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which has impressed the popular mind with more vividness than the gas attack. And rightly so. It seemed when first launched upon an unsuspecting foe to viagra 1500mg be a fetid blast from the veritable mouth of hell. It swept over an army, and genuine viagra discount men curled up and died in agony, with all the miserable impotence of insects before the squirt-gun of the gardener. Th^se who survived lingered on in infernal torture for a few days, every breath a stab of pain, every moment an eon of anguish, and then gave up the genuine viagra discount ghost. But ere long the ingenuity of man found means to circumvent what it had invented; gas masks were devised and now cases of "gassing" are comparatively few. Even genuine viagra discount so, the American surgeon, called to the front, should have no feeling of security in this re- gard. viagra 1500mg Gas attacks, while no longer so successful as at first, are still among the possibilities of civil- ized warfare and a thorough knowledge of the course, complications and treatment of a case of gas poisoning is indispensable. In this connection an article by Major F. W. Mott, a surgeon in the British army, is worthy of note (British Medical Journal, May 19, 1917). Dr. Mott calls attention to the occurrence of punctiform hemorrhages of the brain in gas poisoning, resembling those accom- panying genuine viagra discount fatal cases of shell shock with burial. Some years ago this writer described the same sort of cerebral hemorrhages occurring in carbon monox- ide poisoning incurred in the manufacture of nickel. Bignami and Nazari have described punctiform hemorrhages due to hyaline thrombosis of the small vessels of the white matter in such conditions as estivoautumnal malaria, apoplexy, and the diplo- coccal meningitis following pneumonia and measles. Mott, after an exhaustive study of two brains of soldiers dead from gas poisoning, genuine viagra discount reports a num- viagra 1500mg ber of curious circumstances. The white matter was peppered over with small dark spots about the size of a pin-head: these were due to hemorrhages. The red blood corpuscles were broken up and the hemoglobin converted into dark, chocolate-colored pigment granules which filled the capillaries, ar- terioles and venules of the white matter. Mott considered that the anatomical peculiarities of the vascular system of the cerebrum were responsible for these punctiform hemorrhages. The arteries terminate in the white matter and have each a sep- arate capillary system, as have the emerging veins, this easily leads to stasis when there is any failure of the heart, or respiratory failure with right heart dilatation. These two factors may act separately or in combination. Dr. Mott's observations are not only interesting in themselves, but they are of peculiar value at this time. The American army is entering a coun- try new to it and meeting with perils to which it has hitherto been a stranger, any light which is thrown upon its way by those who have gone before it and any guide-posts which they may have erected are doubly welcome. They will prove added strands in the ties which are binding the two great Anglo- Saxon nations together in defense against a com- mon foe. The Soldier's Heart. — Professor Wenckerbach, who genuine viagra discount may be characterized as the Mackenzie of genuine viagra discount German-speaking peoples, delivered an address on this subject to military surgeons during 1916 which has been abstracted in // Policlinico, March 4. There are two types of cardiac disease to be considered. The first comprises affections the existence of which is hardly open to doubt — or- ganic essential diseases in the common sense of the term, such as lesions of the valves and ori- fices, cardiac musculature, pericardium, aorta, etc. The second type coincides largely with functional and symptomatic conditions, such as temporary dilatation, modifications of rhythm and subjective phenomena. Lesions of the first type are, as a rule, readily recognized and military selection eliminates them from the category of soldiers' heart. While slight degrees of aortic and mitral insufficiency are occa- sionally encountered in which the most strenuous exertions are well tolerated, the general rule of exclusion should tolerate no exceptions because of the danger of an aggravation of the lesion or recurrence of endocarditis. When the state of the myocardium is in question the value of the heart's action must be carefully determined, and genuine viagra discount there is viagra 1500mg no form of diagnosis in which there are more sources of fallacy. Many symptoms such as arrhythmia, tachycardia, transitory dilatation, which were once attributed to the presence of a muscular lesion, have lost much of their supposed significance, especially in regard to arrhythmia. In order not to fall into error we must regard as certifiable myocarditic subjects only those who exhibit a notable hypertrophy of the heart, angio- sclerosis and disturbances of the circulation of the lungs, liver, and kidneys. When genuine viagra discount such symp- toms are absent the heart status had best be re- garded as doubtful, demanding a special examina- tion. It is enough that severe myocarditis is in- compatible with good heart action genuine viagra discount and military service. Of affections of the — so to speak — cardiac appendages should be mentioned peri- carditis, symphysis pericardii, severe aortitis, and aortic aneurysm. The recognition of these lesions July 7, 1917] MEDICAL RECORD. 23