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ular, and intermittent, and this Buy Single Viagra Pills Uk condition persisted during the week. On May loth. nth, T2th. there were haemor- rhages from the bowels, and at this time pain and tender- ness were complained of in the right upper part of the ab- domen. The woman was very ill up to May 26th, the temperature on that day reaching 106° F. From then on, there was a rapid amelioration of all symptoms and on June 1st, the temperature reached the normal. The teirt- perature remained practically normal until June 26th,. when tcinperature and pulse both showed marked evidence of a reinfection ; Buy Single Viagra Pills Uk there were great pain and tenderness over the gallbladder, and some swelling. By June ,30th. the teinperature was again normal and the tenderness over the gallbladder much relieved. On .^ugust i6th there was again a very positive elevation of temperature, and in- creased pain and soreness in the gallbladder re.gibn. On .'\ugust 17th the patient was brought to the Clarkson Hos- pital. The hospital record shows in addition to the above re- port of Dr. Ginn: Phvsical findings: Sclera jaundiced; tenderness over the gallbladder region, with some rigidity. Heart enlarged three quarters of an inch to the left of the midclavicular line, and to the right border of the sternum. Systolic murmur of mitral insufficiency present. Tem- perature, T02.4° F. ; pulse, 12(1: blood, hxmoglobin, eighty- five per cent.; reds, 4,560,000; whites. 7.000. Differential: Polymorphonuclears, seventy per cent. ; large uninu- clears, eleven per cent. ; small leucocytes, seven per cent. : large leucocytes, twelve per cent. Widal reaction, positive. Unfortunately, no cultures were made of the urine or dejecta. .Mthough the patient's general condition was far from encouraging for a surgical operation, T felt positive that the cholecystitis was ty- phoidal in type, and that the reinfections of typhoid fever were due to the presence of typhoid bacilli in the gall- bladder. An attempt was made to better the patient's condition, but failing in this she was operated unon on .August 22d. five days after admission ; the gallbladder was somewhat distended ; there were no stones in it. but the bile was slightly turbid. .\ stone, 1.5 centimetres in length, was found and removed from the lower end of the common duct. Drainage of both the gallbladder and common duct was established. The bile from the 'gallblad- der showed pure cultures of the typhoid bacillus ; that from the common Buy Single Viagra Pills Uk duct, the typhoid bacillus and a small strain of the colon bacillus ("the bile for cultures was taken from the gallbladder and common ducts as thev were inrisedV The woman was Buy Single Viagra Pills Uk dangerously ill following the 876 K.\'0■,I^LES: HAIMORRHAGIC AND GANGRENOUS I'ARICELLA. [New York Medical Jouenau speration. Ijut made a satisfactory recovery and has re- mained well to date. This was a pure case of typhoidal cholecystitis, the gallbladder involvement giving symptoms at the beginning of the first relapse. The absence of any obtainable history of gallstones prior to the illness can fairly fix the initiation of the formation of the stone found in the common duct as taking place probably during the first part of the attack. The time from the beginning of the attack to the time of removal of the stone, was from April ist to August 22nd, sufficient time for its formation. In so far as I am Buy Single Viagra Pills Uk informed, this is the first case of typhoidal cholecystitis with probable formation of the stone during the attack, in which the stone was removed from the common duct. Cultures from the centre of the stone were sterile, a finding which does not negative the origin of the stone as due to typhoidal cholecystitis. Operation fcholecystostomy) upon typhoid car- riers, I think, should be done whenever there is evidence of any infection in the gallbladder Buy Single Viagra Pills Uk or ducts. In cases in which no signs of inflammation can be found it might be considered that possibly the nest- ing place for the bacilli was in a diverticulum, and that operation was not indicated. There is favor- able evidence for the carrying out of cholecystos- tomy in these dangerous persons. Vaccines should be tried before resorting to operative procedures, as clinical reports of their value, when used in ty- phoid carriers, are in evidence. VARICELLA OF A HEMORRHAGIC AND GAN- GRENOUS TYPE. Report of a Fatal Case, with a Revieiv of the Literature.* By Frank Crozer Knowles, M. D., Philadelphia, Dermatologist to the Presbyterian Hospital, the Howard Hospital, the Children's Hospital, the Church Home for Children, the Baptist Orphanage; Assistant Dermatologist to the Phila- delphia General Hospital, and the Dispensary of the Pennsylvania Hospital; Assistant in Dermatology. University of Pennsylvania. An exanthem of an hjemorrhagic type usually points toward one of two conditions or the com- bination of the same, either the development of the disease in a debilitated individual or a virulent in- fection. The author has made a careful review of Buy Single Viagra Pills Uk Buy Single Viagra Pills Uk the literature, and those cases that resemble the one under description, or that should be differentiated from the same, will be given at some length. The subject under discussion, for the purposes of our study, has been divided into varicella with hsemor- rhagic lesions ; varicella with a hemorrhagic and gangrenous exanthem : varicella of the usual type, associated with a petechial eruption : varicella with hemorrhages from the kidneys, the stomach, the in- testines, or a combination of the same : and gan- grenous, nonh;emorrhagic varicella. Under the lat- ter heading are included those cases reported as varicella gangrasnosa, VAblCELLA WITH H.^iMORRH.VGIC LESIONS, Hamann described a case of this type in an in- fant of six months of age. The little boy. after •Read before the Philadelphia Pa;di.itric Society. Febrnary 14, Buy Single Viagra Pills Uk