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on wdiich date he underwent an examination which was made necessary by the Employers' Liability Act of New York State. At this examination he was informed tesco viagra 2012 that his urine showed evidences of Bright's disease, and he was advised to consult his family physician. On physi- cal examination at this time it was found tesco viagra 2012 that there was nothinc; unusual in his general appearance, the patient claiming that his general health had been good. He showed, however, most decided evidences of nervousness due to fright produced by having been told that he had Bright's disease. Examination of his urine at this time showed the fol- lowing: Color, milky, suggestive of albumin; sediment, plentiful and white in color; specific gravity, 1.010; re- action, acid; albumin, Bence-Jones; sugar, negative; in- dican, moderate amount; bile, negative. Microscopic examination, amorphous urates, acid phosphates; casts were not found in this specimen; few pus cells. Subsequent examinations showed a persistence of the Bence-Jones body. In all twelve to fifteen specimens taken at different times were submitted. Our viagra pharmacy express diagnosis rested among three conditions, viz., (1) multiple mye- loma, with which this body is most frequently associat- ed; (2) leukemias, with which blood conditions this body is sometimes found; (3) syphilis, with which this body is infrequently found. Examination of the patient's blood showed the follow- ing: tesco viagra 2012 Hemoglobin, 85 per cent.; total erythrocytes per cu. mm., 3,140,000; total leucocytes per cu. mm., 8,000; tesco viagra 2012 color index, 1.0. Differential Count. — Polynuclear viagra pharmacy express neu- trophiles, 56 per cent.; lymphoeites (large and small), 22% per cent.; mononuclears and transitionals. 18 tesco viagra 2012 per cent.; eosinophiles, 3% per cent; basophiles, 0. Thus we w-ere able to rule out leukemia. A negative Wassermann in conjunction with the pa- tient's past history of lack of luetic infection enabled us clearly to rule out syphilis. Our only conclusion, therefore, could be tha tit was a case of multiple myeloma. As a rule multiple myelomas are not diagnosed before the clinical picture of multiple fractures particularly of the thoracic skeleton are found. The_ symptoms in this case, however, were not typical. Subjectively there was present boring pain over the vertebra, sacrum, ribs, and sternum. Objectively there was tenderness produced by pressure over viagra pharmacy express these painful areas. The literature on multiple myeloma so far as we were able to discover deals almost entirely with advanced cases wdth the ac- companying pathognomonic symptoms of this disease, viagra pharmacy express namely, fractures of various bones, particularly the tho- racic skeleton. The case to our minds was therefore, unusual in so much as the only marked characteristic was the presence of tesco viagra 2012 the Bence-Jones body in the urine. Later in the disease the urine showed the same pic- ture both chemically and microscopically v/ith the occa- sional finding of casts of an apparently waxy consis- tency. This was by no means a constant finding. The patient's general physical and nervous condition dating back to the time of his having been informed that he had a serious kidney lesion grew progressively and continuously worse. He continued to fill his position un- til April 3, 1914, when he had a severe attack of renal colic lasting for a period of twenty-four hours, during which time he was placed under the influence of mor- phine. He again resumed his occupation, filling his posi- tion up to the first of May, 1914, tesco viagra 2012 when he found he was no longer able to continue on account of a feeling of ex- treme exhaustion which had been gradually increasing during the past month. This, together with an ever- increasing nervous fear as to the final outcome of his condition, caused him to take to bed. At this time Dr. Harlow Brooks of New York was called in consultation, who, after examining the pathological reports, without hesitation confirmed our diagnosis, making the state- ment that he laid but little stress on what he found by physical examination inasmuch as at this early stage the diagnosis could be made in the laboratory only. From May 17 until the time of his death. viagra pharmacy express May 27, the patient was viagra pharmacy express unable to retain any form, either solid or liquid, in his stomach. Every means to control his vom- iting was futile. Rectal feeding was resorted to, but with no avail. The immediate cause of death was ex- haustion, coupled with an ever-present and increasing belief tesco viagra 2012 that nothing could be done to prevent his death, even though he desired very much to live. This latter fact with the inability to retain food for a period of ten days seemed to hasten his end. At the necropsy we looked for bone lesions and were not at all surprised to find that the ribs were severed by an ordinary scalpel with a moderate amount of force. The sternum was found so flexible as to be easily dou- bled upon itself in its long axis, and was almost as easily cut through with a scalpel as the ribs. Lungs, normal; stomach and intestines, normal; spleen, normal; liver, some hydropic infiltration; heart, normal; kidneys, both were enlarged, pale in spots, viagra pharmacy express capsule stripped easily. Microscopically. — Interstitial changes with round cell infiltration; tubules were dilated and filled with casts, exudate in capsular space wdth prolif- eration of Bowman's capsule; hyaline degeneration in glomeruli. Adrenals showed marked granular degeneration and hydropic infiltration; no fibrosis seemed as yet to have taken place. Pancreas showed hydropic infiltration in islands of Langerhans. Sternum, very flexible; easily cut through viagra pharmacy express with ordinary knife. Microscopically. — showed absorption of bone tissue. In most places bone trabeculae were absorbed so that medullary canals were coalesced to form one large cavity. This type of cavity was filled with cells nearly all of one type, viz., myelo- cytic. They contained a large stippled nucleus, fre- quently eccentric and resembling very much the plasma cell; cytoplasm fairly large in amount staining faintly with eosin; in most places the whole microscopic field consisted of these cells alone arranged in mosaic; here and there a few normal marrow cells could be seen. Ribs, soft, easily cut through and very flexible. Micro- viagra pharmacy express