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prompt surgical intervention had prevented the exten- sion of the infection. The lung symptoms were typical of tuberculosis, and the condition was not recognized until bacteriological examination revealed the nature of the infection. Exhibition of Some Unusual Aneurysms. — Dr. Philip King Brown presented a specimen of dissecting aneurysm and gave a brief history of four cases. They were all aneurysms of the descending arch of the aorta, and in each case symptoms w-ere present but no signs, the diagnosis having been made by the assist- ance of the .-r-ray. Dr. Dixon of Leland Stanford University, said that the types of coccoidal disease were classified accord- ing to their primary lesion. Dr. Brown had spoken of one case that recovered and he also knew of one re- covery. In this instance a resection of the elbow was done and a diagnosis of the condition was made after the operation, but not before. He viagra price per pill in india outlined the history of another case in which a diagnosis of carcinoma of the stomach had been made. The patient died of bron- chopneumonia, and after death the coccoidal bodies were found. There were findings in this case similar to those in a healed case of viagra in melbourne tuberculosis. Dr. Dixon exhibited frozen specimens and fresh cultures of the organism and also a number of specimens showing the close resemblance between the lesions of coccoidal gran- uloma and those of tuberculosis. Some of the cultures showed the spores, and it seemed that infection could not take place unless spores were injected. Dr. Dixon agreed with Dr. Brown that probably a large number of these cases were not diagnosed. The test for these or- ganisms should be made in every case of clinical tuber- culosis in which the tubercle bacillus could not be found. Dr. Cummins of San Francisco, said he had seen a number of these cases and had studied them clinically and histologically, and it was interesting to compare them with blastomycosis. He described a case in which the patient appeared to have typhoid fever. At autopsy the gross findings appeared to be those of miliary tuberculosis, but the coccoidal organism was found and the lesions involved the viagra in melbourne lungs, spleen, liver, adrenals and kidneys. In another case the organism was found in lesions in the occipit.^1 and temporal bones, the scalp, dura, sternum, third, fourth, and fifth lumbar vertebrae, and the diff'erent viscera were involved. In another case an abscess over the left kidney showed the organisms of this disease. They must take cognizance of the fact that there were more cases of this disease in this part of the country than were being recognized. With reference to the differ- ence between a coccoidal infection and blastomycosis a recent article in the Journal of the American Medical Association would clear up the uncertainty in the minds of many in regard to the differ.;nce of these two conditions. Observations on the Blood Pressure in Cases of Dys- thyroidism. — Dr. John M. Swan of Rochester, N. Y., presented this paper setting forth the results of his observations in fifty cases of dysthyroidism of varyin? degrees of intensity. The cases were analyzed with reference to systolic blood pressure, diastolic blood pressure, and pulse pressure. viagra in melbourne He had also studied the various factors concerned in determining the func- tional capacity of the heart as described in the paper which he presented at the 1914 meeting of the Clima- tological Association. In the cases in which the sys- tolic pressure was higher than normal, the pulse pres- sure was above 40 in all. The cardiac efficiency factor was above normal in thirteen out of fourteen cases, being about 35 per cent. The percentage of the nulse pressure formed by the second phase was below 40, or could not be determined viagra in melbourne in ten out of 14 cases. It appeared to be the rule that in a case in which a high systolic pressure was determined at the first examina- tion, such organic changes had taken place in the heart, kidneys, or arterial system that it was impossible to restore a normal condition to the circulation. The writer also included the report of a case in which he had made observations with reference to the alterations in blood pressure during and after hemithyroidectomy. Observations were made every five minutes during the operation, and after the operation other observations were made at varying intervals for several weeks. From a study of these cases it seemed legitimate to conclude that the first effect of dysthyroidism on t"he blood pressure was a lowering of the systolic pressure. This was accompanied by a disturbance in the pulse pressure, viagra price per pill in india usually an increase. After the case had j)er- sisted for a varying period the systolic blood pressure began to rise, and after the development of cardiac hypertrophy and renal and vascular changes, the cases were converted into typical examples of chronic hyper- tension. The study of the various functional niyo- cardial tests would seem to show that the myocardium was disturbed in nearly all cases, whether or not there was clinical evidence of such disturbance. During the operation of hemithyroidectomy in one case there was a sharp fall of systolic and pulse pressure and a rise in diastolic pressure. After the operation the systolic pressure again arose to a high viagra in melbourne point; but after the use of sodium nitrite it returned to a more nearly normal figure. Dr. Henry Sewall of Denver said that many of their theories held well in the test tube, but clinically would not hold water. There was no subject so apparently simple as that of blood pressure, yet it presentedmany puzzling questions. It seemed that all the affairs of blood pressure in man had been deter- mined before he assumed the erect viagra in melbourne posture, and it was difficult to explain the return circulation from the lower extremities on their theories of blood nressure. The physiologists were making extracts of various organs and all seemed to have a depressor effect. Howell said Oct. 2, 1915] MEDICAL RECORD.