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give birth to a syphilitic child without herself also being syphilitic; although the viagra india purchase disease may be, viagra old buy and often is, dormant for a long period of time. A clinical diagnosis of syphilis viagra old buy can be made from the placenta within certain limits. Evidences of the disease are found in the placenta in 70 per cent, of all cases. This, in spite of the fact that the child may show no signs of lues. It is apparent viagra india purchase in some cases that the disease has exhausted itself on the placenta and in consequence the fetus is but slightly affected. It is also well known that infants who have viagra india purchase syphilis do not always show symptoms at birth nor for a considerable time thereafter in a large percentage of cases. The child may viagra india purchase exhibit symp- toms of syphilis and yet the placenta may be per- fectly normal in appearance. This is the exception, however, rather than the rule; the placenta shows certain signs which if not pathognomonic of the disease are strongly suggestive of it. Almost in- variably there is a marked disproportion between the size of the placenta and the size of the child. In syphilis the placenta is decidedly larger. Be- tween a normal child and a normal placenta the proportion by weight is about 1 to 6. In syphilis this is reduced 1 to 4 or even 1 to 3. Pinard has pointed out that the amount of amniotic fluid is also increased. I desire to say in passing viagra india purchase that the dis- proportion between the placenta and child is, in my opinion, more apparent than real because the syphilitic child is often under weight. The syphilitic placenta shows deep sulci between the lobes which causes the cotyledons to appear more prominent. Its color is paler and its surface is covered with yellowish white patches. Its sub- stance is extremely friable and on section has a mottled appearance that has been likened to sausage meat. The vessels of the cord are visibly thickened, although this is sometimes present without syphilis. When the fetus is born viagra india purchase dead the cord is often edematous and the vessels may be plainly seen, shining through the swollen cord. Wharton's jelly may be absent. The amniotic fluid may be in- creased to such an extent as to constitute hydram- nios. This is to be accounted for by the placental 18 MEDICAL RECORD. [July 7, 1917 lesions incident to the disease. It may be due to a syphilitic cirrhosis of the liver. The changes occur- ring- in the placenta are in most instances the cause of fetal death. The condition known as habitual death of the fetus is frequently due to syphilis. The child dies in each succeeding pregnancy, usually between the thirtieth and thirty-fourth week, and is soon there- after expelled. It cannot be denied that syphilis tends to the formation of monsters and of children malformed to a lesser degree. It is not true, how- ever, that recent syphilis transmits itself as con- genital syphilis and tertiary syphilis causes mal- formations. While syphilis is undoubtedly the most frequent cause of abortion — Charpentier found that in 781 luetic pregnancies there were 302 abortions, and Miller states that 70 per cent, of luetic viagra old buy women abort — the consensus of opinion among modern ob- servers is that viagra india purchase syphilis does not cause abortion as frequently as was formerly supposed; nor does it follow that every macerated fetus is syphilitic. In the viagra old buy study of syphilis and pregnancy from the standpoint of the clinician the observations of Mangiagalli are worthy of note. He recognizes four conditions: viz., both parents syphilitic when con- ception occurs; the mother alone infected; the father alone infected; the mother becomes infect- ed, after conception, both parents having been healthy prior to conception. His conclusions are that an apparently healthy child born of a syphilitic mother is syphilitic although the syphilis is latent. When the mother becomes infected after the seventh month the disease in the child is apt to be less severe than if the infection occurred earlier in preg- nancy. He could discover no direct relation between a positive Wassermann and viagra india purchase the clinical manifesta- tions of syphilis. When both parents are syphilitic the child inherits the disease in about 75 per cent. of births. When the mother alone is syphilitic the child inherits in about 60 per cent. If the father alone is syphilitic the child inherits in from 10 per cent, to 20 per cent. Syphilis is always to be regarded as a grave com- plication of pregnancy. It increases puerperal morbidity more than any other cause. viagra india purchase Many cases of nephritis occurring during pregnancy can be traced to syphilis. Sepsis is more apt to occur in syphilitic women than in those who are healthy. Cicatricial stenoses of the os due to syphilitic lesions may cause undue delay and complication of labor. The same is true of edema of the cervix due to active syphilis. Syphilis in the pregnant woman should be treated the same as when it occurs otherwise. That is, sal- varsan, mercury and potassium iodid should be ex- hibited sufficiently and properly to cure the disease. In the treatment of pregnant women, however, there are certain refinements which should be observed in order to attain the best results for the mother and her unborn viagra india purchase child. viagra india purchase In giving salvarsan it must be remembered that the drug has been known to cause premature expul- sion of the fetus; but in my opinion this danger is remote. If the woman's veins are sufficiently prominent the salvarsan should be administered in- travenously, unless she is suffering viagra old buy with myocarditis or if her blood pressure is abnormally high. If her