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quite frequent amongst the poor and especially the Russians, but the proportion of cases of tuberculosis was less than amongst those of other races under the same social conditions. Subacute and Chronic Non-Tuberculous Pulmonary Infections. — Dr. J. A. Miller of New York said that his report was based on 22 cases, but this report was not a report of the entire number of observations, there viagra online versand being twice as many or more. These cases he grouped into three types, the subacute, the subacute with re- currences and the chronic type. There order viagra articles were 9 cases in the first type with a clinical course similar to what was found in other types. This group was character- ized by a mild onset, slight febrile disturbances lasting about five days. The expectoration consisted of a marked purulent discharge and sometimes with hemo- ptysis. There was no pain and the physical signs were characteristic and limited, as a rule, to the lower lobe. There was usually a slight impairment of resonance and a diminished vesicular breathing. There were moist rales over the entire lobe. These cases usually presented the physical signs with tuberculous infiltra- tion. He had seen evidences of consolidation. Among the nine cases the termination occurred in four weeks or six months. Sometime the physical signs persisted for two or three months and then entirely disappeared. The examination of the sputum had been thoroughly done for the tubercle bacilli and was consistently nega- tive. One of the characteristic signs and the striking viagra online versand sign was the lack of evidence of pulmonary markings. There were 6 cases viagra online versand in the second type. This type was practically the same as the first type, but the con- dition recurred at intervals of several months or a year. In one instance there were four recurrences. In each recurrence the signs and symptoms were the same and always in the same area. The sputum was negative to tubercle bacilli. In 4 the x-ray was abso- viagra online versand lutely normal. In the third viagra online versand type there were 7 cases. The history of onset was as in the first type. The signs never cleared up. There were exacerbations in the symptoms. There was pain in three cases. In the sputum the pneumococci, Type IV, was found in 4 cases order viagra articles and the order viagra articles streptococci viridans in 3 cases. Unless taken in an acute exacerbation the number of bacteria was much less. The x-ray showed in all increased mottlings, very marked in 2. There were pleuritic ad- hesions in 4. Summary: The ages ranged from 7 to 60 years. The subacute form predominated in young people. The seasonal incidence was the cold months. The site of lesion showed the left lobe affected in 13 cases, the right lobe in 5, both lobes in 3 and right upper and left in 1. Two patients had friction sounds. In 3 of the third type there was pain and thirst. Frank hemoptysis occurred in 2, and bloody sputum in 4 others. Cultures were taken in viagra online versand 21 cases and showed pneumococci, Type IV, in 10 cases; influenza bacilli in 8; streptococci viridans in 3 cases of the chronic type. The x-ray showed 7 normal cases; 1 with effusion; 10 increased mottlings; 4 pleuritic adhesions and in the chronic type. Dr. James B. Herrick of Chicago said he had had six cases of the subacute type with recurrences. He had one case which recurred five times in as many order viagra articles years. The x-ray showed the same signs as in the subacute type. In the chronic type clearing up never seemed to occur. There were exacerbations of the symptoms that were similar to the acute type with the recurrences. He had had seven cases and three of the seven showed distinct pain. The x-ray showed some- thing quite distinct. In all seven cases there were similar changes. In four there were evidences of pleuritic adhesions which were not present in the others. Recovery occurred in a few months in the subacute cases. In the Presbyterian Hospital in Chicago there were a great many of these cases. Dr. Nathan E. Brill of New York said that there had been brought out a type of disease that had been familiar to him for years. Since the first order viagra articles pandemic of influenza in 1888 and 1889 this type had been known to him. In that pandemic he had seen such cases for the first time. In most of the cases the left lower lobe was attacked through the upper lobe, the right lobe, or both might be affected. During the last seven years he had frequently seen one or more such cases in the wards. He had demonstrated them to his students as cases of pulmonary invasion, non-tuberculous in char- acter. Dr. Brill then showed slides. Dr. Gerald Bertram order viagra articles Webb of Colorado Springs, Col., showed slides. Dr. Hobert A. Hare of Philadelphia said that two or three years ago he read a paper before the College of Physicians and Surgeons and pointed out that there were no physical signs in these cases at all character- istic of tuberculosis. They made records of pulmonary lesions that occurred in the students and often advised them to lay off for one or two years. This showed how viagra online versand dangerous it was not to recognize that prolonged phy- sical signs might exist in the lungs which were not due to any tuberculous lesion. Dr. S. Solis Cohen of Philadelphia said that Dr. Da Costa had called atention to order viagra articles this class of cases that had been alluded to, especially the cases of recurrent bronchopneumonia following influenza. In 1880 he lec- tured on influenza and spoke of the persistent fevers, after influenza, stating that "like the poor viagra online versand they were always with us." 42 MEDICAL RECORD. IJulv viagra online versand 7, 1917 Dr. Lawrason Brown of Saranac Lake said that they should prove that these cases were not tuberculous be-