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aortic incompetency to be found in the literature no reference was made to a Wassermann test, so it was obvious that the figures underestimated the true role of syphilis in the production of this condition. Early diag- nosis of aortic incompetency was of the utmost im- portance to the end that serious damage to the aortic segments might be obviated by intensive antisyphilitic treatment. In the absence of rheumatism, gout, lead, alcoholism, pyogenic infection, or a predisposing occu- pation, cases of aortic incompetency should be labelled suspects and given the benefit of vigorous antisyphilitic treatment. Special physical signs that aided in the es- tablishment of the luetic character of the chronic val- vulitis were enlargement of the left ventricle 'and therefore capillary pulse and double sound over the crurales were not so marked) and a greater degree of arrhythmia. The cardiac lesions of syphilis usually appeared within two or three years after the infection and sometimes much earlier. The importance of the Wassermann reaction as a means of determining the etiological variety of the lesion should be emphasized. When myocardial syphilis developed in the secondary stage the comprar viagra en barcelona onset was' rapid or even acute and the nrin- cipal features v\'ere irregularity of heart action, tachy- cardia, intermittence, extrasystole, and rarely soft mur- murs, especially in the mitral area. The symptoms did not differ from myocarditis due to other acute infections. These symptoms "might disappear after a few days as a result of energetic antisyphilitic treatment. This fact helped to emphasize the importance of early recog- nition of the comprar viagra en barcelona condition. True angina pectoris might be associated with the myocarditis comprar viagra en barcelona and angoid pains were not infrequently present. The Stokes-Adams syndrome was commonly caused by syphilitic myocarditis or fibroid change in viagra street value the bundle of His. The A^Titer had collected 270 cases of angina pectoris from the liter- ature and only 26.5 per cent, gave evidence of syphilis. This was too low an estimate since there was no men- tion of the Wassermann test having been made. Every case of angina pectoris during the younger period of life was open to the suspicion of svphilitic origin. When either aortic regurgitation of syphilitic myocarditis of marked extent existed curative treatment was impossible of achievement as a rule, and hence the necessity of vigorous early and prolonged treatment. The Wasser- mann tests should be made until they were no longer positive. The treatment consisted of the alternate use of intramuscular injections of the salicvlate of mer- cury and salvarsan. The iodides were reserved for later use after the active syphilitic process had comprar viagra en barcelona been checked. In the later stages the use of salvarsan was quite justifiable in the opinion of the author in myo- carditis and aortic insufficiently in which the actual condition of the myocardium was undeterminable but not degenerated to a marked degree and in those cases in which the patients urgently demanded that some- thing be done. Dr. John M. Swan of Rochester said that it was his experience that cardiac disease where there was no his- tory of rheumatism or of other infectious disease was very often due to syphilis. This was especially apt viagra street value to be true of physicians, who often had a syphilitic lesion without recognizing it. Dr. Swan related the case of a physician with a typical case of aortic regurgitation. After going over his history carefully comprar viagra en barcelona it was found that he had probably been infected with syphilis while attending a labor case. According to the statement of Dr. Harlow Brooks cardiac irregularities often cleared up after the administration of the iodides, and he had seen several cases of ventricular extrasystole definitely disappear after the administration of the iodides. One should always suspect syphilis in these cases in which there was no other definite etiological factor. Dr. John A. Lichty of Pittsburgh said that no one was more competent than Dr. Anders to speak on this subject, but there were several points he wished to call attention to. He had heard Dr. Collins read his paper in Washington eight years ago when the Wassermann test was comparatively new and he had followed the work of Dr. Harlow Brooks and there seemed to be no doubt that there were more cases of syphilitic aortitis than ever before, yet the point should not be over- looked that unless there was an autopsy one viagra street value was not free to speak definitely about them. For all cases hav- ing a positive Wassermann were not necessarily due to syphilis. One should have the autopsy record with which to back up his statements. Dr. Lichty stated that he had had three viagra street value cases that gave a positive Wasser- mann and aortic lesion and yet at autopsy he found an infective aortitis. In one case the infection was a streptococcus viridans, in another a tuberculous peri- carditis, and in the third the streptococcus was found in the blood stream. In Pennsylvania they did not find the spirochete so frequently in heart lesions as Dr. Warthin had found them ; viagra street value this was probably due to a difference in the source of the material, since Dr. Warthin got most of his from an orphan asylum. It was well to point out the value of other clinical symp- toms and not to permit the Wassermann reaction to have undue weight. Dr. Swan suggested that in the cases spoken of viagra street value by Dr. Lichty there might be a possibility that the strepto- coccus infection viagra street value was implanted on top of a syphilitic condition. Dr. Henry Sewall said it always seemed to him that the syphilitic presented a psychic or nervous condition different from the normal individual and that this would have a definite effect on aortic trouble due to syphilis. Dr. James H. McBRroE of Pasadena, Cal., said he could not say definitely that there was a psychical de- viation which could be attributed to syphilitic degenera- tion. One author had said that aortic aneurysm was always due to syphilis except in cases of injury, and he had seen several cases of heart lesions directly due to syphilis, but his experience was not extensive as was that of Dr. Anders. Some of the Disputed Anatomicopathological Ques- tions in Tuberculosis. — Dr. F. M. Pottenger of Monro- via, Cal., presented this paper, in which he discussed first the subject of bovine and human tuberculous in- fection versus bovine and human clinical comprar viagra en barcelona tuberculosis and gave his reasons for believing that the bo\'ine tubercle bacilli after living in the human tissues for a