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which is often absent entirely, and at other times appears only several days after the onset of the other symptoms. The physical signs are usually either those of a more or less Viagra Generico Online Italia extensive plastic pleurisy or of a small area of pneumonic consolida- tion which lasts only for three or four days. Venous phlebitis and thrombosis, in very many instances, begins in the small peripheral veins, espe- cially in those of the calf, where it may exist for some days before the symptoms of thrombosis of the large veins appear. The chances of pulmonary embolism seem to be much greater at the beginning of a venous thrombosis than later on in its course. Some of the obscure chills in typhoid fever are related to the lodgment of pulmonary emboli. 2. Street Sanitation in New York. — Hayes concludes his paper as follows : Dust is dangerous, being- mechanically irritating and infectious. The following suggestions for the prevention of dust formation and Viagra Generico Online Italia littering of streets are recommended : A campaign Viagra Generico Online Italia of education already begun to be car- ried on ; Viagra Generico Online Italia the present regulations preventing spitting on the sidewalks should be extended to the streets ; improvement in ash removal ; laws regarding the complete combustion of soft coal to be enforced : dogs to be banished from the city streets ; coopera- tion of the police in enforcing the sanitary laws es- sential. The present methods of street cleaning need to be supplemented by inore Viagra Generico Online Italia extensive use of flushing ; and by use of suction cleaning automo- biles. The subways, connected with the streets and really a part of them, merit consideration, as they present problems as pressing as they are difficult of solution. Again, there is seen gross misbehavior on the part of the public ; spitting on the tracks in front of the station, and throwing upon them bits of juiper and other unsightly articles ; and on the part of the subway management, failure to properly remove the warm, stale air laden with dust, sixty- one per cent, of which is made up of irritant filings. From the street dust sifts in through the open grat- ings, and from them in turn comes the contaminated subway air to be breathed by the pedestrians and residents on the higher level. During the cool months, when the warm subway air rises rapidly, being replacerl by the colder air from above, the conditions are not bad for one who would take a rapid journey underground ; but Viagra Generico Online Italia during the warm Viagra Generico Online Italia third of the year such travel is undertaken with dread and endured only because of urgent neces- sity. Improvement could probably be effected in the following ways : The construction of the road- lied opposite the stations so as to admit of thorough cleansing with water. This Viagra Generico Online Italia would, of course, make alterations and repair of the tracks more difficult and costly. Screening of the air coming in through the gratings. The use of dust gathering cars, with funnel shaped screens, to be sent over the tracks at May 6, 1911.) PITH OF CURRENT LITERATURE. 8q9 times in the wake of the trains. The construction of tunnels running into high stacks built in connec- tion with the hotels and other high buildings along the route, through which the air could be sucked out of the subway by means of electric fans Viagra Generico Online Italia or hot radiators, being cleared of its dust at the same time by proper screening. BRITISH MEDICAL JOURNAL. At>ril 22, 1911. I Kinks which Develop in Our Drainage System in Chronic Intestinal Stasis, Bj- \V. Arbuthxot L.\.\i;. Chronic Intestinal Stasis Treated by Short Circuiting or Colectomy. By H.\rold Chapi'IK. 3. .\n Address on Arteriosclerosis and the Kidneys. By Sir Clifford .'\llbutt. 4. Interdependence of the Circulatory and Respiratory Systems, By Ivy McKenzie. 5. Hepatic Distomiasis (Sheep Rot) in Man, By Gordon R. Viagra Generico Online Italia W.xrd. 5. Distomiasis or Sheep Rot. — ^Ward gives the symptoms of this disease in man. The period of invasion may pass unnoticed clinically, and in the early part the host may gain weight and enjo_\- a good appetite. There may, however, be slight jaundice and moderate enlargement of the liver. In sheep the miniinum duration of this stage is six weeks ; in man it Viagra Generico Online Italia is probably longer. Secondly, the stage of anaemia is recognized, and this is supposed to coincide with the maturity of the flukes. An- jeniia of the mucous membranes is the most obvious sign, but the symptoms are rather those of toxaemia ; in the case about to be considered they were cer- tainly quite disproportionate to the anaemia. Ap- petite fails or ma\' become depraved, the tempera- ture is irregularly elevated, and the frequency of the pulse increased. Gastric pain and intestinal dis- orders become evident, diarrhoea and vomiting are not unusual, constipation may be present. The Viagra Generico Online Italia eyes are lustreless and the skin dry ; experienced veter- inary surgeons have been known to base a diagnosis on the condition of the skin alone. Slight exertion aggravates the dyspnoea which is present, and the third stage soon appears. This is the stage of ema- ciation and ascites, and is accompanied by increased anscmia and progressive hepatic derangement. Q-".dema of the eyelids, conjunctivitis, hydrothorax. bronchitis, ascites, and jaundice are among the com- mon symptoms. The fourth stage seems to corre- spond in time with the emigration or excretion of the parasites, and in those who have survived the third is one of slow recovery from to"xic symptoms. Fibrosis and other changes in the liver remain, and may cause permanent ill health. .Abscess ijf the lung and general peritonitis are among the possible causes of disease. As to the management of the disease, treatment with anthelmintics is of no value,