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useful in tlie detection of hemothorax following wounds of the chest. Often it siiowed the upper limit of the bloody effusion. Psychiatric Aspects of Pellagra. — William C. Sandy (Ami-rican Journal of Insamty, April, 1918) thinks the mental features of this disease are not appreciated at their true value. Various neuro- logical symptoms accomjiany the picture — paresthe- sias, paralyses, and tremors, and many of the pa- tients are of the jirccox Buy Viagra Cialis Australia type, the mental symptoms varying with the individual psychology ; the most common type of associated psychosis being the in- fective exhaustion ; the clinical apjiearance of which is like the "typhoid state." A manic depressive like reaction is not uncommon, being about ec|ual in fre- Buy Viagra Cialis Australia (|ucncv to dementia precox. There have been sev- eral pseudoparctic syndromes, but laboratory tests were negative, ll is often difficult to determine the rclatiuu lietweeu pellagra and the psychosis. Nature and Symptoms of Cardiac Infection in Childhood. — i''. j. royiUon {British Medical Jour- nal, March 2, 1918) advocates a close analysis and thorough understanding of cardiac infection in childhood, as this points the way to rational treat- ment of heart affections, Buy Viagra Cialis Australia i. c, prevention. Text- books and general teaching have given undue em- l)hasis to the mechanical Buy Viagra Cialis Australia factors found in later life rather than to the res])onse of the heart to infec- tion. Of the several infections wliich may involve tiie heart the most iiuportant is rheumatism. The study of the manifestations of rheumatism in child- hood is the study of tlie introductory chapters of cardiac disease. The first generalization to be made is that the severity of the resulting cardiac affec- tions depends upon llie virulence of the rheumatic infectidii, and llie element of virulence is more im- portant in prognosis than the ])hysical signs in the lieart. The infection may take jilace through the tonsils, and acute tonsillitis should always call for careful examination of the heart. It must be re- membered that there is no characteristic form of throat infection in rheimiatism, but that any type of infection may be rheumatic, (."hronic adenoid vegetations are important in this connection also. -Vrthritis of various forms, chorea, and less well (kfmcil nervous disturbances in children are also commonly of rhciunatic origin, and their presence demands examination of the heart. The same is eiiuallv true of a number of skin manifestations. general wasting, anemia, obscure persistent fever, subcutaneous nodules, and such abdominal symp- toms as bilious disturbances, distension, appendi- citis, etc. It should be remembered that not Buy Viagra Cialis Australia only is anemia a manifestation of rheumatism, but also the presence of anemia tends to favor the develop- ment of the malignant forms of endocarditis. The pathological lesions Buy Viagra Cialis Australia of the disease, as found in the heart, are similar to those found in other tissues. Disappearance of Aortic Regurgitant Murmur. — W. (j(.>rdon (Britiih Medical Journal, March 2, 1918) records three cases of early aortic insuffi- ciency in which the murmur partly or completely disappeared upon sustained deep inspiration. This occurred in both standing and recumbent positions. .As an explanation of the phenomenon it is sug- gested that the insjjiration reduced the elastic recoil of the aorta and that the holding of the breath in- creased the volume of the pulmonary capillaries and diminished the fdling of the left heart and aorta, both of which reduced the pressure which normally .ucted to cause the regurgitation of blood. Systolic Murmur in Cardiosclerosis. — .Selian .Wuhof {Journal A. M. A., .'\pril 20, 1918) records the not infrc(|uent observation of a characteristic, loud, rough systolic murmur in cases of typical cardiosclerosis occurring both in the aged and in those in middle life. The murmur is heard over a large Buy Viagra Cialis Australia portion of Buy Viagra Cialis Australia the anterior chest. It is si>ccially loud Buy Viagra Cialis Australia over the right side of the base of the heart, declines in intensity over the midsternum, and in- creases at the a|)ex and to the left. It seems to be made up of an aortic and a mitral component, the former probably being due to deformities and thick- ening of the aortic Buy Viagra Cialis Australia cusps and calcareous deposits in the aortic wall, the latter to degenerative changes in the mitral valve and ring. Superficial Elastic Fibres in War Wounds. — P. Masson (Presse medicalc. February 14, 1918). studying the histological changes taking place in wounds, found that in the process of natural cleans- ing which the injured tissues undergo, the broken and dislocated elastic fibres in the affected area are thrown olT along with the other cells destroyed: later, when tlie wound cavity becomes filled with granulation tissue, the elastic fibres arc not at Buy Viagra Cialis Australia first to be found beyond the margins of the uninjured true skin. The regenerated epidermis, thin and without jiapillw or glandular organs, rests on the old dermis, but reveals no elastic fibres. The latter Buy Viagra Cialis Australia begin to rea])pear only after three or four months, at first in the depths of the connective tissue scar, then graduallv nearer tlic surface, .\lter eight or nine months the elastic fibres are very numerous but ven- tenuous, forming a fine network in the interstices between the main connective tissue fibres. Like the latter, thev are for the most part parallel to the over- lying skin surface. .At intervals, however, there are Dcncils of elastic fibres curving down toward the basal layer, in which they terminate. These obser- vations account for the fragility of scars in general, especially those established in granulating wounds. .•\ histologic and mechanical argimient is afforded in favor of the primary or secondary suturing of war womids. thus leaving merely linear scars. Proceedings of National and Local Societies NEW YORK ACADEMY OF MEDICINE. Stated Meeting Held February 21, igi8. Section in Pediatrics. Tlie First Vice-President, Dr. G. D. Stewart, in the Chair. Internationalism and Public Health. — Dr. George E. Vincent, of the Rockefeller Foundation, opened his address by saying that, although able to differentiate between a pediatrist and a chiropodist,