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Then, too, we have the pleura in an unphysio- logical position, which, as Kaufmann has demon- strated in dogs, produces an anatomical change in the serosa, as is evidenced by the decreased ability of gas resorption. One has a right to expect that the infected pleura is particularly disposed to exu- dative inflammation under these changed where to buy viagra in sydney relations. Forlanini observes that exudates occur after ex- posure of cold or from exertion, and mentions the fact that the transitional seasons, especially March and April, show the greatest number of such cases. In our viagra sex video experience we are able to bear this out to a certain extent, our greatest number developing in the change from our excellent fall climate to the winter. In my opinion there is also an irritative effect of the gas pressure on the layers of the pleura, even though minimum pressure is produced. The very fact of a foreign element within the pleural cavity must of necessity cause inflammation with its attendant exudation. I see little, viagra sex video if any dif- ference, in the effect upon the pleura of the differ- ent methods of operation, although I believe all Americans, at least, used the Forlanini procedure. This fact alone, when one considers the percentage of effusions abroad, where for a long time at least the Brauer open method was used, speaks little for the technique as a causative factor. Exudates may be classified as serous, seropuru- lent, and purulent, the latter being divided into viagra sex video those showing no organism except the tubercle bacillus and those showing a mixed infection, usu- ally viagra sex video the staphylococcus; the latter are relatively rare, in the work both here and abroad. In my classification I have grouped the seropurnlent and purulent exudates under one head. It may be well to state at this time that in all our pus cases the specific gravity was high and a large albumin con- tent was demonstrable, showing without question the fluid to be an exudate rather than a transudate. It would seem that there should be little question at least as to this distinction unless a hydrops could be demonstrated elsewhere in the body. In all of our series of pus cases, as I will show later, we were able to demonstrate by cultural methods and microscopic examination tubercle ba- cilli alone in all but three, and two of these showed a staphylococcus, the other patient leaving before a specimen could be obtained; however, owing to the symptoms we supposed this case to be one of mixed infection. Another patient developed high fever, but we could not demonstrate the presence of fluid after repeated examination. Later he left for Colorado and his physician reported that a few days after arrival the presence of a pleural effu- sion was noticed. The journey, no doubt, was responsible for the formation of the fluid, since I feel reasonably sure that had it been there in an 602 MEDICAL RECORD. [Oct. 9, 1915 appreciable amount we should have detected its presence. The effect of effusions is open io discussion. Certain writers (von Muralt, Koniger) believe that they have demonstrated the presence of antibodies in the exudate and also in the blood stream, and attribute the beneficial effects noticed to this bio- chemical reaction. However, I fail to see why we should look further than the mechanical effects which, in my opinion, seem to explain everything. It is a conceded fact that in very unfavorable cases of tuberculosis antibodies can me demonstrated in the blood, but these same patients die of their disease, while in many favorable cases the presence of such bodies cannot be demonstrated, and yet those patients recover. Taking now the funda- mental idea in the production of pneumothorax, we agree that it is the absolute rest of the lung by the application, so to speak, of a gas splint, to all intents and purposes the same as a plaster cast on a tuberculous knee that produces viagra sex video our results. Why then, when we substitute fluid for gas, should there be any difference in the outcome? As a matter of fact the presence of fluid slowly absorbed length- ens the intervals between the filling, which in itself is to be desired. However, we must admit that the complication is undesirable, highly disagreeable, even dangerous, and the slight advantages gained do not counterbalance the disadvantages. Many authors mention the diminished absorp- tion of nitrogen and a stiffening of the medias- tinum, which, of course, would allow of the possi- bility of higher pressure without danger of a pushed-over mediastinum and a disagreeable down- ward pressure on the abdomen. These high pres- sures even under such conditions are, however, to be discouraged. Added to this we have noticed in a viagra sex video few cases, after absorption of the fluid, a shrinkage of the affected side which is no doubt viagra sex video due to pleural thick- ening and the formation of adhesions, together with a certain amount of fibrous deposits on the exu- date. The one possible advantage to be gained from this, I believe, is the ultimate tying down of the diseased lung for life; in other words, we have established a continuous compression even after the absorption of the gas. Now relative to the treatment of these condi- tions. In the common serous exudates I believe in- terference is contraindicated so long as the effusion is producing no pressure effects or is showing no tendency to absoi-b and thus glue the pleural sur- faces together; when if pneumothorax is to be con-