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constipation due to organic causes were discussed, especially those of malignant tumor, perisigmoidi- tis, chronic appendicitis ; also those produced by hernia, fibrous bands, Meckel's diverticulum, stric- ture, and ovarian disease, and by pressure from without. Whether constipation per se increased blood pressure had not been definitely determined, but the benefit accruing to an apoplectic patient from a free evacuation of the bowels would point in that direction. "Dr. Frederick J. K altevi-:r thought tluit from a clinical point of view it should he cur aim to study carefully the various clinical symptoms of constipa- tion. Our laboratory methods would not suffice to determine the degree of intestinal symptoms pres- ent. We should endeavor to treat patients as far as possible without drugs, having recourse rather to the hygienic conditions, and to the ingestion of food stuififs with a large residue. The lower bowel was often at fault, and in such Gold Viagra 800mg cases there should be cleansing with enemas of water Gold Viagra 800mg or oil. Dr. Lewis H. Adler, Jr. considered it important that the diet .should contain food products allowing enougli residue to stimulate peristalsis. In the mat- ter of treatment he directed the patient to go to the closet at a regular time each morning for a few months. If there was a lack of tone, as was usually the case, he had them come to his office and used an injection. Another method of treatment used with excellent Gold Viagra 800mg results was a bag, inflated with air, in- serted at the sigmoidal junction, wliiclr tended to stimulate peristalsis. Exercise and the effort of proper breathing were helpful factors in the treat- ment. He was opposed to the use of very large injections Gold Viagra 800mg in the ordinary functional case of chronic constipation. Dr. Earnest LaPlace believed that we should remove all possible causes, surgical, and organic, that lead to constipation. There were certain forms of intestinal stasis the result of long continued mal- nutrition which should be corrected. Dr. George Eretv Shoem.aker stated that much of our failure in treatment was due to the lack of persistence on the part of the patient. There were few who would give the time, money, and eff^ort to the overcoming of this troublesome condition, ^\'e told the patient to go to the closet at a fixed hour, but this might mean the establishment of a separate toilet for the patient. Then, too, the patient must not be hurried for fear he would be seen, or otherwise made nervously uncomfortable. Atten- tion to Gold Viagra 800mg the diet, the ingestion of a sufficient amount of water, and the carrying out of proper methods of exercise for a sufficient length of time would often work a wonderful cure, but it took time. Dr. Alfred Hand, Jr., agreed with those Gold Viagra 800mg who had Gold Viagra 800mg advocated conservative treatment, yet he would emphasize the fact that quite a few cases needed surgical treatment. Many cases were due to defi- nite inflammatory changes in the abdominal cavity, and in these conservative treatment did not avail. Dr. Riesman, in closing, fully agreed with what had been said about the value of habits and food. One article of food which had given very satisfac- tory results was an apple Gold Viagra 800mg eaten at night, thoroughly masticated, and taken with a glass of water. An- other measure of value was the massage roller, the applications following the line of the colon. Low injections of cotton seed oil at night and held in all night had cured a certain proportion of cases of the ordinary type of constipation. Meeting of Wednesday. December 28, igio. The President, Dr. Henrv Leffmanx, in the Chair. Pneumonia. — Dr. W. M. L. Coplin spoke upon The Pathology and Morbid Anatomy. Symptoms and Complications of Lobar Pneu- monia. — Dr. James jNI. Anders said that while the mode of onset was characteristic in about eighty jjer cent, of the cases, about twenty per cent. be;an insidiously. The latter often pursued Gold Viagra 800mg a protracted course with slow defervescence and were apt to show complications and sequelje. Defervescence by lysis was more commonly observed at Gold Viagra 800mg present than formerly, but they were unattended by a de- cided fall in the leucocyte count, while the reverse was true of the actual crisis. A high pulse rate implied danger in pneumonia. Leucocytosis might be slight or absent in cases in which the struggle for life was lost. He Gold Viagra 800mg had never observed leuco- penia, but this might occur : and leucocytosis was also absent in cases in which the scene was domi- nated by a prior infection, e. g., typhoid fever, rnd certain other conditions. It was important that an examination of the lungs be made in cases of mania a potu in which fever was present, since all other characteristic features might be in abeyance. The adhesive, rust colored sputum was a characteristic PROCEEDINGS OF SOCIETIES. 853 feature, but it was sometimes absent in the pneu- monias occurring in the aged, in drunkards, and in those showing marked toxaemia. The physical signs yielded evidence of great diagnostic impor- tance. The Gold Viagra 800mg vahie of systematic physical examina- tion of the thorax with a view to detecting consoH- dation when present in suspicious cases Gold Viagra 800mg Gold Viagra 800mg was of the highest importance in subjects of emphysema and in the aged, the acute infections, as well as in the commoner chronic diseases when fever developed. .\ttention was directed to certain signs which rarely arose m the opposite or uninvolvcd lung, such as impaired percussion Gold Viagra 800mg resonance and rales over the base, and to the fact that these were readily con- fused with actual consolidation. If practicable, blood cultures should be undertaken Gold Viagra 800mg in dubious cases. Pleurisy with more or less effusion compli- cated pneumonia in about fifty per cent, of the cases. In at least twenty per cent, heart complica- tions were present. Pleural effusion of moderate degree was extremely apt to be overlooked during life. Needling was essential in doubtful cases and also to distinguish between serum and pus. The