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follows evacuation, and a reactionary inflammation is set up, engendering cell hyperplasia, the intruder is walled in and retrograde degeneration sets in. Intrathoracic Tuberculosis Dr. George Rvkr- SON" Fowler, of Brooklyn, went into the historical part of the disease at great length, and devoted con- siderable attention to the surgical treatment of pleu- online viagra emails ritis and empyema. Of all the organs in the human body, the lungs are most frequently the seat of these affections. Inasmuch viagra usa buying as there is no lung affection that cannot be complicated by tuberculosis, it follows that pleural affections are most frequently tuberculous in character. Few patients who have suffered from pleurisy escape tuberculosis, and this fact increases the importance of the surgery of viagra usa buying pleuritic affectionsin their relation to tuberculosis. The author gave a brief 'discussion of the effects of the presence of the pleu- ritic effusion upon the progress of tuberculous disease of the pulmonary structure. The view formerly held that the activity of the circulation in the lung tissue constitutes a trustworthy means of protection against the occurrence online viagra emails of tuberculous infection of the respira- tory organs was combated, and reference was made to the viagra usa buying observations of Laennec, who in the early history stated that stasis was incompatible with the progress of pulmonary tuberculous affections, and Bier's obser- vations, supported viagra usa buying by those of Miller, in the treatment of tuberculous joint disease by means of a constricting bandage were held to confirm the views of Laennec in this particular. Note was taken of the fact that in any pleuritic affection, even when due without doubt to tuberculous infection, if the effusion is found to be serum, the inference follows that the effusion pos- sesses some resisting influence over the development of the tubercle bacillus, while it undoutedly forms a favorable culture medium for other organisms. The application and technique of exploratory puncture or thoracentesis, incision and drainage, and Koenig's operation, online viagra emails the resection of a portion of rib, were gone into by the speaker quite extensively. This was fol- lowed by a consideration of the operation of thoraco- plasty and its indication. Schede's operation for ex- tensive resection of the chest wall, including with the bony resection removal of the attached soft parts, namely, the intercostal muscles and thickened pleural membrane, was described. It was recommended that the edges of the incision be closed tightly about the drainage tube and the dressing be applied in such a manner that the tube passes through these. The drainage tube is then attached to a tube sufficiently long to extend over the side of the bed and touch the surface of a sublimate solution. When the online viagra emails patient can sit up, the tube is fastened to a bottle at the waist, as suggested by Bulau, of Hamburg. By this method and drainage the patient online viagra emails is saved from the discomfort produced by soiled dressings. The question of the complications occurring in connection with thoraco- plasty operations upon the chest wall, namely, pul- monary thrombosis, cerebral embolism, and the result- viagra usa buying ing paralysis, was alluded to. The consensus of opinion at the present day seems to discountenance thoracotomy in tuberculous patients, preference being given to repeated puncturing or at the most to the method of permanent siphonage. The question of the direct treatment of tuberculous cavities was entered into quite extensively, and it was stated that some difficulty must necessarily be experi- enced in the selection of proper cases. In cases in which the disease has come to a standstill any interference would be unjustifiable, for the reason that it is these cases that undergo cure by natural processes. In ad- dition to limiting operations on tuberculous cases to those that are circumscribed, the operation may be applied to certain cases of a doubtful nature which form at the expense of both pleura and lung, namely, pulmonary abscesses secondary to tuberculous caries of the ribs. Three examples of these are quoted. The operation of resection of the lung was discussed at some length, and attention was called to the fact that the pulmonary structure differs from all other structures of the body in its susceptibility to infection and its anatomical peculiarities. The experiments of Gluck, of Berlin, and Hans Schmidt upon the lower animals for resection of the lung were gone into in detail, viagra usa buying and also those of Vi- rondi, who produced localized tuberculosis in the lower animals. Tuberculosis of the Superficial Glands. Dr. De Forest Willard, of Philadelphia, first detailed the method of tuberculous infection of the lymph nodes. The route of entrance is usually by very slight abra- sions or injury. Slight wounds are more liable to ad- mit bacilli, as they arouse lo viagra usa buying al resistance to a less 868 MEDICAL RECORD. [June 13, 1896 degree than more viagra usa buying severe injuries. The face and neck are especially common routes of entrance. The lymph -lands act as nitration stations and often prove effec- tive in overpowering the invading foe. They are likely to be successful in" proportion to their amount of re- sistive force. An individual resistive force may be lessened by hereditary impairments of cells, or by the temporary conditions of the tissues. Local karyokinetic action may be successful, or if partially successful, caseation viagra usa buying and absorption may occur with less resistive power, or if staphylococcus infection results suppuration follows. When once the glands have become infected they are a viagra usa buying perpetual menace to the general system and