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suppuration, injury to nerves, fracture into joint, disloca- tion, septicemia, fat embolism, pneumonia, and delirium tremens. GYNECOIOGY. 1. Laceration of the cervix may cause hypertrophy, tadacip 5mg online elon- gation, sclerosis, cystic degeneration, or carcinoma of the cervix; subinvolution, or displacements of the uterus, also endometritis. Other results may be pain on walking, on defecation, or during coitus ; sterility or abortion ; head- aches, backache, neuralgic pains, neurasthenia, indigestion, constipation. 2. Lacerated perineum may be followed by local tender- ness, irritable scar, reflex disturbances, subinvolution of the uterus, rectocele, cystocele, prolapse of the uterus, and in- continence of tadacip (generic cialis) feces. 3. Vaginismus is a condition of painful and spasmodic contraction of the vaginal orifice, which renders coitus either painful or altogether impossible. Its causes are irri- table hymen, ulcer, or fissure anywhere in the immediate vicinity, urethral caruncle, carunculae myrtiformes, a long perineum with vaginal orifice placed too anteriorly. The treatment consists in removing the cause when tadacip 20 mg uk possible, tonics and general constitutional treatment, dilatation of the vaginal orifice; local application of a five per cent, solution of cocaine will relieve the hyperesthesia and allow of coitus. 4. The sources of streptococcic poisoning in the puer- perium are the hands of the physician, generika-apotheke tadacip nurse, midwife, or of the patient herself; unclean tadacip erectalis 20 mg tabletten instruments and catheters; coitus during the time immediately preceding labor; contact tadacip online kaufen with secretions from wounds of any kind, no matter where situated ; general unhygienic surroundings, and contact with a patient suffering from scarlet fever or erysipelas on the part of any one attending on the woman. The percentage of such cases will depend on the care exercised by doctor, nurse, etc. ; when infection does occur, it is generally streptococcic infection, either pure or mixed with other germs. OBSTETRICS. 1. In external pelvimetry four measurements are gen- erally taken: (i) between the anterior superior spines of the ileum, normally about ten and a quarter inches; (2) between the external edges of the iliac crests, normally about eleven inches ; (3) between the heads of the two great trochanters, normally about twelve and a quarter inches ; and (4) between the spinous process of the buy tadacip canada last lumbar vertebra and the upper margin of the anterior sur- face of the symphysis pubis, normally about eight inches. 2. It was formerly held that pregnancy had a beneficial effect upon tuberculosis, that the mother was likely to improve as long as the pregnancy lasted, though she might rapidly fail after the birth of the child. The more recent view is that pregnancy exercises a harmful effect; that pregnancy, labor, and lactation only weaken the patient, lower the vitality still further, and hasten the end. 3. The patient should be advised to avoid indigestible or very highly seasoned articles of food; her diet should be Nov. 17, 1906] MEDICAL RECORD. 807 nutritious and sufficient. In patients who have previously had unduly heavy children it would be well to restrict the carbohydrates and fluids during the lajt two or three months of pregnancy. The tendency to constipation, which may be increased during pregnancy, should be overcome by laxative foods or fruit. PATHOLOGY. 1. The etiology of hyaline degeneration is somewhat obscure ; it is said to be caused by infections and intoxica- tions, such as lead, alcohol, and syphilis. The seats are: the blood-vessels in the brain, lymphatic glands, voluntary mus- cles, and ovaries. Aneurysms, sclerosed arteries, the heart in endocarditis, and gummata may also undergo hyaline degeneration. 2. Normally, the blood contains about o.i per cent, of grape sugar, which is chiefly derived from the carbohy- tadacip 20 price india drates in the food, but also by a splitting up and rearrange- ment of the elements of the proteids, and possibly also from the fats. This and other changes are supposed to take place in the liver, which, together with the muscles, converts the sugar into glycogen, and also acts as a storage place for the glycogen. The glycogen is changed again into sugar and passed into the blood, which is thus kept supplied with its proper amount. In diabetes this arrangement becomes disturbed, with the result that some of the sugar delivered to the blood is not utilized. According to Tyson, this may be brought about in several ways: (l) It may be that the glucose arising by tadalafil tadacip 20 mg a reconversion of the glycogen stored in the liver is contributed to the blood too rapidly to be oxi- dized; (2) It may be that, although the glucose is deliv- ered in normal quantity, it is still not consumed because of some defect in the oxidizing mechanism, some deficiency in the glycolytic ferment; (3) It may be that the glucose arising from sugar and starch digestion in the intestine is not first converted into glycogen as in health, but passes directly through that organ to the vena cava too rapidly or in too large quantity to be utilized, or lacking some molecular quality which permits its oxidation. 3. In extreme cold the skin is pale and waxy, with irreg- ular dusky, reddish patches ; the superficial parts are blood- less, while the viscera, including the brain, are congested; the heart and large vessels leading from it are full of blood, and the blood is of a brighter red color than usual. In extreme heat, the lesions are great congestion of the viscera, early rig*r mortis and putrefaction, the red blood corpuscles are broken up, and otherwise altered in appear- ance, there is also coagulation of the proteid matter in the tissues, and the kidneys have a reddish-brown color. 7. Fibrinous pneumonia is the same as lobar pneumonia; catarrhal, is the same as lobular or bronchopneumonia; purulent, is any form of pneumonia in which pus is formed; fibrinous pneumonia is the same as interstitial pneumonia, and is cialis generika tadacip often called fibroid phthisis, or cirrhosis of the lung. 8. Caries means molecular death and disintegration of bone, attended with suppuration. Necrosis implies that a portion of bone has died en masse, molar death of bone. These two terms are used in regard to bone, in the same way that ulceration and sloughing are, with regard to the soft tissues. PRACTICE OF MEDICINE. 1. The remote effects of syphilis of the nervous system are: Mania, melancholia, paretic dementia, pseudoparesis, myelitis, meningomyelitis, paraplegia, hemiplegia, locomotor ataxia, general paresis, neurasthenia, hysteria, epilepsy and neuralgia. 6. In duodenal ulcer the pain is apt to be more to the right and to occur at an interval of two or three hours after meals; the hemorrhages will tadacip 5 mg be intestinal, and the blood will be passed by way tadacip 20mg generic cialis of the bowels, and not vomited. In many cases the symptoms are identical with those of gas- tric ulcer. 7. In typhoid fever there is a dull and apathetic ex- pression, the cheeks may be flushed, the tongue dry, and the teeth covered with sordes. In tetanus the jaws are firmly closed, the corners of the mouth are drawn up, and the forehead is wrinkled. In exophthalmic goiter there is a staring expression, accompanied with more or less pro- trusion of the eyeballs. 9. Streptococcic infection of the throat presents symp- toms that are apt to be more severe than those of diph- theria. The temperature runs as high as 104° to 106°, but the only sure test is in the absence of the Klebs-Loeffler bacillus. EYE, EAR, NOSE, AND THROAT. 2. In the condition known as the Argyll-Robertson pupil, the pupil responds to accommodation, but not to light It is found in locomotor ataxia, general paralysis of the insane, and sometimes in cerebral syphilis. MEDICAL JURISPRUDENCE. tadacip erectalis 20 mg I. Medical Jurisprudence is the application of th« knowledge of any of the branches of Medicine to the prob- lems and requirements of the law. 4. According to Taylor, the term insanity is applied to "those states of disordered mind in which a person loses the power of regulating his actions and conduct according to the ordinary rules of society. In all cases of real insanity the intellect is more or less aflfectcd." 5. Malpractice includes any act, wh«ther willful, or tadacip pille 20mg cialis generika through negligence or ignorance, by which a physician or surgeon causes a person under his care to suffer death or unnecessary injury. The physician is not supposed to guar- antee a cure, but is expected to do his best to bring about a cure. HYGIENE AND PUBLIC HEALTH LAWS. 1. Hygiene is the science cialis generico tadacip and art of all that tends to the maintenance and improvement of buy cheap tadacip health, the prevention or shortening of the duration of diseases, and the prolonga- tion of life. Health laws are such regulations, ordered and enforced by the proper powers in a community, as deal with the subjects comprehended under hygiene, and include the arrangement and building of houses, schools, etc., their ventilation, water supply, lighting, and the removal of refuse and excreta; the regulation of dairies and slaughter- houses, the management of infectious diseases, the regula- tion of trades, the supervision of nuisances, and the dis- posal of the dead. 2. Impure water may cause typhoid fever, dysentery, diarrhea, indigestion, goiter, vesical calculi, cholera, yellow fever, scarlet fever, diphtheria, tapeworms, and lead poison- ing. Impure milk may cause tuberculosis, scarlet fever, diphtheria, typhoid fever, and cholera. 3. COj, organic matter, or crowd poison may accumu- late As an adult is supposed to require 3,000 cubic feet of fresh air per hour, a child may be supposed to require, say, 2,400 cubic feet per hour, or forty cubic feet per min- ute. MATERIA MEDICA AND THERAPEUTICS. 1. By the empirical use of remedies is meant the em- ployment of them, because it has been found by experience that they are of benefit in conditions similar to the one under treatment ; e.g., colchicum in gout, opium to relieve pain. By the intelligent employment of remedies is under- stood their use based upon a knowledge of the physiological action of the drug and a further knowledge of the patho- logical tadacip by cipla condition present; e.g. the use of digitalis in mitral lesions of the heart. 2. Among the so-called remedies now relegated to a judicious oblivion, may be mentioned the use of quintine in typhoid, potassium chlorate in diphtheria, large doses of creosote in pulmonary tuberculosis, bleeding for nearly everything, methylene chloride as an anesthetic, Condu- rango for cancer, and sarsaparilla for syphilis. 3. Hypnotics are agents used to induce sleep. tadacip price in india The two classes into which they may be divided are: (i) those which relieve pain and produce sleep, and (2) those which will produce sleep, but will not relieve pain. Opium is an example of the former class, and chloral of the latter. 4. Anthelmintics are drugs used for the purpose of re- moving intestinal worms. Vermifuges cause the expulsion of these worms, and vermicides destroy them. The para- sites against which they are directed are: (i) the round worm {Ascaris lumbricoides) ; (2) the tapeworm (Tbuy tadacip uk (4) Ankylostoma duodenale. Conception During the Existence of Amenorrhea.—

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