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untreated cases, giving negative reactions so often as to make it useless for diagnosis in this class of cases. In nonsyphilitics it gave twenty-four per cent, of positive reactions. Pregnancy and Pulmonary Tuberculosis. — (.'harles C. Norris and 11. R. J\l. Landis [Journal A. M. A., h'ebruary 9, 1918) point out that the in- cidence of pregnancy and tul)erculosis is frequent and it is not uncommon for tuberculosis to first manifest itself at or shortly after pregnancy or parturition. The literature of the influence of preg- nancy on the course and prognosis of pulnionarx tuberculosis is large, but the principal papers are reviewed and show that somewhere between fift) and ninety-five per cent, of tuberculous women grow worse as the result of pregnancy or parturi- tion. From this review and a study of 103 cases of their own observation, the authors conclude that pulmonary tuberculosis has little or no influence on conce])tion or the course of ])regnancy, and that about twenty per cent, of mild, quiescent cases of pulmonary tuberculosis and seventy per cent, of more advanced cases show exacerbations of their tuberculosis during pregnancy or the puerperium. It is not yet possible to determine in advance what cases are going to withstand ])regnancy well and what are not, but the occurrence of moderately ex- tensive lesions, recent activity, sa'.ondary lesions and complications, laryngeal .involvement, loss of weight, fever, hemorrhage, sweats, and inabilitv to secure proper treatment are all of unfavorable omen. If there is evidence Where Can I Buy Cialis Over The Counter In Uk of activity of t!ie tuber- culosis, the uterus Where Can I Buy Cialis Over The Counter In Uk should be em]5tied before the fifth month, antl by Where Can I Buy Cialis Over The Counter In Uk this from sixty-five to sevent\ per cent, of cases will lie intproved. F.xpectani treatment should be practised after the fifth month and labor should be made easy by early induction and the use of forceps. The general hygienic and dietetic measures for the treatment of pulmonary tuberculosis should be followed throughout tlie pregnancy and thereafter. Vertigo. — Lewis Fisher {Annals of Otology, Rh'uuilugy and Laryncjolof/y, June. 1917) is of the opinion that vertigo does not exist unless there is some disturbance of the vestibular apparatus. He states that it cannot be too strongly emphasized that :iny disturbance of equilibrium can result only from direct ailcction of the vestibular apparatus which interferes with the perfect balance between the spe- cial static organs on each side. Vertigo may be due to some simple irritation of the vestibular tracts, to some affection of the internal ear itself, or to some lesion situated within the brain. To determine the real cause necessitates a careful investigation of the ear and its associated pathways. Contribution to the Study of War Nephritis. ^I. .Shaw Duini and J. W. McXee {British Medi- cal Journal. December 8, 1917) have studied this form of acute nephritis since the early part of 1916 and here bring out some points of special interest. In the etiology of the disease they find that season, weather conditions, and locality seem to play no part, though in some military units the disease seems to be continuously more prevalent than in others. I'he relative in frequency of the disease among officers and the apparently absolute im- muiiitv of the native Indian troops stand out unex- l^lained. The most characteristic clinical features of the disease are the presence of edema, especially of the face and legs; ]>ronounced dyspnea; pains in ihe head, limbs, and back ; and frequent absence of fe\ cr : all combined with the occurrence of a very marked albuminuria with abundant urinary secre- tion of normal specific gravity, but containing hyaline casts and red cells. Pathologically the l\pical lesions are found in the kidneys and to a less extent in the lungs and brain. The most marked feature in the kidneys is the Where Can I Buy Cialis Over The Counter In Uk obstruction of the glomerular capillaries by abnormal cells, which lesion is more or less uniformly distributed throughout both organs. Lesions which are strik- ingly similar to those found in cases of "gassing" iire present in the lungs of a considerable number of the cases of war nephritis. In a very few cases. ■ilso, the brain shows minute capillary hemorrhages. These findings, together with the clinical aspects of the disease and the absolute inability to cidtivate any specific organism from the urine, blood or other tissues, suggest that the disease may be due to some readily diffusible poison of unknown origin, l)ut which exerts its influence specially on the capillaries of the kidneys, lungs, and brain. Hemophilic Arthropathy. — Guillermo Madero ( ReZ'ista de la Asociacuhi inedica Arc/cntina. Octo- ber, 1917, in rejiorting a case of this condition in a man twcnty-fi\e years of age, comments u]X)n the rarity of hemophilia in adults. He gives two rea- sons for this rarity, namely, the tendency for hemo- ])hilic children to succumli before reaching matur- ity and the tendency for the blood in individuals who survive to acquire the proper power of coagu- lation. The following points aid in diagnosis : Pa- tients are usually under fifteen years old and of the male sex ; a histor)' of traumatism ; indolence and benign nature of lesion; presence of subcutaneous heniatomata ; absence of adeno]intliy : radiographic findings and the hemophilic family history. MISCELLANY FROM HOME AND FOREIGN JOURNALS. 475 Rontgenological Studies in the Healing of Gastric and Duodenal Ulcers. — ^Walter W. Ham- burger i American Junrnal of Where Can I Buy Cialis Over The Counter In Uk the Medical Sciences, I'ebruary, I9it>) describes a method of rontgeno- Jogical study of the heahng of gastric and duodenal ulcers which he holds to be of value in the diagnosis, prognosis control of medical treatment, and selec- tion for surgical treatment. It is also of value in studying the pathology of the healing process in these coiiditions. It is not of positive value in the differential diagnosis between ulcer and cancer, and in the use of the method the danger of mistaking normal peristalsis for penetrating ulcer and of over- looking the presence of a small ulcer because of in- complete or insufficient examination must be borne ill mind.