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quent. Dr. Henry M. Hurd said that the general practi- tioner was not usually familiar with the technical terms of insanity. He cannot tell what he sees. It is sometimes easy to see that a person is insane, but hard to say why this is so. The diagnosis should be made by the general practitioner. Insanity should be studied in the medical schools, but it is rarely touched on and no examination on that subject is held. The certificates that come from the general generic viagra abuse practitioner are usually correct and the mistakes are occasional only. buy viagra cream Another difficulty arises from the fact that many definitions of insanity are legal and not med- ical, and the mistake is that the physician tries to show that the patient is legally and not medically in- sane. The legal diagnosis is a delusion and a snare. It is behind the medical. Physicians are often too accommodating, and when friends come and call on the physician and state what they think and ask for generic viagra abuse a certificate, the physician is sometimes willing to sign one without seeing the patient. The physician should investigate every case, and sign no paper unless he has seen and studied it. Development of the Nervous System. Dr. Lewel- lys F. Barker then made some remarks on " Some As- pects of the Study of the Human Nervous System with Particular Reference to its Development." He spoke of the neurons and types of cells. He said that these cells were separate and generic viagra abuse yet connected in a way that was too complex to explain. The development of the nerve cells depends on simple mechanical principles. They grow out and send their branches in the direc- tion of least resistance. The neuron is the morpho- logical and physiological unit. The study of the nerve anatomy of recent years would necessitate a re- cast of our knowledge of this subject. There are four varieties of skin sensation : sense of pressure, heat, cold, and pain. There are also definite sense areas in the brain. The new-born baby has a cerebrum with no medullated fibres. There is a great field for in- vestigation in nerve study with the microscope since the newer methods of staining have been introduced. Dr. G. J. Prestom spoke of the great advances made in neuro-histology in the past ten years. The neuro-histologist is far ahead of the physiologist. The clinician should make a careful study of all his cases buy viagra cream and not only profit by the resaerches of the la- boratory student, but help him. Dr. J. D. Blake asked if the collateral branches of the axon were real branches or were they simply fibrillar passing down from the cell with the body of the axon for a generic viagra abuse certain distance and then branching off ? He also asked if Dr. Barker had not said that the fibres in the pyramidal tract did Hot cross. How did he ex- plain crossed paralysis? Dr. Barker replied that the lateral pyramidal tract does cross over, but the direct buy viagra cream tract does not. Dr. generic viagra abuse H. J. Berkley then made some remarks on the " Psychical Nerve Cell in Health and Disease." He explained the different shapes of the cells; some were pyramidal, some like whetstones, and others irregular. The branches of these cells have on them small lat- eral branches. In poisoning from alcohol, ricin, etc., the nerve cells and branches show thickening. Dr. A. K. Bond asked how wasted buy viagra cream nerve cells could be affected by the thyroid treatment in twenty-four hours. buy viagra cream Dr. Berkley replied that the thyroid extract caused a congestion around the nerve cell and a temporary improvement only. The nerve cell degenerates in a very short, time, and as it is a complete substance in itself it does not recover. He is not very much pleased with the thyroid treatment. Discussion on Diabetes Mellitus. Dr. William H. Welch, in speaking of the pathology of this dis- ease, said that no lesion was universally present in diabetes ; nevertheless it is hardly correct to say that there is no buy viagra cream lesion characteristic. There is one which is generic viagra abuse pathognomonic, but it stands in no relation of cause and effect. It is constant in this disease and is found ~o6 MEDICAL RECORD. [May 1 6, 1896 in certain cells in the kidney. Armani described it in Cantani's book about twenty years ago. It is little recognized. It was supposed to be a dropsical affec- tion of the cell, but now we know 7 it is not. It is a glycogenic metamorphosis of the cells. The epithelial cells lose their clearness, but the nucleus is clear. This is found chiefly in the ascending arm of the tube. but elsewhere as well. If the specimen is so prepared that the glycogen is still retained there, it can be easily seen under the microscope. The specimen is put into boiling water, absolute alcohol, or water with iodine. These cells are filled with buy viagra cream glycogen, and in all cases which he has examined, and they are not many, the glycogen was present. The diagnosis of this disease can always be made at the autopsy, but there is no reason to suppose that it is a cause; more probably it is a secondary effect. The causal lesions which we know are of two classes of the central ner- vous system and of the pancreas. The extirpation work of physiologists generic viagra abuse called our attention to this first. Bernhard von Mering and others first described le- sions in the medulla oblongata. These have been found in many cases. Bouchardat, Lancereaux, Fre- richs, and Senator all understood generic viagra abuse this disease and an- tedated the experimental work, and indeed it was known in the last century. It is only in the last seven buy viagra cream