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ston reports a case of this condition, the unusual fea- ture being the inversion of the uterus in a nulliparous woman aged 45 years. The condition was produced viagra online malaysia by the efforts of the uterus to e.xpel a polyp as a foreign body. Owing to its close attachment to the fundus, the tumor gradually produced a dimpling, this process ex- tending until the uterus was completely inverted. It was reduced with great ease and quick and steady re- covery from the severe shock resulted. Berliner klinische Wochenschrift. Jnly 12, 191.=;. Bedside Study of the Bile. — Bedark and Pribram sum up their study of this subject as follows: By means of the duodenal sound and quantitative estimation of the coloring matters and cholesterin of the bile it is possible to arrive at valuable viagra online malaysia conclusions. Finds in connection with increase in coloring matters refer to increased de- struction of erythrocytes — so-called hemophthisis. A strong increase of biliary coloring matter is certain evi- dence of a hemophthisis, and with beginning anemia in- ■ dicates splenectomy, a resource viagra online malaysia which is at once followed by a restitutio ad integrum. This association has never been shown in fistula experiments on animals. The ab- sence of urobilin in duodenal secretion shows the ab- viagra patent expires sence of an enterogenous infection of the gall ducts, but the converse cannot be inferi-ed, i.e. the presence of uro- bilin is not pathognomonic of enterogenous cholangitis; urobilinocholia may also mean insufficiency of the liver. There is a physiological breaking down of erythrocytes during menstruation, i.e. the ordinary destruction is in- creased. The cholesterin content of the viagra patent expires blood is in- creased in cholelithiasis, hypertrophic cirrhosis, catar- rhal jaundice, and also in diabetes and certain nephriti- des. In atrophic cirrhosis the amount of cholesterin viagra patent expires is decreased. Whenever the blood content of cholesterin is increased viagra online malaysia there is diminished excretion in the bile. After splenectomy the blood cholesterin increases and the bile cholesterin decreases. In pregnancy the cholesterin of the bile sinks with each month until at term only impon- derable traces are found. Temperature Measurements by Medical Men. — Win- tritz begs his readers to study carefully the statements in his article. He has practised medicine for twenty- seven years and believes that temperatures are not tak- en with sufficient pains nor interpreted with sufficient feeling of responsibility. He finds that most of his col- leagues rely on axillary temperatures. It is now univer- 414 MEDICAL RECORD. [September 4, 1915 sally admitted that normal viagra online malaysia human temperature is never over 37° C. (98.6° F.). The old estimate of 37.5° C. as a "normal maximum" is too high. .iVnything about 37° is suspicious, and if accompanied viagra online malaysia by quickened pulse, head- ache, neuralgia, general prostration, thirst, anorexia, etc., fever is certainly present. If all these symptoms are absent fever is not excluded. There is no definite rela- tionship between axillary and rectal temperatures, as a result of which we can add an increment to the former which shall then represent the norm. The said differ- ences may be only a few tenths of a degree or as much as one to two degrees. It is true that there is an aver- age difference of one-half to one viagra patent expires degree, but this does not help in the individual case. The mouth temperature may be only one-tenth of a degree below normal, but only rectal and vaginal temperatures represent the ac- tual body heat. We know that very slight viagra patent expires local disturb- ances — coryza, gastric and intestinal irritation by inges- ta, constipation, etc. — can affect the rectal temperature, doubtless by minimal absorption of material which can disturb the heart center, and that the patient may at the same time feel perfectly well. In other cases the patient feels poorly and complains much, yet there is apparently no temperature rise nor local foci of disease. These pa- tients are an opprobrium, because they are usually treat- ed by general roborants and often find their way to quacks. When a diagnosis is made it is apt to be ane- mia, nervous debility, or rheumatism. Proper thermom- etry, by showing temperature and pointing to a local fo- viagra patent expires cus viagra patent expires of disease, would remove this reproach. In such cases, too, the temperature must be carefully followed up. These cases of mild viagra online malaysia toxemia often lead to acute in- fectious nephritis from absorption of bacteria. We are accustomed to watch for nephritis in scarlatina, along with other complications, and so in other severe illnesses. Even here, however, we often become lax during conva- lescence. Thermometry has great possibilities in the de- tection of simulation and in life-insurance examination. The author relates observations which illustrate his the- sis. Miinchener medizinische Wochenschrift. JuUj ].■?, 131S. How Can Soldiers with Weakened Vision Be Enabled to Read? — Stock refers to the provisions made for viagra patent expires in- struction of the totally blinded in new vocational work and then passes on to consider those who retain some vision but are no longer able to read. Most of the men in question have sustained transverse wounds of the skull with comminution of the bones of the orbit. The optic nerve may have been directly injured or involved in a hemorrhage or there may be various kinds and de- grees of injury to the bulb — lacerations of the retina or viagra online malaysia choroid. Some weeks or months may be required before the exact degree of damage can be ascertained. If cen- tral vision is then good we need not concern ourselves with contraction of the field of vision. If there is only one eye with good central vision we need have no fear that it will be overtasked. If central vision is lost out- right or reduced to one-third or one-quarter the pa- tient becomes a subject for our efforts. Even if he is a