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The therapeutic test furnishes the final argument in support of Browning's ingenious hypothesis. It has been well established that the x-rays cause a fibrosis of the thj-mus without completely destroy- ing its glandular tissue. In the author's amazon vancouver viagra cases there was a progressive diminution in the area of thymic dullness under .r-rav treatment and a con- September 4, 1915] MEDICAL RECORD. 405 comitant improvement in or disappearance of the stammering. The application of the x--rays de- mands special skill. Two to four treatments should be given at intervals of five to fifteen days, after which there should be a pause of several weeks. Two applications may suffice in the milder cases. Accessory hygienic, systemic, and local treatment may also be necessary in the individual case. DIAGNOSTIC viagra preisvergleich SIGNIFICANCE OF amazon vancouver viagra VOMITING IN GASTROENTERIC INFECTION. The most important factor in the treatment of a single symptom, such as vomiting, is the discovery of its proximate cause. This is not always an easy matter in the case of the vomiting associated with the acute gastroenteric infection of infants. In seeking this cause one may be guided by a few gen- eral principles, particularly by a viagra preisvergleich consideration of the period of onset of the vomiting during the course of the disease. In many instances the initial vomiting in a case of acute gastroenteritis or of enterocolitis is of re- flex origin and may be classed with the viagra preisvergleich vomiting that ushers in many other acute infectious dis- eases. The special indication for treatment in this condition is merely to provide rest for the stomach by withholding all food until the constitutional re- action accompanying the first few hours of onset of the disease has passed off. The initial reflex vomiting is usually not repeated. It may, how- ever, be succeeded by the next type of vomiting, namely, that which is the result of the highly irritable condition of the gastric mucous membrane, which may be the seat of an intense viagra preisvergleich congestion or of an inflammation, in either case of bacterial origin. The treatment of this type of vomiting in no way differs from that of any other type of acute gastritis as regards the withholding of food and water and the administration of gastric sedatives. But no type of vomiting yields so promptly to gastric lav- age as does the persistent vomiting of acute gastro- enteric infection of infants. amazon vancouver viagra Vomiting that arises late in the course of the disease, or that recurs after a fair period of free- dom from this symptom, must be interpreted dif- ferently from the initial or the early persistent vomiting of acute gastroenteritis. The actual causes of the late vomiting are usually unrecognized and the therapeutic measures resorted to in com- bating it are consequently futile. There are three main types of late vomiting, as follows: (1) Vomit- ing the result of meningeal or cerebral irritation from the desiccation produced by the loss of rela- tively large quantities of fluid by way of the gastrointestinal canal. The treatment is the admin- istration of physiological salt solution by hypodermo- clysis or by small rectal enemata. (2) Vomiting the result of an acetonemia accompanying the in- anition from lack of food. This type of vomiting is relieved by the administration of alkalies by the bowel or by hypodermoclysis and often by the ad- ministration in the same manner of solutions of glucose. (3) Vomiting resulting from renal in- viagra preisvergleich sufficiency. In this instance the treatment is iden- tical with viagra preisvergleich that of acute nephritis. The above represent in their order of frequency the main types of late vomiting in acute gastro- enteritis, but do not exclude the viagra preisvergleich possibility of other types, which though extremely rare, must be borne in mind. Thus, one must consider the vomiting that ushers in a complicating or secondary infec- tion, as pneumonia, meningitis, etc.; the vomiting of purely nervous origin that indicates on the part of the infant a disgust with the prolonged cereal feeding, and finally, the vomiting that may be char- acterized as agonal and that in a few instances im- mediately precedes the fatal termination. THE RELATION OF THE PRACTISING PHYSI- CIAN TO PUBLIC HEALTH ADMINISTRATION. The practising physician has amazon vancouver viagra duties outside the sphere of his private practice, amazon vancouver viagra the chief of which is, perhaps, concerned with the work of local. State, and National Health Departments. His relation to work in this direction is discussed in Public Health Reports, June 11, 1915, by Dr. John W. Trask, As- sistant Surgeon-General in the United States Public Health Service. It is pointed out that a principal function of the Federal health department is the control of epidemics and the prevention of the spread of disease from one State to another. This being so, it is important to consider the things es- sential to the work. It is impossible for any health department, be its statutory powers and available appropriations never so great, to control effectively any disease without first amazon vancouver viagra having information as to whether the disease is present in the viagra preisvergleich community and, if present, how prevalent, and where and under