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this overwork caused by the high protein dietary and increased bacteria, and later the thyroid, pitui- tary, adrenals, pancreas, and kidneys, one or all, may likewise suffer. This impairs nutrition and lowers the powers of defense, thus making the system more susceptible to the bacteria and their toxins. Dr. Goldthwait wrote an article recently dividing people into two classes: the wolf or carnivorous type, and the ox or vegetarian type, according to their distinctive anatomical peculiarities and natu- ral habits. The ox type, with broad joints, high cheeks, is naturally vegetarian, and if forced to live upon a high protein diet will be more readily disposed to arteriosclerosis, gout, nephritis, etc. The ox type is more susceptible to the toxic effects of certain amino acids of protein foods. The wolf type is more lithe, smooth, and has a shorter ali- mentary canal, and can thus metabolize proteins better, without serious consequences. In an article printed in the March, 1902, issue of the American pfizer viagra fda Journal of Dermatology and Gen- ito-V rhvary Diseases, the writer first reported ten cases of chronic arthritis caused by urethral stric- ture, or contracted meatus, all relieved by dilatation and drainage. I stated therein that most rheu- matic and pfizer viagra fda neuralgic conditions, I thought, were due to a violation of that well-known surgical prin- ciple — canadian viagra drugs drainage. I still believe that statement is true. There is present in some mucous membrane of the body, between the nose or mouth and rectum, the kidneys and meatus, the tubes and vagina, a focus of infection characterized by (1) abnormal retention, (2) fermentation or bacterial prolifera- tion, (3) irritation, (4) absorption. Back of every such stricture or contracted meatus in those cases I found a tender, irritated canadian viagra drugs spot. These four things are always present, it matters not what bacteria may be the causative agents. The focus of infection should be located, if possi- canadian viagra drugs ble, and drainage established. It may be imperfect drainage from an abscess at the roots of the teeth, pyorrhea, frontal sinus, antrum, tonsils (often im- bedded with no soreness), the gall bladder, colon, appendix, tubes, uterus, prostrate, pfizer viagra fda urethra, or rec- tum from a fistula or tight sphincter. I could recite many cases from our own experience to prove the above sources of infection. One patient this past summer, with an affection resembling a one- sided Jacksonian epilepsy, was relieved by a ton- sillectomy, and many cases of arthritis may canadian viagra drugs have been thus relieved. I am coming more and more to recognize the great importance of a complete history of each case as to origin, onset, and first symptoms. The sore throat will always precede and often subside a few days before the arthritis begins, when the tonsils are the source of the infection. Differential Diagnosis and Treatment. — The acute gonococcic arthritis usually begins with fever and migratory pains for 24 to 36 hours, then one or more joints become sore and diffusely swollen and remain pfizer viagra fda so, other pains ceasing. A careful history will show an acute gonorrhea of 12 to 18 days' duration, in which the discharge stopped two or three days before the arthritis began. The imme- diate application locally to the inflamed mucous membrane, if possible, for 5 to 8 minutes two or three times daily, of a 2 per cent solution of mag- nesium sulphate, with 1 per cent of carbolic acid. will often reverse the osmotic action, drain the mucous membrane, start up the discharge again, and stop the arthritis which otherwise would con- tinue for weeks. There is also one other condition which is so often called rheumatism and treated as such with very disastrous results to the pfizer viagra fda patient. It is acute osteomyelitis. The careful history will enable one to diagnose it readily. Quick onset by chill and fever, sharp boring pain in the bone near but not in the joint made worse by tapping, with no swelling nor visible redness the first few hours. John B. Murphy claimed that this is strictly a surgical con- dition and should be so treated within 24 to 36 hours. If no surgeon is present, he says, take a gimlet, boil it and bore into the region of the pain in the medullary cavity, when after a few minutes pus will exude and relief follow. If not thus treated the patient will canadian viagra drugs be sick for weeks and perhaps ren- dered a cripple for life. Trauma is an exciting etiological factor in these cases. With a large aspirating needle I have re- moved two or three drops of fluid and relieved a streptococcic periostitis. Free opening, however, is the treatment. A chronic luetic or tuberculous ar- thritis or osteoarthritis may closely resemble each other, requiring the luetin or Wassermann test to determine which canadian viagra drugs is present. One or both of canadian viagra drugs these tests should always be made in all chronic cases having pain and soreness especially wnen canadian viagra drugs worse at night. A Roentgenogram will often clear up the diagno- sis and I have several plates showing this point. The staphylococcus infection has moderate fever and will terminate by formation of pus, as a rule. The pneumococcus arthritis has sore muscles, dif- fusely swollen joints, moderate fever, and may change suddenly pfizer viagra fda from all the joints to the lunjrs. giving an acute lobar pneumonia. The streptococ- 16 MEDICAL RECORD. [July pfizer viagra fda 7, 1917