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these early cases of phthisis, there china viagra 50mg is, first, a deficiency of movement at viagra pill container one apex and a difference in the per- cussion note below the clavicles, that on the side in which there is deficient movement being shorter and higher-pitched than on the other side, or is actually dull, while on auscultation and comparing the breath sounds on the two sides, it is found that expiration is prolonged and respiration is divided or that there is cog-wheeled inspiration on the diseased side. The signs of deficient movement at one apex indicate a de- ficient entrance of air into the upper part of the lung, and the difference in the percussion note, together with the prolongation of expiration, suggests slight con- solidation. But in these early cases such physical signs are sometimes absent, china viagra 50mg are more frequently doubt- ful, and the chief signs to rely upon in the diagnosis of early consolidation are an increase in the vocal china viagra 50mg or tussive resonance at one apex or the presence of crepi- tations and rhonchi. As regards rhonchi it may be said that these alone may be present, and one may hear a sibilus at the end of inspiration or coming out on cough, which, if present at the same place on two or three different examinations, would be indicative of the apex being tuberculous. The crepitations June 6, 1896] MEDICAL RECORD. 827 china viagra 50mg which are characteristic of consolidation china viagra 50mg are those which occur during inspiration, but also those which are produced by the act of coughing or are heard on the first inspiration following a cough. The proce- dure, therefore, of making the patient cough while the suspected apex is being listened to is of great impor- tance, and the absence of crepitation is frequently de- cisive in a chronic case of illness as to thy presence or absence china viagra 50mg of tuberculosis. Dr. Sidney Martin, Clin. Jour., London. Neurasthenia of Nations. At this time, says an editorial writer in the Cincinnati Lancet-Clinic, there exists a rather remarkable condition of unrest and Ir- ritability among the governing nations of the earth. Even the people viagra pill container of our own land, who have in their past history refrained from any active exhibitions of a desire to mould boundary lines or sit in the councils of other countries, are pluming their feathers for any contingency viagra pill container that may arise, In army and navy circles there are manifest activities of a very practical na- ture. By order of Congress the navy is being in- creased in efficiency as rapidly as possible. In ob- serving what is going on, members of the medical profession are equally interested with their neighbors. An increase of men in the army and navy indicates a necessity for a corresponding addition to the medical Staff, in each of which there are now several vacancies. There is much reluctance on the part of viagra pill container young physi- cians to enter the United States navy because of the inferior rank and pay that is accorded the medical staff. This is supplemented by an indisposition on the part of officers of the line in the naval service to e anything like a fair recognition to medical officers, 1 1 accountof which there are at this time scarcely less than twenty vacancies in the medical corps. The n cent increase of sailors will add to the number of sur- geons needed for active service. Congress should rec- ognize the fact that, while line officers in the army and navy are educated at the expense of the government, members of the medical staff must pay the entire ex- china viagra 50mg p.-nse of their professional preparation for service. Next, their service china viagra 50mg is equally arduous, and requires as high a degree of intellectual attainments, as that which is found to be necessary in any other of the war de- partments. This is easily shown by the character of examinations for entrance to the several services. For this reason medical men, while asking no special favors, do earnestly demand fair play. Active young recruits in the prime of life and health sometimes ex- hibit some contempt for the labors of the surgeon, but the time comes eventually when there is a high appre- ciation of the work of the doctor. So it is with young men from the schools at Annapolis and West Point ; china viagra 50mg they are inclined to sniff at and look upon the surgeon as a very useless appendage in the service, which comes to some extent, no doubt, from there china viagra 50mg being no professorship of viagra pill container gumption in those institutions. There are some vacancies in the army medical staff as well as in the navy. In this service there is a better recog- nition of the value of medical men than in the navy. Congress should viagra pill container rectify the malpositions referred to. Millions of dollars are annually appropriated for in- struments of precision intended to destroy life and property, while beggarly thousands are grudgingly given for the care and preservation of the lives of sol- diers, sailors, and citizens. The nerve irritations of the great nations is not likely viagra pill container to be quieted by ano- d .nes, but will probably seek relief in war measures. Weak spots will be uncovered and probed to the bot- ; im, where, if necrosis exists, excisions and amputa- ti ms, followed by vigorous aseptic treatment, will be inforced. In other instances transplantation of grafts of new tissue will be necessary for the preservation of the integrity of a nation's life; even then there maybe a weakening in some quarters so great as to cause the vital spark to forever depart from ancient kingdoms. There is a rise and fall, an ebb and flow, in the tides of nation life similar to that found in men, which, when taken at the Hood, leads on to fortune and to victory. Sometimes the fight for existence is very hard and the days are very dark, but there comes a dawn, and the sun shines brightly in all of his glory over the victor. There is a survival of the fittest among nations. There are to-day nations which represent an effete civiliza- tion, that in the natural course of events will soon go to the wall and be numbered and remembered china viagra 50mg only in books of history. The rise and decline of great em- pires is a study of intense interest. In their consider- ation it is well to draw lines of comparison between