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short of breath. This was not constant and was more marked after exertion. It was now sufficient to keep him from work and accompanied generic viagra myths by epigastric pain re- ferred to the heart and through to the back. He stated he had done light work most of his life, except for a short time in an iron-rope factory. He has had no seri- ous illnesses, denied venereal diseases and used alcohol daily, but moderately, except for a time when he was a generic viagra myths watchman in a generic viagra brazil brewery. His physical examination revealed a pallid complexion, with generic viagra brazil a dilated and weak heart. The blood pressure was systolic 215, diastolic generic viagra brazil 160. Urine analysis: dark, generic viagra myths flocculent sediment, specific- gravity 1030, acid, light cloud of albumin, great many hyaline, dark and light, granular casts, some mucus and epithelium. After treatment his blood generic viagra brazil pressure became systolic 165, diastolic 130. June 9, blood: R. B. C. 5,450.000, W. B. C. 15,200, hemoglobin 85 per generic viagra brazil cent, polymorphonuclears 75 per cent, lymphocytes 21 per cent, large mononuclears 2 per cent. •June 10. Phenolsulphonephthalein test showed zero for the first hour, 13 per cent for the second. June 11. Blood pressure, systolic 155, diastolic 115. June 14. The patient complained of severe pain in both legs and this was increased upon movement. A large purpuric patch appeared on both legs, which increased in size and depth of color. This has resulted on this date in a large bleb, and it was first noted that a blue spot appeared on the right toe. Some bloody material was generic viagra myths coughed. June 15. Examination revealed diffuse purpura over both thighs and knees. The legs were cold, espe- cially the feet. No pulse could be obtained. He had generic viagra myths some power in the thigh muscles, but could generic viagra brazil not move the feet or toes. Both femoral veins were full and red. June 16. The toes were bluer and more shrivelled. June 17. The legs above the knees were warm, and the feet seemed generic viagra brazil less intensely cold than before. They were bluer and more shrivelled, and the lower legs a deeper hue. Abdomen was swollen, but tympanitic throughout. Cardiac sounds were of poor tone and sweating was profuse. *From the McManes generic viagra brazil Laboratory of Pathology of the University of Pennsylvania. Presented to the Phila- delphia Pathological Society. June 22. Patient continued to do poorly. Sweating was profuse. Twitchings were present over the entire body. The tympanitic abdomen was very persistent and resistant to treatment. The bowels became in- continent. A large bleb and superficial ulceration ap- peared on the lower back. Typical Cheyne-Stoke* respiration followed and the patient died. On admission the temperature was 97.1°, respiration 20, pulse 95. The temperature rose to normal, fluc- tuating between 96.3 and 99.3. Respirations increased gradually to 35 and the pulse as high as 110. On June 19 the temperature had risen to 104, the pulse to 120, and respiration to 32, and remained so until death. The following is a brief autopsy protocol: A. G., 4220-13-86. June 22, 1913. Permission was granted for an abdominal incision only, without complete autopsy. The body was that of an adult white male about forty years of age. The lower extremities were swollen, dark blue and covered with large liquid blebs. This extended to the inguinal region. The abdomen was markedly distended and upon incision contained some bloody fluid. The intestines were black and friable, so that they were easily torn upon manipulation. The abdominal organs showed a picture of advanced putre- factive changes, although the body was dead only a few hours. The kidneys were swollen, had multiple infarcts, and microscopically showed a diffuse necrosis with an underlying glomerulonephritis. The spleen was the seat of multiple older infarcts, soft and mushy. The heart was enlarged, the musculature pallid, with a densely adherent clot in the apex of the left ven- tricle. This was considered grossly an acute mural endocarditis, but the microscopical sections did not bear this out. The valve leaflets were free from acute in- flammation. The aorta showed a generic viagra brazil moderate degree of intimal arteriosclerosis, without large plaque formation. The abdominal portion was completely closed b« a fresh currant jelly and marantic clot, which grew older as one went down and which was quite fibrinous at the blfur cation of the iliacs. This thrombus extended down t hi - femorals as far as it was possible to dissect. This case presents a man suffering with a cardio- renal lesion for at least the period of a year. This progressively became intensified and terminally re- sulted in a thromboangeitis of the femorals, or lower with extension of the thrombus, until the ab dominal aorta was reached. This, in the course of about seven days, began with pain in the extremi- ties, coldness, numbness, loss of motion, blueness. swelling, distention of abdomen, and finally death. In the generic viagra brazil absence of an acute endocardial lesion with the formation of an embolus, it must be agreed that this was probably an acute infection. Although no etiological factor was demonstrated, the patient had a leucocytosis of 15,000. While this presup- posed an infection, it cannot be so stated defi- nitely. The loss of motion in the legs may be accounted for purely by the loss of muscular nutrition, and thus the loss of tone; but recent experiments upon the ligation of the abdominal aorta in the dog, with changes in the lower spinal segments of the cord, may have been also active in this case. The persistent abdominal distention is easily un- derstood from the condition of the intestine. Here, putrefactive changes advanced rapidly, probabh over the last three days, until the entire intestine was generic viagra myths so generic viagra brazil friable that one could put the finger through the wall at any point. The extension of the throm- bus to the arteries of supply of the abdominal paren- chymatous organs resulted, not so much in a gan- grene as in a nutritional necrosis. Conclusions. — Clinically, an adult male in the course of a cardiorenal disease developed throm- bosis of both lower extremities, probably as a result of infection. This produced, over a period of six