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ployed. Patients must buy viagra modalert never be sent down with tourniquets on their limbs. (3) Abdominal wounds viagra online brazil and all severe cases demanding early treatment at a casualty clearing station should be sent there by a special motor ambulance direct from the advanced dressing station. They should not be kept waiting for the regular convoys. There being few good roads "corps dressing stations" were arranged by joining up some members of staffs of various field ambulances, so as to supply tent accommodation for a thousand or more wounded, with a staff of about thirty medical officers. This could do the duties devolving on separate field ambulances and was very successful as well as economical in medical officers and orderlies. It has been the supply of motor am- bulances only that has made it possible to deal adequately with the surgery at the front. One aspect of this subject is often overlooked, viz., the use of motor transport in saving the wounded from capture, for it is certain that had motor ambu- lances been at hand in large numbers there would have been very few British prisoners after Mons and Le Cateau. In getting patients rapidly to the casualty clearing stations and also in saving wound- ed from falling into the hands of the enemy, motor transport has been of the greatest value, in fact the ambulance is the foundation on which the sur- gery of the front is based. No horsed vehicles could deal with the numbers resulting from a heavy light unless they were so numerous as to block buy viagra modalert the roads for all other transport. The development of the casualty clearing stations has been the chief factor in creating the new school of surgery at the front and it is said that they have assuredly saved thousands of lives. They were at first called "clearing hospitals" and were intended merely to clear the field ambulances and pass on the patients buy viagra modalert to the base hospitals. So their equipment was slight and their staff of eight offi- buy viagra modalert cers less than that of a field ambulance. They tarried 200 stretchers. These stations were soon overtaxed but became a nucleus around which an efficient organization for more complete surgical treatment could be established. Bedsteads and bed- ding were supplied and trained nurses appointed. The next addition was surgical equipment in the way of instruments and apparatus. The election of special surgeons viagra online brazil followed and before the close of 1914 good surgical work was being carried on at eight centers. Progress continued from this time and by the end of 1916 more than 50 casualty clear- ing stations buy viagra modalert were at work. They were situated behind the line of trenches on the entire front. Every one must be at or near to a railway siding so that evacuation by train is easy; further they must be where good roads connect them with the front. Moreover they must have a good water sup- ply. There are two series; (o) those nearest viagra online brazil the front at a distance of 6 to 9 miles from the viagra online brazil front trenches; (b) those in the second line which are buy viagra modalert from 3 to 6 miles further back and act as a reserve during active operations, or as units for special cases. $mgr?BS nf Mitral £>rtrnre. Boston Medical and Surgical Journal. Jnnt 21, 191 7. I Massachusetts Medical Societ] : The Shattuck buy viagra modalert Lecture — The Physiological Factors omcerned in Surgical Shock. Walter B. Cannon. - The Recognition of Pancreatic Insufficiency, with Special Reference to the Loewl Test. H. Ryerson Decker. 3 Some Unusual Conditions Observed in 245 Postmortem Ex- aminations at Danvers State Hospital. Lawson <; Lowrey. i Some Conditions Leading to Incorrect Diagnosis of Ad.-, in viagra online brazil Children Virginius Dabney. 5. A Note on Barany's Sign In Epili ptlcs and in School Chil- dren. Edward A. Tracy. 2. The Recognition of Pancreatic Insufficiency, with Special Reference to the Loewi Test.— H. Ryerson Decker bases his conclusions buy viagra modalert of the reaction of the Loewi test in pancreatic conditions on the results ob- tained in a series of 500 cases from the surgical and medical wards of the West Penn Hospital, Pittsburgh. The technique followed was that recommended by Loewi. Three drops of adrenalin chloride solution 1-1000 were instilled in one conjunctival sac, the other eye being used as control, viagra online brazil and followed in five minutes by three more drops, the point being to fill the conjunctival sac. Dilatation of the pupil should occur within an hour if the test is positive. The amount of enlargement varies 32 MEDICAL RECORD. [July 7, 1917 from less than a millimeter to complete pupillary dila- tation and occurs within a 15-minute period. The length of time taken for action seems to be dependent on the facility with which the adrenalin is absorbed, rather than on the amount used. Care is taken to exclude im- paired or inflamed eyes. In the 500 cases, which covered a wide range of injury and diseases, there were 18 posi- tive reactions, only 2 of which were known to have pancreatic lesion — one, a case of carcinoma of the pan- creas, the other, chronic pancreatitis associated with gallstones. It might be of interest to note, on account of the etiological relationship which is viagra online brazil thought to exist between gallbladder and pancreatic disease, that in 15