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tion, with the Report of a Case Occurring Cheap Generic Viagra India in New York City, By Joseph Collins and Luther Sheldon. \'entilalion of Kitchens and Bakeries, By W. A. Evans. Surgical Anatomy of the Abdominal Wall with Refer- ence to Appendectomy, By Walter E. Tobie. Cheap Generic Viagra India A Theory as to the Untoward Efifects of Diphtheria Antitoxine; Prophylaxis in Suspicious Cases, By Raymond Wallace. The .American Game of Football : Is It a Factor for Good or for Evil? By Morris Joseph Ci.urman. 2. Diagnosis of Insanity. — McDonald remarks that in the diagnosis of insanity it is important to ta1Cheap Generic Viagra India litnum of Cheap Generic Viagra India fever, meningitis, etc., have occasionrdly been committed to institutions for the insane through inattention to these points. Other condi- tions which have been mistaken for insanity are prolonged intoxication, delirium tremens, the de- lirium of cerebral meningitis, and of the various continued fevers, sunstroke, hysteria, and the de- lirium which Cheap Generic Viagra India sometimes precedes death in certain diseases and in old age. Most frequent among the prodromes of mental disease are insomnia and con- Cheap Generic Viagra India stipation. In fact, so common are these symptoms in the onset of acute insanity that the experienced observer comes to anticipate their presence, and to expect an affirmative answer to' his interrogations respecting them in substantially every case that comes before him. The significant diagnostic fac- tor to be sought for in the early stage of mental dis- ease is evidence of a change in the mental charac- teristics of the individual. In fact, any prolonged change in the mental or moral tone of an individual should at once excite suspicion of approaching in- sanity, especially if he is descended from insane or neurotic stock. Prominent among the premonitory symptoms of insanity are disturbances of the bodily functions, morbid emotional manifestations, and al- terations in the mental characteristics of the indi- vidual. Somatic functional disturbances express themselves in various ways, such as pavor noc- turnus, insomnia, headache, tinnitus, vertigo, fibril- lary tremors, clammy extremities, and other vaso- motor disturbances ; anorexia, indigestion, constipa- tion, etc. It should be said in passing that while these phenomena, especially insomnia and constipa- tion, are frequently observed in the prodromal stage, they may, one or all, occur in persons who never become insane; hence, they are not to be regarded as pathognomonic, nor singly, perhaps, as even di- agnostic signs of mental disease. If the tendency is to mental exaltation, Cheap Generic Viagra India or mania, the emotional changes usually take the form of unnatural buoy- ancy, loquacity, undue levity, and morbidly quick- ened mental operations, the patient frequently ap- pearing to be unnaturally bright. If Cheap Generic Viagra India the tendency is to mental depression, or melancholia, there are gloomy forebodings, morbid introspection, hyper- conscientiousness, senseless self-condemnation, a inorbid aversion to friends, morbid suspiciousness, irritability, and frequently a vague sense of impend- ing evil of some kind. Marked alterations of char- acter are seldom wanting in this stage of the dis- ease.^ It should also be borne in mind that the pa- tient's statements regarding himself are often un- reliable and misleading, owing to delusional ideas or misinterpretation of what actually took place, even though in other respects he may be perfectly truthful. Again, the truth or falsity of certain statements made by the insane can only be Cheap Generic Viagra India deter- mined by evidence from other sources. 6. Untoward Effects of Diphtheria Antitox- ine. — Wallace states that recognized autiiorities up to the present year have failcdto emphasize the oc- c-isional danger of sudden death in sensitized indi- viduals or those subject to bronchial asthma or to respiratory distress in other forms. Individuals pe- culiarly susceptible to the odor of horses or stables anti those subject to asthmatic attacks, hay fever, .'■nrl bronchitis should have horse serum adminis- tered only upon most urgent cause, and then with due prophylaxis. Insufiiciency or inade(|uacy of ihj suprarenal glands may account in the asthmatic 90 PITH OF CURRENT LITERATURE. ' York JOUttNAU type for the peculiar reaction. The administration hypodermically of aqueous extracts of the supra- renal glands previous to the use of serum in this class of cases is desirable in order to rehabilitate and control the vasomotor system, and may prove of great prophylactic value, as well as useful in the heroic treatment of the acute attacks of serum dis- ease. The desquamation following serum disease should not be confounded with scarlet fever. BRITISH MEDICAL JOURNAL. December 31, 1910. 1. Hyperchlorhydria and Its Complications, By William Russell. 2. The Cheap Generic Viagra India Distribution of Appendicitis, with Some Observa- tions on Its Relation to Diet, By Owen T. Williams.