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admitted evil ? I for one believe that equal justice to- both plaintiff and defendant will not obtain until such time as the so-called expert is placed by a statute be- yond the influence of monetary considerations.'" In conclusion the speaker said : "I do not wish to be understood as disparaging one's individual evolu- tion in a special line, for God knows we are both weak enough in any of them, but with a view of maintain- viagra canadian viagra ing the integrity of this association, and particularly the surgical section, for it is an important integral part of the whole, and its life and future usefulness depend upon the hearty co-operation of the pioneers who have hewn the way and made it possible for the younger and less experienced to follow- and viagra canadian viagra participate in the formulation of a professional fabric which will be a credit to our leaders, add to the laurels of the Amer- ican profession, and amalgamate and strengthen this organization. I venture viagra canadian viagra to say that there is not a suc- cessful specialist in any branch to-day who is not in a large measure dependent upon his ' general medicine ' for his following and success, and if my premises are correct he is obligated viagra pakistan price to attend these gatherings, par- ticipate in their labors, and reap the benefits justly earned. If he is a man of stout heart, a good cam- paigner, and has a large income, he may be able to- attend all the other association meetings; but to this one he should pledge his special fealty because of its national character, because of its cosmopolitan per- May 1 6, 1896] MEDICAL RECORD. 713 sonality, and finally because the viagra pakistan price character of work done by this section reflects the quality of the whole." ' Subphrenic Abscess and Its Relation to Pyotho- rax. I >r. Carl Beck, of New York, stated that in five cases of subphrenic abscess which he had observed, only twice was he able to make a correct diagnosis be- fore operation. The fact that subphrenic abscess is very often confounded with pyothorax is well known, and such errors impress one gravely with the necessity of widening his limited diagnostic knowledge upon the subject. Subphrenic abscess may even be said to take the rank at viagra pakistan price the present time of appendicitis of yore, when it was thought that under extremely rare circum- stances perforation of the vermiform appendix, caused by "the obligate grape seed," might occur. It used then to be said that a cure in such unfortunate cases was, of viagra pakistan price course, out of viagra canadian viagra the question. As soon viagra canadian viagra as the viagra pakistan price profession at large will take the same interest in sub- viagra pakistan price phrenic abscess that they do in appendicitis, the number of cases, which in the whole present literature amounts to less than two hundred, will rapidly swell to an en- ormous number, and accordingly will the prognosis, except in those of malignant origin, be most favorable. After referring at some length to the fact that the history of the viagra pakistan price case was a most important guide in differentiation, and mentioning at some length the va- rious physical signs to be detected, Dr. Beck said that it is sometimes impossible to distinguish an encysted pyothorax from a subphrenic abscess. The pathogno- monic signs of such effusions urged by Leyden were absence of cough and expectoration, slight displace- ment of the heart, and rapid change of note if the pa- tient is rapidly turned. According to his observation, pleuritic effusion, particularly pyothorax, sometimes occurs without these symptoms. The motions of the exploratory needle introduced into the abscess were also regarded as pathognomonic. But viagra pakistan price bearing in mind th.it in subphrenic abscess the function of the dia- phragm is greatly impaired, and that, furthermore, the point of the exploratory needle may be fixed by the diaphragm as well as by the abscess membrane, neither the presence nor the absence of the motion can be re- garded as a determining pathognomonic factor. The author referred to Litten's diaphragm phenome- non and to Jendrassik's observation of a well-marked concave undulating curve parallel to the costal mar- gins in the mammary as well as the axillary line dur- ing deep inspiration, the value of the former of which two methods, however, he did not consider established. In the author's opinion, aside from the history there are but few viagra canadian viagra absolutely reliable pathognomonic data for the diagnosis of subphrenic abscess, and the main question will practically always remain as to the pres- ence of an viagra canadian viagra abscess. Dr. Beck discussed at some length the method of treating subphrenic abscess, and after stating that the same aseptic precaution should be observed viagra canadian viagra as in any other operation, said that if the first trial be negative the needle should be introduced several times into different portions, as the pus cavity may either be of small extent, may contain a cheesy accumulation, or may be divided into several minor cavities by adhe- sions. In viagra pakistan price the first event the cavity may be missed al- together by the exploratory needle ; and in the second the needle, being introduced into the solid cheesy mass, can draw no pus. After each negative result a wire should be pushed through the needle (which must not be of too small a calibre). Thus, some pus which had remained adherent to the inner surface of the nee- dle will become attached to the wire. Occasionally it will be useful to fill the syringe with sterile water after the operation and force the water through the needle into a Petri dish. In case cheesy masses are present small particles are sometimes drawn into the calibre of the needle, which cannot be seen by the naked eye, but which by being mixed with the sterile water can be recognized under the microscope. In case the microscope does not give sufficient informa- tion, resort should be had to cultures of the fluid. The treatment of pyothorax is practically the same as that of subphrenic abscess, that is, resection of a piece of a rib, as it is only in this way that a sufficiently