to see that the perineum is not torn by the birth of the shoulders. 7. Treatment of pregnancy complicated with ne- phritis: "Prophylaxis is of the first importance. The urine should be examined every month in the first six months of every pregnancy, no matter how normal it Oct. ;•. 1915J viagra like over the counter Mi:niC\l. Rh'-CORD. 6S7 may seem, and every fortnight in the last three months. If albumin is present, the amount should be estimated in an Esbach tube, and the urea in a Doremus ureo- meter. The total quantity of urine per diem should also be ascertained. The principles of viagra like over the counter treatment are to relieve the kidneys by free elimination by the bowels and skin, and by diminishing the nitrogenous part of the dietary; and at the same time to prevent any fur- ther interference with the renal functions by guarding against cold. In mild cases where the albuminuria is viagra like over the counter the sole gratis viagra probe symptom, the patient should be warned to rest and guard against cold. The diet should be restricted to milk food, with bread and butter, and a little fish or chicken once a day, and the bowels should be made to act freely once every day. Where there viagra like over the counter are, in addi- tion, symptoms such as edema gratis viagra probe or headache, the patient should be kept in bed, the diet even more rigidly re- stricted, and nothing but milk foods given for some days. The bowels should be briskly purged by a hydra- gogue, such as jalap, and the kidneys flushed out with diluent drinks. This treatment must be continued until the symptoms have disappeared, although it is rare for the urine to clear up altogether. A little fish and chicken, and some light fruits and vegetables may then be added to gratis viagra probe the diet, but the regular free action of the bowels must be continued. In more severe cases the skin functions must be stimulated in addition by the use of hot packs. The diet also should viagra like over the counter be nothing but plain milk and diluent drinks. Hot salines per rectum help to flush out both bowels and kidneys. If the condi- tion grows worse in spite of treatment, it argues either viagra like over the counter a very severe toxemia, or severely damaged kidneys. The outlook in either case is so bad, owing to the probable onset of eclampsia, that the pregnancy should be terminated, particularly as the prospects of obtain- ing a healthy living child are remote. This viagra like over the counter interference becomes urgent if signs of di^owsiness indicate ap- proaching coma, or sickness and epigastric pain suggest the near onset of eclampsia. The obstetric treatment then consists in emptying the uterus. Where there is no great urgency this should be done by Krause's method of induction of prematui-e labor. In urgent cases some method of accouchement force must be em- ployed, the choice depending upon the condition of the cervix, and on the degree of urgency" (.Johnstone's Tcrt-book of Midwifery). 8. Periiicimi-t vomiting of prcgnttncij . "The treatment consists in rest in bed in a quiet, darkened room and the administration of easily digested foods, viagra like over the counter such as milk, broths, eggs, etc. A careful search must be made for some local exciting cause, and if any such condition is found, it should receive appropriate treatment. Sexual intercourse should be interdicted. The bowels should be kept freely open. Sodium bromide, camphor, cocaine, silver nitrate, cerium oxalate, hyoscine hydro- bromide, antipyrine. etc., are among the drugs used internally. Rectal alimentation may be necessary, and, as a last resort, dilatation of the cervix and internal OS, or abortion may be performed (f'orhef Ctji-lo- pcclia ) . P.\THOLOGY 1. Tlirovibus is gratis viagra probe a blood-clot formed within the heart or blood vessels during life. Embolus is a clot or other substance brought by the blood current, and forming an obstruction where it lodges. Emboli are most frequently found in the following arteries: Pulmonary, renal, splenic, cerebral, iliac, axillary, mesenteric and coronary. 2. A physiologiea! leticocytosis is a leucocytosis which is found in certain physiological conditions; it is gen- erally moderate and of brief duration. It is found in the newborn, after parturition, after exertion, after a cold bath or massage, during pregnancy, and during digestion. A pathological leiu-ociitoai.'i is a leucocytosis which is found in certain pathological conditions; it is generally found in inflammatory, toxic, and infectious conditions. As a viagra like over the counter rule, the polynuclears are increased. Of the diseases mentioned there is a leucocytosis present in: Pneumonia. It is absent in: Typhoid, malaria, and acute miliary tuberculosis. .■'. Tuberculous lesions may be diagnosed by the vari- ous tuberculin tests, such as those of Koch, von Pirquet, Calmette, and Moro. 4. In chronic alcoholism there may be found peri- pheral neuritis, viagra like over the counter meningitis, catarrh of stomach, cir- rhosis of liver, arteriosclerosis, and granular kidney. 5. Acute Lobar Pneumonia. "It is convenient to de- scribe four stages, those, namely, of (1) hyperemia or