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atropine test was found to become positive at about the tenth and to disappear at about the thirty-first day Cialis Buy Australia of the disease. In the nontyphoid group three cases gave a positive reaction. The author deems the test of great value in the diagnosis of fevers of the enteric group. In many cases it precedes the positive Widal reaction. The use of atropine in the manner described is suggested as a means Cialis Buy Australia of diagnosing the syndrome termed vagotonia. Prognosis in Cardiac Affections. — Robert H. Babcock {Journal A. ilf. A., February 9, 1918) dis- cusses this subject from the point of view^ of the relation of the discovery of murmurs and arrhyth- mias to the outlook for life. He says that a case must not be judged on the detection of a murmur alone, whether diastolic or systolic, because a reallv intelligent opinion is possible only from a study of tile case in all of its aspects. The question of whether Cialis Buy Australia a murmur is organic or so called functional can arise only in the case of systolic murmurs, be- cause those occurring during cardiac diastole or in presystole are always due to some structural defect. Even where such definitely structural murmurs are present, prognosis depends largely on the degree of the lesion, Cialis Buy Australia the integrity of the myocardium, and the subjective symptoms. It may be stated as a gen- Cialis Buy Australia eral ]>roposition that mitral or aortic stenosis is less favorable in outlook than similar insufficiences because the stenotic lesions are usually progressive. Alitral .systolic murmurs should be divided into those which are due to endocardial lesions and Cialis Buy Australia those of myocardial origin. The lattef are far more common after than before the middle period of lite and are not usuall)' of very good prognosis be- cause their [presence is an indication of lack of soundness of the musculature. The prognosis even in these must consider the age of the patient, the evidences of cardiac muscular impairment, the l^resence or absence of focal infections, angina, and other factors indicating the precise degree of myo- cardial damage. In true endocarditic mitral sys- tolic murmurs one must consider the factors likely to cause further injury such as a marked tendency to repeated rheumatic attacks, infected tonsils, etc. If there is little or no dilatation or hypertrophy and the patient can withstand severe exercise without discomfort, the prognosis of a mitral leak is good in the absence of further involvement. Such prin- ciples as these must guide one in prognosis in the presence of murmurs. Of the arrhythmias auricu- lar fibrillation and persistent ventricular extrasys- toles in the aged or associated with valvular lesions are almost the only ones of serious prognostic im- port. Bone and Joint Lesions in Yaws. — H. G. Maul {Philippine Jounial of Science, September, 1917), among 100 cases with a positive diagnosis of yaws, found twenty suffering from bone and joint lesions. In X ray studies these lesions generally appeared as irregularly oval or elliptical rarefied areas, with the Cialis Buy Australia long axis parallel to that of the Cialis Buy Australia affected bone. These areas, at times two or three centimetres in length, showed moderately well defined borders and varied in translucency from a slight tmnatural trans- ])arency to one simulating a perforation. Most of the lesions appeared to originate in Cialis Buy Australia the interior of the bone, but a number were seen as small surface excavations. In the latter, the periosteum was usually destroyed ; occasionally the cortex showed thickening and the periosteum was separated from the bone. About two per cent, of such cases show a nodular type of lesion, with swelling over the bone and a localized thickening of the cortex, which sooner or later undergoes central rarefaction. In the chronic lesions the bone, as a whole, becomes deformed and its growth is interfered with, espe- cially in the presence of epiphyseal involvement. Within the joints, destruction is most often seen in the portions of the articular surfaces most ex- posed to tratuna, or oval or irregidar excavations. Apart from the nodular cases, the Cialis Buy Australia x ray picture differs from that of bone syphilis in the absence of periosteal proliferation and cortical thickening. In the nodular cases the thickening does not tend to extend along the bone. The differential Cialis Buy Australia diagnosis of the bone lesion of yaws from tuberculous or sep- tic central bone abscess gumma, hydatid cyst, be- nign cyst, fibrous osteitis, enchondroma, endothe- lioma, secondary carcinoma, myeloma, and sarcoma is made through the x rays, the history, the physical signs of yaws, and the evidences of disease or tumor in other parts of the body. The Cialis Buy Australia Castellani treatment causes gradual disappearance of the yaws bone and joint lesions. Salvarsan is followed by rapid bone regeneration, which is complete if the Cialis Buy Australia destruction has not been too gjeat. 474 MISCr.l.LAXY FROM HOME AND FOREIGN JOURNALS. [New Yokk Medical JoukMAL. Bruck Precipitation Test for Syphilis. — Arthur William Slillians iMt-dical Insurance and Health Conservation, January, lyiBj describes liie test as follows: To 0.5 c. c. of clear senmi in a large test tube two c. c. of distilled water are added and the tube shaken. Then 0.3 c. c. of acidum nitricum purum of the (jerman riiarmacoixi'ia are added, rhc tube is again shaken and allowed to stand at room Cialis Buy Australia temperature for ten minutes. To the white precii>itatc thus formed, sixteen c. c. of distilled water are added and the tube, capped by the finger, is carefully inverted tliree times, the formation of frotli being avoided. The tube is allowed to stand again for ten Cialis Buy Australia minutes and then inverted three times in the same manner. After the tube has been allowed to stand for twelve hours at room teiiii)erature the reaction may be read. The tuljes showing Cialis Buy Australia a slight precipitate should be read as doubtful or negative, those showing more than a slight opalescence as positive, and those remaining clear as negative. The atithor has employed this test in ninety-seven cases of syphilis and in seventy- four nonsyphilitic cases. Cialis Buy Australia As a result of his ob- servations he concludes that the test is not of clinical value as it is remarkably weak in earl\