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times as an epidemic. A note on the disease was communicated to the Royal Medical and Chirurgical Society at its last meeting by Surgeon-Captain M. Louis Hughes, who found that clinically this fever had a peculiarly irreg- ular temperature curve, consisting of intermittent waves of pyrexia of a distinctly remittent type. These waves of pyrexial intensity buy viagra men were separated by periods of apyrexia or abatement of severity, giving a peculiar relapsing character to the fever. In some instances the daily remissions became so marked that the tempera- ture might become intermittent (but non-paroxysmal) in character. Its duration was long and indefinite, the average pyrexia duration being from sixty to sev- enty days, and the average stay in hospital over ninety davs, while patients had been known to suffer from the pyrexial condition for over six months. This pyrexia was accompanied by progressive anaemia, a tendency to constipation, swelling and effusion in various joints, buy viagra men profuse perspirations, and a peculiar irritability of the nervous system, characterized by sciatica and other neurotic symptoms. Pathologically the spleen was enlarged and softened; many of the organs. were con- gested, but the intestines were free from ulceration. The microscopical appearances were those of toxic ir- ritation of the tissues. A definite species of micro- organism (discovered by Bruce in 1886) was constantly present in viagra tablet 50mg those tissues inwhich from clinical symptoms and post-mortem appearances it might be expected to be present. Pure cultures viagra tablet 50mg of the " micrococcus mili- tensis" produced by inoculaton into the tissues of monkeys a similar form viagra tablet 50mg of pyrexia, and in all other points fulfilled the postulates laid down by Koch. The disease prevailed during the hot, buy viagra men dry months buy viagra men be- tween May and October, with a maximum prevalence in July, August, and September. It was not viagra tablet 50mg conta- gious, nor did there appear to be any close connection between its prevalence and the milk, water, or food supplies. Its dissemination appeared to be brought about on shore by an aerial infection arising from drains or soil infected by the excrement of previous sufferers from the disease. By this means it entered viagra tablet 50mg the human system by way of the throat buy viagra men or air passages. Its prevalence followed a ratio inverse to the amount and continuance of the rainfall. The mortality did not exceed two per cent, of cases, but the duration of sickness was very long. There is no specific. Care- ful nursing and dietary, confinement to bed during the acute stages, removal from all sources of reinfection, and a moderate regulation of temperature by the ex- ternal application of cold were the measures of most importance. Dr. Thin said that when viagra tablet 50mg in Malta last autumn he carefully examined the blood of six patients in differ- ent stages to see if the parasite of malaria was present. He could discover neither parasites nor pigment in the blood or in the spleen of those whom he examined. Typhoid symptoms were characterized by their absence and the intestinal lesions were not of typhoid nature. One characteristic of the disease seemed to be that the patients were quite unaware of the gravity of their condition. Professor Pisani, of Malta, had told him that whereas formerly the fever was confined to those parts of Malta where English soldiers or sailors were commonly present, it was now common in the country districts. In the neighboring island of Gozo the fever was formerly absent and patients were sent to conva- lesce there, but now- the fever had taken root there as well. The fever was the most serious disease con- nected with Malta. At Hong-Kong a fever of the same type had recently reappeared. In Sicily the dis- ease viagra tablet 50mg was formerly not known, but there was an epi- demic in 1872. For some years afterward a few spo- radic cases occurred; buy viagra men then in 1884 an epidemic broke out at Catania, and also in countrv districts where the air and sanitarv conditions were bevond suspicion. ( ases also occurred on the sides of Etna. It was a fever with viagra tablet 50mg an absence of symptoms that were specific or pathognomonic, and in most instances there was ex- cessive sweating. At the apex of the lung a condition May 1 6, 1896] MEDICAL RECORD. 717 was often present which suggested phthisis, viagra tablet 50mg but was not phthisis. He held that the government should take steps to have the fever fully investigated. Dr. Norman Moore said that Dr. George Cleghorn, in a book on the " Diseases of Minorca,'' described an affection which was clearly Mediterranean fever, and which was existent in Minorca between 1740 and 175 1, at the time when the island was occupied by our troops. viagra tablet 50mg Dr. Cleghorn was, of course, prejudiced with the old classification of fevers, and he regarded this as a variety of tertian ; but his descriptions were very clear and he recorded one hundred post-mortem exam- inations. He mentioned that definite destructive ul- ceration of the mucous membrane of the large intes- tine sometimes occurred; that certain varieties of skin rash appeared in the course of the affection ; and that it was often complicated with pleurisy, and doubtless under this term he included croupous pneumonia also. Dr. Patrick Manson said he had little experience of this fever. He had seen several cases in London and one or two in China. In Amoy he once witnessed an epidemic of a fever in which there were two pyrexial waves separated by an apyrexial interval. From what was known of this disease it certainly was neither ma- laria nor typhoid. Every credit is due to Surgeon- Captains Bruce and Hughes for the work they have done on the subject. THE TREATMENT OF HEART DISEASES BY