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case of the Japanese, who it is said never have scarlet fever, but are more susceptible to beri-beri than are Europeans, while the negroes escape yellow fever and are less liable to malaria and dysentery than are Euro- peans. Acquired immunity is not necessarily a matter of juggling with bacteria of the disease in question, but may be produced by the employment of other agencies. In a general way it may be said that the conditions which afford protection, in so far as they are control- lable by the surgeon, are those which tend to increase what, for lack of better knowledge, we must viagra online free call vital resistance and to decrease vulnerability. In closing the author said : "The conclusions of surgical importance which may be legitimately reached from the study of the conditions dealt with in this paper are essentiallv these : that the surgeon in emergency cases has to do the best he can, not merely with the means at hand, but with the tissues at hand; and here, so long as he can control what may happen outside of the bodv, he has done his full viagra boots sale moral and legal duty. On the viagra online free other hand, in any case where patients deliberately come under observation, and where time may be afforded, it is the surgeon's bounden duty, bearing in mind a sum- mary of the conditions which notoriously conspire, upon the one hand to lower vulnerability, upon the other hand to afford protection, to so order the habits, the diet, the surroundings, and the preparation of his patient as to restore his tissues and vital fluids, so far as possible, to their normal condition, before he inter- feres with their functions by viagra boots sale an operation. " A distinct and as yet an unworked field lies-before him who will study carefully and for sufficient length of time the effect of anaesthetics in increasing suscep- tibility and infection. This is a problem which must be worked out upon human patients rather than upon animals, since the conditions are so exceedingly differ- ent, most of the animals used for experiment being too relatively susceptible, dogs notoriously so. I have for years cherished the opinion that anaesthetics affect all people to a greater or less degree in this direction; yet am not able to present to you any definite statis- tics or statements. Loss of blood is certainly a factor lowering vitality, and in the complex condition of shock it must assuredly be that natural immunity is at least temporarily lowered. Equally important in my estimation are the auto-intoxications and toxaemias, of viagra online free which two particularly call viagra boots sale for attention here. The effect of sugar in the urine, or rather the effects of the condition which leads to its presence, is everywhere recognized, but I am more viagra online free and more convinced that in the body condition which is most easily recognized by hyperacidity of urine and which is so often a compli- cation of uricacidasmia, oxaluria, etc., we have a grave and sometimes insuperable obstacle to ideal success after operating. The other condition to which I par- ticularly allude is that which I usually speak of as in- testinal toxaemia, and relates to auto-intoxication viagra online free pro- duced by absorption from the contents of the alimentary canal of substances which ought not to be therein re- tained, nor allowed to so accumulate and undergo chem- ical viagra online free changes which shall permit such absorption. This condition is in a large measure represented by chronic constipation ; and yet it certainly does occur in patients who have a regular daily habit of alvine evacuation. It is to be recognized by the hue of the skin, by the appearance of the tongue, often by the presence of indol or indican and ethereal sulphates in the urine, and quite often by the viagra online free diminished elimina- tion of the fluid and mineral elements of the urine. It should be combated, if possible, by a careful course S;o MEDICAL RECORD. [June 13, 1896 of hot air or Turkish baths, copious viagra boots sale draughts of fluid, the administration of saline laxatives, and of intesti- nal antiseptics, among which, in my estimation, the very best is a solution of mercury and arsenic in hydro- chloric acid (given in the shape of mercuric chloride, dissolved in dilute muriatic or nitromuriatic acid, with the addition of liquor arseniosi chloridi . I have tried a great variety of the vaunted intestinal antisep- tics, but have settled upon the conviction that some such mixture as this gives results far superior to any which can be obtained from salol, naphthalin, etc. If, in conjunction with these measures, we resort to exercise, when it can be taken, to sunlight, which is always available, and perhaps to massage, by which circulation is quickened and equalized, excretion has- tened and viagra boots sale waste material dislodged and taken out of the system, we have done what we can to prevent in- fection. ' And I have, furthermore, for years contended that since the inauguration of the so-called antiseptic era and in our enthusiasm for combating infection from without, we have lost sight of a most important truth which we cannot afford to disregard, viz., that in our enthusiasm for combating infection from without we have almost neglected the measures for, first, the rec- ognition, and, second, the successful prevention of infection from within. Certain it is that in the ma- jority of instances the latter {i.e., infection from with- viagra boots sale in) is much the viagra online free more liable to ensue, and particularly in a class of cases in which one viagra boots sale is tempted, for viagra boots sale one rea- son or another, to be less careful than he ought to be. 1 would give then this most important practical conclu- sion to my remarks, that only he who weighs judi- ciously the possibility or the eminent probability of one or.the other viagra boots sale of these forms of infection is really capable of guarding against both of them, and that the best surgeon is he who will always take time, when it can be afforded, for the preparation of his patient for operation. In other words, I would remind you of Sir James Paget's too often neglected statement, that we ought to examine patients for operation with fully as much care as we do for life insurance; -and add to it that if this examination be so conducted we shall often