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poisonous gases, which not only are in some measure absorbed, but also, by mechanically displacing and dis- commoding, embarrass organs above and below the diaphragm through gastrointestinal distention. In all three of these forms of food influence, the first recog- nizable effect is on the cardiovascular viagra modo de uso system. The author viagra modo de uso has experimented on laboratory animals and on himself, and has questioned very carefully patients in his viagra modo de uso care with a view to gaining light on this point. From all three sources he states that he has obtained ample evidence that the heart and vasomotor system experience very early the influences of a food toxemia of whatever nature. Usually there is a marked quickening of the cardiac action, often a distinct palpitation ; almost always in the acute viagra modo de uso stages (before collapse) there is a marked elevation of both the systolic and diastolic pres- sures. Later, as the heart begins to tire, the systolic pressure may fall and the rhythm become irregular. Not infrequently the author has seen distinct signs of cardiac dilatation in the entire absence of abdominal distention. It would seem, therefore, as though the purchase viagra no prescription clinical symptoms suggesting a toxemia, especially as re- viagra modo de uso flected in the cardiovascular system, viagra modo de uso are to be ascribed in the main to poisons elaborated in the intestine, but not from any one group of foodstuffs. The only requi- site would seem to be that a given food substance or one of its constituents or end-products shall prove toxic for its individual host. The summer heat of the bowel, the retention decomposition of masses of undigested and often indigestible food, the presence even of food sub- stances that are innocuous and tissue builders in other individuals, only provided they are toxic for the given one — provide all the conditions favorable to the pro- duction of acute cardiovascular crises, which, if re- peated often and persistently enough, will result in cardiovascular disease. 5. Casualties of Modern Naval viagra modo de uso Warfare. — By F. E. McCulIough. (See Medical Record, July 3, 1915, page 41.) 8. Management of Peritonitis. — W. D. Haggard states that the most essential treatment of this condi- tion, with or without operation, is an absolute prohibi- tion of anything whatsoever by mouth, with immediate preparation for operative relief when possible. When for any reason this cannot be done the continuance of this principle with the addition of deep morphinization is the most dependable method. After operation drain- age by the glass tube suprapubically and the employ- ment of the upright posture and proctoclysis are well- nigh routine. 9. Post-Mortem Reflexes. — .J. H. Catton concludes from his observations that the tendon and superficial reflexes disappear at death. Muscular irritability to mechanical stimulation is increased immediately follow- ing death, and continues to increase to a maximum and then to decrease, disappearing at about sixty minutes post-mortem. Since a similar increase in muscular irritability is observed in certain organic diseases of- the nervous system, these reflex studies and similar studies of the electrical reactions of muscle and nerve following death should lead to new aids in the diagnosis of nervous disease. In eliciting tendon reflexes, one must be careful to tap only muscle-free tendon. The instru- ment must be made to stroke and not dig into the sole in eliciting the plantar reflex. The persistence post- mortem of many reflexes about the wrist cautions one not to confuse them with the periosteal reflexes in life. 10. Elimination of Potassium Iodide in the Urine. — W. A. Wovschin notes that the major portion of the eliftiinated potassium iodide is excreted in the first twenty-four hours, from 5 to 10 per cent, is given off purchase viagra no prescription in the second twenty-four hours, and by the third day only a trace of or no potassium iodide is excreted. As is to be expected, the amount of potassium iodide recovered never equals or even approximates the amount intro- duced, indicating that purchase viagra no prescription other avenues of elimination (skin, saliva, etc.) excrete a considerable portion, and perhaps part may be utilized in thyroid-protein moleculi- zation. Patients who expectorate a great deal excrete less potassium iodide in the urine. The total elimination of potassium iodide in nephritic cases, as compared with other diseases, is the lowest and serves as a hint of poor renal function. When the potassium iodide is given per rectum in the nephritic cases there is a more notable elimination, due probably to slower absorption and the proctoclysis acting as a renal stimulus. 11. Quinine and Urea Injections in Hyperthyroidism. — L. F. Watson presents the results of a study of the quinine and urea ti-eatment in fifty cases of goiter in which it was used. The method is recommended only for the control of the symptoms of hyperthyroidism in cases of toxic goiter, and is not recommended for the removal of the tumor in atoxic (simple) goiter for cos- metic reasons alone. The injection does not relieve the symptoms of advanced toxic goiter when the vascular and nervous systems have been permanently damaged. Much depends on a proper selection of cases; the neces- sity of preventing pain from any injection, by the use of local anesthesia, is of vital importance; if acute attacks of hyperthyroidism are to be prevented, the use of pre- liminary injections into the most prominent portion of the goiter, of a few minims of sterile salt solution given at one to three day intervals, followed by injections of sterile water, are found indispensable; the result of the quinine and urea injection depends on the amount of tissue destroyed. The quinine and urea injection in ex- perienced hands is a viagra modo de uso harmless procedure; it is almost painless, and there is no post-injection discomfort. It is suitable for use only in a hospital by men skilled in goiter work. The gradual improvement of the exoph- thalmos in certain patients following the quinine and urea treatment points to a control exerted by the thyroid on the exophthalmos, through the sympathetic nervous system, as first suggested by Landstrom. The viagra modo de uso author believes the greatest field of usefulness for the injec- tion is purchase viagra no prescription to be found in those cases of beginning hyper- thyroidism not severe enough to justify operative treat- ment, and as a preparatory measure to partial thy- purchase viagra no prescription roidectomy in chronic cases of toxic goiter in which the patient is too ill to warrant any form of immedi- ate operative procedure. 14. Treatment of Syphilis of the Brain.— G. O'N. Ireland and C. S. Wilson find that the injections of 1/.50 grain of mercuric chloride intradurally, by the method