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tion cf the skin was presented by the sections. There were extensive emigration of polynuclear leucocytes, marked exudation of serum, small quantities of fibrin, particularly in the neighborhood of the blood-vessels, pronounced dilatation of the lymphatics, and an in- crease generic viagra pfizer in the number cf lymphoid cells. The epi- dermis was practically normal. The present paper contained generic viagra pfizer observations on three additional cases of urticaria factitia and tin: examination of spontaneous wheals, together with the application of improved technique. " Mastzellen" were stained after a slight modification of Unna's method and they were found to be apparently increased in numbers. In these fur- ther cases the results were the same, viz., acute in- flammation of the skin. Other points noticed were nuclear fragmentation of the polynuclear leucocytes and in one case even of the fixed connective-tissue cells, a point to which the speaker's attention was called by Dr. Welch, of the Johns Hopkins Univer- sity. On account of the evidence of generic viagra pfizer this nuclear frag- mentation presented by Dr. Welch the author thought, and this idea was again suggested to him, that some powerful irritant, probably a toxin, was set free from the blood-vessels upon producing the wheal, demon- strating a toxaemic condition of the blood. The pres- ence of indican in the urine in large quantities in some of the cases examined might possibly point to viagra tablet do the chemical nature of this toxin. After due consid- eration the author thinks this theory explains all the phenomena of all varieties of urticaria. Dermatolo- gists who have examined urticaria pathologically have generally agreed with the belief in the inflammatory nature of the wheal. The author brought forward the fact that in these wheals we are able to study the early stages of inflammation in man, which heretofore has never viagra tablet do been done. It was found that the polynuclear leucocytes were observed first in the vessels in two minutes; in generic viagra pfizer five minutes the emigration of these cells was first noted; in eight minutes there was be- ginning disintegration of these cells; in fifteen min- utes there was an increase in number of lymphoid cells and apparently of " mastzellen." THE NEW YORK ACADEMY OF MEDICINE Stated Meeting, May 7, /8p6. Dr. Egbert H. Grandin, Vice-President, in the Chair. The Polyarthritis of Scarlet Fever. Dr. Henry W. Berg read a paper on this subject. He stated that the acute infectious diseases are quite universally sup- posed to leave as a specific sequel of their occurrence a predisposition to the subsequent development of chronic osteitis, both of tuberculous and non-tubercu- lous character. How much truth there is in generic viagra pfizer this as- generic viagra pfizer sumption is doubtful, for two reasons: First, the more or less direct connection in point of time between the occurrence of the earliest joint manifestation and the infectious disease does not prove a specific etiological connection between the two maladies. Second, the viagra tablet do universality of the occurrence of acute infectious dis- ease is such that very few persons affected by chronic joint disease can fail to recall being the subjects of measles, scarlet fever, or mumps at some time previous to the development of the joint manifestations. generic viagra pfizer The speaker said he had accordingly been extremely scep- tical as to the etiological connection between chronic joint disease and the acute infectious diseases, and this feeling of doubt had led him to observe and study with especial interest a series of joint complications occurring in the course of scarlet fever. Joint affec- tions are more frequent in this disease than in any other of the acute infectious diseases. Dr. Berg then briefly reported six cases of polyar- thritis complicating scarlet fever seen during his ser- vice of two months at the Willard Parker Hospital in the generic viagra pfizer summer of 1895. In all of these cases more than one joint was affected, and in most of them the ar- thritis affected the joints of both sides of the bod}'. In several of the cases the smaller joints, those toward the periphery of the extremities, such as the joints of the hand and foot, wrist, elbow, and knee, were affected: Five of the cases ended in almost perfect recovery, while one was discharged with two suppurat- ing joints. The speaker expressed the opinion that the occurrence of polyarthritis as a complication of scarlet fever generic viagra pfizer does not render the prognosis of the lat- May 30, 1896] MEDICAL RECORD. 785 ter any worse per &, so far as regards danger to life. This is in contradiction to the view held by many writers that polyarthritis occurs generic viagra pfizer only in scarlet fever patients who are extremely apt to die. In all the cases that have come under his observation during the past two years the patients made a fairly good recov- ery. Disability of a more or less chronic character occurred in some viagra tablet do of the joints affected, but even this yielded to appropriate treatment. Dr. Berg mentioned four varieties of polyarthritis occurring as a complication of scarlet fever or other acute infectious disease: 1. Cases in which there is a simple inflammation of the joint structures without effusion of serum and with little swelling. 2. Cases in which the clinical symptoms are chiefly those of synovitis. The other structures of the joint are in an acute inflammatory condition, but this gradually sub- sides as the swelling and effusion disappear. 3. There is a group of cases in which viagra tablet do the arthritis con- sists of a simple or (later) a purulent synovitis, ac- companied by or terminating in osteitis, with or with- out necrosis of the affected joint ends of the bones.