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Equally favorable conditions for surgical intervention do not occur in all affections of the lungs. 3. Wounds caused by contusing bodies, bj stabbing and cutting instruments, and by gunshot projectiles of small and medium calibre usually heal well without causing sup- puration or troublesome reaction. 1. The danger which results from such injuries is due, not to the in- jury of the lung structure itself, but rather to the mul- tiplicity and extent of the wounds and to the lesions of important neighboring parts. 5. The surgeon should not intervene generic viagra california too hastily in these injuries, either by making a simple exploration or by attempting to extract a projectile which tan Lie seen near the sur- face. 6. Large projectiles, such as fragments of shell, give rise, especially on the canadian viagra healthcare field of battle, to disorders which in a large majority of instances are so severe that it is impossible for the surgeon toward off danger even by suturing the visceral and parietal layers of the pleura. 7. A certain number of spontaneous affec- tions of the lung may be successfully dealt with if the surgeon be careful to make a study of symptoms and indications, and a proper selection of his operative measures. S. Simple and gangrenous abscesses, when they are of limited exterrt, show no tendency to cure, and threaten life, are amenable to surgical treatment. 9. In such cases the results are almost always favor- able. 10. It is advisable to open, scrape, drain, and even cauterize tuberculous abscesses of the lung, when these cause severe pain or have resulted in fistula, or contracted extensive adhesions with the pleura, ri. It is often useful in these cases to associate with such treatment partial resection of the ribs. 1 2. No benefit is likely to result from excision of fragments of the lung surrounding the tuberculous cavities, as the canadian viagra healthcare tubercle bacilli have already spread beyond the ap- parent limit of the disease. 13. It is advisable to open hydatid cysts of the lung, the surgeon taking ad- vantage of adhesions when such exist, and generic viagra california establishing still further adhesions when those existing are not of sufficient extent, in order to be able to wash out the cavity with antiseptic solutions. 14. Solid tumors of canadian viagra healthcare the lung should be extirpated when superficial; canadian viagra healthcare the occasions, however, for this treatment must be rare, as such growths are almost always secondary. La Fresse Mc'dicale. Primary Cancer of the Lung. Dr. Wolf has pub- lished a record of thirty-one cases of primary carci- noma of the lung which have been met with in the Dresden City Hospital since 1885. generic viagra california The percentage of occurrence was .428. Twenty-seven cases occurred in men, four in women, and the ages ranged between thirty-six years and seventy years, the majority being past fifty years. The right lung was five times the seat of the tumor, the left lung three times. generic viagra california Thirteen times the right bronchus was affected, eight times the left bronchus, and twice both bronchi were primarly involved. In five cases the bronchial carcinoma ex- tended to the trachea. Thirteen cases were compli- cated with tuberculosis, and in several instances the tuberculosis is asserted to be the cause of the later developing carcinoma. In one case miliary tubercu- losis was observed, in another miliary carcinosis; in another both miliary tuberculosis and miliary carci- nosis. The course of the affection is very various, and there is no distinctive clinical indication of the disease. The diagnosis is easier in a case of lung carcinoma, especially when the tumor is situated near the pleura, than in a case of bronchial carcinoma. In the former instance a circumscribed dulness in conjunction with great wasting, and catarrhal sputum free of bacilli but occasionally bloody, may suggest canadian viagra healthcare the affection. Pain is occasionally present, but natu- rally dyspnteic sypmtoms are more common to bron- chial carcinoma than to lung carcinoma. Implication generic viagra california of the bronchial glands often manifests itself by dysp- noea or recurrent paralysis. Metastasis is more apt to occur with bronchial than with the proper lung carcinoma, as in the former instance the affection of the bronchial glands favors implication of the great vessels. The presence in the sputum of particles of the tumor is rare, as it was observed in only one of the thirty-one cases. Fortschritte tier M-edirin. The Treatment of Acute Gout. generic viagra california Dr. Jaccoud, of Paris, divides this subject into three parts, according as one has to deal with the generic viagra california acute attack proper, the subacute attack, or the recurrent disease. In the first case he does nothing during the first five days except to promote diuresis by the most simple means, such as the administration of a litre or so of Evian or Vittel water daily, with perhaps the addition of a little acetate of potash ; he does not even give milk, pre- ferring that the power of the disease shall be expended on the organic tissues themselves. He applies ano- dyne embrocations to the joints and covers up the parts with a thick coat of wadding. At the end of this time, if the fever and pains have subsided, the attack is nearing its end and no further treatment is necessary; milk should now always be given. If no improvement has taken place Jaccoud gives a generic viagra california grain and a half of hydrobromide of quinine with three-fourths of a grain of digitalis generic viagra california powder in four pills, five, or six times a day; this usually produces the desired effect within two days. If, however, the pains are worse on the fifth day than at the onset salicylate of sodium in canadian viagra healthcare thirty to forty grain closes should be given, provided that the urine is free from albumin; after the second dose the urine is to be tested with ferric chloride, and if generic viagra california the salicylate reaction is feeble or wanting the drug must be stopped. In the subacute form of the disease, which is characterized mainly by its pro- longed duration, if canadian viagra healthcare this treatment, though it dimin- ishes the pains, does not cut short the attack on the ninth or tenth day, recourse must be had to colchicum. 6 9 S MEDICAL RECORD.