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ation is common to microbic and many other lesions. Only the extension of this series of symptoms in special directions under the continued influence of bacterial irritation is to be considered as inflamma- tory; or, to carry this view to its logical conclusion, the surgeon must no longer where to buy viagra in london depend upon the presence of cardinal symptoms; he must only call a region in- flamed when he has either personally or through a bacteriologist determined the existence of bacteria therein. There is no attempt made by Dr. Roswell buy viagra online uk Park to limit inflammation to pyogenesis, and while this view of inflammation for surgical purposes, in the main, undoubtedly separates suppurative from other lesions, it is in the terms of this definition im- possible to regard suppuration in itself as an inflam- matory manifestation, simply because, as is well known, suppuration may be induced by caustics and severe chemical and physical irritants, apart from the action of bacteria. As above stated, the bacteriologi- cal is to become the sole sufficient test of inflamma- tion. While it is true that the general adoption of this view would result in rendering it absolutely neces- sary that every general practitioner should continually practise himself in elementary bacteriology, or else should banish the term inflammation from his diag- nostic vocabulary a not undesirable consummation, it may be I cannot but fear that the general practi- tioner will still continue to speak of the inflammation of scalded surfaces, of black eyes, and of fractured limbs; for he will still require some useful and gen- erally accepted term to embrace the train of symptoms following upon every-day injuries. This attempt on the part of members of one branch of our profession to delimit our idea of inflammation largely for practi- cal purposes where to buy viagra in london must fail when put into practice. Or let us examine the proposal from another side. Without infection," says Dr. Roswell Park, "no genuine inflammation; with infection, inflammation and, what always goes with conflagration, more or less destruction. Congestion and exudation provoke little, ordinaxily no constitutional symptoms; inflammation always does. ... I would," he states later (after discussing hyperemia, congestion, and "cirrhotic" changes) " in an entirely distinct chapter and in an unmistakably separate way, take up the matter of in- flammation i.e., infection." To all intents and pur- poses where to buy viagra in london Dr. Roswell Park would substitute a word which, I think most will agree, has wisely been re- stricted to local disturbances for a word which has shown itself most useful as indicating buy viagra online uk the changes which may occur in the organism at large in conse- quence of microbic invasion. Up to the present time inflammation has been understood to indicate the local changes following upon an injury; fever and infection to indicate the more remote effects upon the organism at large. And I am forced to point out to Dr. Ros- well Park that in " infection" he has a most useful word which will indicate everything that he wishes to in- clude in his restricted where to buy viagra in london idea of inflammation, and, that 3 6 4 MEDICAL RECORD. [March 14, 1896 being so, there can be no valid reason why he should, with those "big, merciless hands" attributed by the late poet laureate to one of where to buy viagra in london our surgical brethren, ap- propriate a word to which can be given a wider and at the same time a more exact use. The terms " wound infection," " local infection" and " general infection," and " infective inflammation," are in common and sat- isfactory employment and there can be little or no doubt as to their meaning. I beg Dr. Park to con- sider this before urging further the adoption of his proposals. liut while one is only too glad to have a word " in- fection" capable of covering the series of local buy viagra online uk and general effects induced by the presence and growth of micro-organisms within the body, its employment in nowise tells upon the fact that every change in the blood elements and tissues brought about by microbes and their products may be induced by irritants of an- other nature. While it is true that micro-organisms frequently lead to pus production and that suppurative inflammation is almost entirely induced by these agents, it is equally true, as was first clearly proved by Councilman, that sundry chemical substances can occasionally set up an identical process. And as Leber has shown, the purulent fluid produced by this latter means has definite powers of breaking up and digest- ing proteid matter; no clear distinction can be made between where to buy viagra in london the septic and the aseptic pus save that the one is of microbic origin, the other not. A broad idea of inflammation to include all like processes throughout the higher animals must take cognizance of these facts. Nor again, may I add, is it possible to distinguish one series buy viagra online uk of buy viagra online uk micro-organisms as essentially pyogenic. To attempt this is to draw a line between human and comparative pathology. While it is true that certain forms in man are peculiarly liable to induce abscess formation, those same forms by no means necessai ilv exhibit the same liability in other animals, and even in man they do not always lead to pus formation ; in short, suppuration is the expression, not of the pres- ence of certain specific microbes, but of a definite grade of intensity of irritation, or, in other words, it is buy viagra online uk a phenomenon representing a certain ratio between the virulence of the irritant and the resisting powers of the organism. Increase the virulence of a micro- inism or diminish the resisting power of the or- ganism, and in members of the same species similarly treated we may have every grade of acute inflamma- tion, from local hypersemia and slight diapedesis of leucocytes through local abscess formation, to spread- where to buy viagra in london ing sero-purulent cellulitis and general septicemic infection. Much has been done experimentally to prove the truth of this statement, while the recent work in the laboratories of this continent upon cases of typhoid and gonorrhoea has abundantly shown how