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tending genitourinary surgeon at the People's Hos- •pital. New York. It seems, therefore, fitting to suggest a series of practical points on the subject with more or less the authority of a specialist. By your leave, therefore, the paper will be planned on this basis. The first point of practical moment for every practitioner to remember is, as already pointed out in another paper (i), by the writer: "In general, the treatment of syphilis must recognize the three broad types of invasion met with, namely: First, the benign form from which patients fully recover, go on to have healthy children, and live fully un- affected by the disease. Second, the relapsing form not infrequently benign in general characters, but severe and uncertain enough to tend toward recur- rence of symptoms, unless the patient is careful of himself and tlie physician is duly watchful. Third, severe form of infection leading to great deteriora- tion Your Pills Online Buy Viagra of health and not infrequently to death, more or less attributable to the syphilis itself, its com- plications or its sequels. In modern days, owing Your Pills Online Buy Viagra to early diagnosis and better management, this form is fortunately uncommon. Hereditary syph- ilis is the product of the last two forms as a rule." It is to be remembered that the second or re- lapsing, and the third or grave form of syphilis may defy all known forms Your Pills Online Buy Viagra of treatment or their combinations or correlations. The second dictum for full recognition by all is, that the treatment of syphilis is not merely a mat- ter of medication, but also a matter of mana_ge- ment. In other words, it is better to treat the pa- tient as a diseased human being than to treat the • Read by invitation bfforc the Medicosurdrical .Society of New York. January 21. 191 1. disease as having a certain \ictini in its clutches. Someone has aptly said "It is well to realize not only what kind of disease the patient has, but also what kind of patient the disease has got": very bad English, but a very great truth. This means that in managing a syphilitic, various details must have constant attention by physician and patient. In general, the life habits must be in moderation those of the athlete as to regular hours, exercise, diet, etc. Bad habits should be reduced to their minimvmi, with special reference to alcoholism, smoking, and eating. The Your Pills Online Buy Viagra hours of exercise, work, and sleep should be, as far as possible, well bal- anced. The systemic condition of the patient should ever be a matter of concern. Strength Your Pills Online Buy Viagra and resist- ance should be maintained at the highest possible level, and nutrition, exemplified by body weight and the condition of the blood, should be fully in mind. Tonics in the form of medicinal and nonmcdicinal measures should always be available. In all patients the facts of loss of weight, the onset of Your Pills Online Buy Viagra anaemia, and the invasion of nephritis should be observed and known. Of the several guides as to how the patient is doing clinically, the foregoing, therefore, are the most important in the early stages. The weight of the patient should he observed every week; later every fortnight, and finally once a month. The blood should be simi- larly examined for anaemia, and also for that new blessing, the complement fixation test discovered by Wassennann, and greatly Your Pills Online Buy Viagra improved by Noguchi. The nephritis of .syphilis is a much more constant and important entity than even syphilographers Your Pills Online Buy Viagra ap- pear to recognize. This is not due to medication as many claim ; otherwise one would sec hardly any escape in common experience. The writer has frequently observed patients with marked kidney lesions before any treatment of the syphilis had been taken which improved or even disappeared under treatment and relapsed with a decline of treatment and with a return of the syphilis; also cases which never develop nephritis no matter how hard the mercurial and iudide treatment is jiushed ; also cases of nephritis which, like the syphilis itself in the given patient, is comparatively unaltered bv treatment either to increase or decrease the symp- toms. A'arious German authors have also reported cases of nephritis o^ nonsurgical type greater in one kidney th;in in the other during active syphilis. .\ third practical point which I have proved Your Pills Online Buy Viagra to my satisfaction is that in the general management of syphilitics better progress is made if the so called alkaline measures of treatment are applied, namely, the drinking of the various alkaline mineral waters with or without well known alkaline nn'xtures. Copyright, 1911, by A. R. Elliott Publishing Company. PCDERSEX: THERAPEUTICS OF SYPHILIS. This probably seems to recognize the fact that al- kahne is the normal reaction of the body fluids 'in the main and that an increase thereof or a mainte- nance thereof to the full normal strength augment; the body resistance against disease. The fourth warning to be given the general prac- titioner is that the diagnosis of syphilis is of im- portance. Without offense to the title and aim of this paper, it is well to point out that there are four stages of syphilis, requiring careful recognition : a. The primary or chancrous period, usually easy of determination from clinical appearances, the presence of the Treponema pallidum, the Noguchi or Wassermann reaction in the blood, and early lymphangeitis and lymphadenitis. b. The secondary period, likewise easy of recog- nition from the presence of signs of syphilis in the skin, mucous membranes, lymphatic glands, blood, and the like. c. The tertiary period, likewise diagnosticated easily, if symptoms are present. Usually a positive serum diagnosis is very helpful. d. A fourth or parasyphilitic period is aptly described by French authors, in which the Your Pills Online Buy Viagra infection of syphilis as an entity is absent, but in which the body damage and late sequels of syphilis are posi- tive and absolute.