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combined with digitalis. P/EDIATRICS. April, igii. 1. Neurasthenia in Children, By Clive Riviere. 2. The Orthopaedic Treatment of Infantile Paralysis, By .Arthur J. Gillette. 3. Tuberculosis in Children, By Herbert M. Rich. 4. Case of Arrested Hydrocephalus, By Emm.\ Antonr-s. 5. Vital Statistics of Twelve Towns in the Island of Cebu, Philippine Islands, By Is-\.\c W. Brewer. 6. Address of the President of the New England Pe- diatric Society, By John Lovett Morse. I. Neurasthenia in Children. — Riviere says, in (I including his article, that the treatment of the neu- rasthenic boy or girl resolves itself into the removal of the cause, whether overpressure or want of sleep, or both. Change to country air and country pur- suits, with cheerful company and a quiet life, will generally complete the cure in these cases. An open, dry locality should be chosen, with much sun and little Generic Viagra Online Overnight Shipping foliage, so that abundant time may be spent out of doors. Long hours in bed must be provided, cold bathing is useful, and the work of the digestive organs must be studied. In cases where nutrition is very Generic Viagra Online Overnight Shipping low a full Weir Mitchell treatment may be advisable or necessary. Any spe- cial condition, such as anremia or constipation, must be specially treated, and care must be taken that sufficient time is given for complete recovery. It is probable that a proportion Generic Viagra Online Overnight Shipping of these cases do not return wholly to their former health, a tendency to relapse may remain, and attempts at brain work may be followed by warning symptoms which teach them to desist. In any case a return to former oc- cupations must be gradual or tentative, and the attention must be concentrated only in short spells at first. The smaller the causative overpressure has been, the more unstable must be the nervous sys- tem it has overthrown, and in some cases it may be obvious that a strenuous future is altogether out of the question. Nevertheless, these cases must be saved from chronic invalidism. It must be remem- bered Generic Viagra Online Overnight Shipping that a stimulus is needed to call forth a re- sponse and, after sufficient rest has been allowed and compensation begins to be established at a low level, these patients must be coaxed further, and the amount of work steadily increased till the level of ordinary living is attained. This entails a carefully planned out life, the work arranged Generic Viagra Online Overnight Shipping being of a dif- ferent kind, preferably physical, to that which orig- inally determined the breakdown. At the same time it must be borne in mind Generic Viagra Online Overnight Shipping that physical exertion car- ried to excess will lead to disaster as surely as will brain work. Lastly, it may be said that the older the patient the more nearly do his complaints, their causation, and the method of their treatment ap- proach to those of the adult neurasthenic. 5. Conditions in Cebu, P. I. — Brewer, in his account of vital problems of the; Philippines, says that one of the greatest desiderata is physicians. In Manila and a few of the larger towns there are physicians, but in the smaller towns and the rural districts there are none. On the Island of Cebu, with a population of over 600,000, and a density of population of 337 per square mile, there are no physicians excepting in the town of Cebu. A large portion of the inhabitants of the island are born, live and die without ever having the services of a physician. Here and there Americans have estab- lished small hospitals, but there is a great field for more. The expense will be slight compared with the great returns to be had. If some of the money which now goes to China and other Asiatic coun- tries for hospitals could go to our islands the Generic Viagra Online Overnight Shipping re- turns would be as great if not greater. An enthusi- astic physician, with a few nurses at his command, could, if located in a provincial town, do more to elevate these people than any other worker. It is hoped that some of the philanthropic people of our country will look into this matter and help us. .-\ny of the churches that have been established in the islands will gladly undertake the work, but it would be best to conduct it on a nonsectarian Generic Viagra Online Overnight Shipping basis. CANADIAN MEDICAL ASSOCIATION JOURNAL April, igii. 1. Eight Hundred and Fifty Cases of .Scarlet Fever: Seventy-one Fatal Cases, By John M.\cRae. 2. Some Considerations in Duodenal ITcer, By W. H. R.'VNKiN. Generic Viagra Online Overnight Shipping 3. Human Carriers of Disease, By \V. T. Connell. 4. Mounting Moist Specimens, By E. L. JunAH. 5. Social Problems in Relation to Medicine. By Ricii.'iRD .\Iii\AiiAX. 2. Duodenal Ulcer. — Rankin warns the prac- titioner, in treating these cases, never to give mor- phine until a diagnosis has been made, for shortly Generic Viagra Online Overnight Shipping after the administration of this. drug, both patient and physician are ushered into a most bc;iutiful fools' paradise. The symptoms subside, ■ and. meanwhile, the fluid escaping through the opening in the duodenum is pouring down into the lower abdomen and pelvis. When the physician has sat- isfied himself as to the nature of the disease, mor- phine may then be given, and the patient hurried to the operating table as quickly as possible, for there is but one hope, and that is in surgery. The abdo- men should be opened by a free incision, the intes- tines packed off, the pylorus located, and the open- ing of the duodenum brought into the field of vision. The crater of the ulcer may or may not be excised, as seems best to the operator. The opening is then closed, first with a row of catgut, and then with a row of silk sutures placed transversely to the lower axis of the bowel. If the ulcer is large and the patient in fair condition, it is well to do a gastro-