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July 5th he walked about with some slight help from a cane. July 10th ho went away almost cured, not being able to stay longer away from home. Chronic Rheumatism. This disorder has usually progressed so far in patients who seek the help to be found at bathing-resorts that structural changes at- tended by proliferation and thickening of the syno- vial and periarticular connective tissues have taken place as a consequence of the chronic inflammatory ir- ritation. The membranous elements usa viagra sildenafil of the viagra generic image articula- tions in many of the cases have become rigid and per- haps coalesced with the soft parts lying over them. In old and obstinate cases the disturbances of nutrition may have extended to the bones and soft tissues sur- rounding the joints. Motion is interfered with and the adhesions have occasionally viagra generic image given rise to complete ankylosis, which has persisted in spite of all ordinary treatment. According to Maclagan, lactic acid, al- though not the cause of rheumatism, is present in ex- cess even in the chronic forms of the disease, and causes great irritation of the tissues, which have be- come more liable to disturbances on account of the in- flammatory changes. As a usa viagra sildenafil general rule, the disease drags on for months and years, terminating in even the most satisfactory cases in a very imperfect recov- ery. The general health usa viagra sildenafil of these usa viagra sildenafil patients is often poor and calls for tonic remedies to improve their nu- trition. The most efficacious treatment in correcting the extensive viagra generic image changes just referred to are the mineral baths, which have a good influence on the nutritive processes by dilating the blood-vessels and by increas- ing the excretion of lactic acid and other products of metamorphosis. The natural springs usa viagra sildenafil capable of producing these effects are always noted for their high temperature. Senator was convinced of the greater value of waters rich in mineral matters, especially the concentrated brine springs, for stimulating absorption. Massage and douches are important factors in the treatment of this disease. Mrs. McF , aged thirty-three, of Fruita, Col. Feet became swollen, tender, and inflamed usa viagra sildenafil eleven years ago. At different times almost every joint of her ex- tremities lias been affected. Her trouble always be- came aggravated in the spring, and has grown stead- ily worse. She came to Glenwood one year ago and took forty-five vapor baths in the cave. She received more relief from this than from any previous treat- ment, and has been almost free from the disorder until the following spring, when it again recurred. The attack was not so severe as previous ones, although she attended to her duties with difficulty. June i2th, 1895. Physical examination: Joints of fingers, hands, wrists, and ankles swollen; otherwise normal. Treatment, vapor baths in the cave every other day for the first week, and then daily; water internally before breakfast. July 12th she had taken twenty-five baths.- All swelling had disappeared from joints; very little pain. She probably felt even better after her viagra generic image return home, as that was her experience before. Miss P. R , aged nineteen, of Denver, in March. 1894, began to have swelling of hands and feet. In viagra generic image the summer of 1895 the joints were very much swollen and painful, but were somewhat better in the fall. The trouble grew worse than ever during the following winter. She was treated in a hospital in Denver without any improvement, so she came to Glenwood, April 29, 1895. At this time her feet and hands were much swollen usa viagra sildenafil and very painful, and her muscles were stiff. Locomotion very difficult : bow- els constipated: appetite poor. She took tub and vapor baths regularly, and dran c the water before breakfast. June 17th the swelling of joints was much less; she walked better; the bowels were regular and the appe- tite was good. July 15th she could walk a long distance without pain: all swelling had disappeared. Mrs. E. S , aged forty-nine, of Philadelphia. June 13, 1896] MEDICAL RECORD. 843 Her present trouble began nine years ago, with swell- ing of left arm and lower extremities. During the course of the attack large nodules appeared in various parts of the body. This was accompanied by mild fe- brile symptoms, a good deal of pain, and a red rash. The condition lasted about four weeks and was fol- lowed by considerable pain on exertion. Was im- proved at Clifton Springs by means of baths and wet packs. Since then she has usa viagra sildenafil had many attacks, affecting the muscles and joints all over the body. While coming West she had a severe attack at Denver about one usa viagra sildenafil month ago, and was confined to bed for three weeks. This time the pain was severe in the region of the sciatic nerve, and the knees and feet were swoll- en and painful. The patient became improved enough by means of medicines, massage, and electric- ity to continue her journey to this place, but she was still almost completely disabled. Physical examination: Aortic insufficiency; other-