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26.9, Denmark from 30.8 to 29.9, while Norway has re- mained stationary at 30.3, and Russia, blessed with the great- est relative number of births, shows a decrease from 50.2 to 48.3. On an average the tendency is toward a constant diminution of the birth rate in all European countries. Setting aside the comparatively unimportant amount of illegitimate births (an average for all Europe 6.18 per lOO of all living born), the question arises whether the dimin- ishing birth rate is due to a decrease in the Vasotec 5 Mg number of marriages or to a decreasing fertility in matrimony. In this connection it is interesting to note that the relative number of marriages is nearly constant in all European countries and equal to 7 or 8 per 1,000. Only Sweden and to a lesser degree Norway form exceptions to this rule. L'ntil 1825 the marriage rate in Sweden was the same as that of the other European countries : but after 1825 the number began to decrease, and now it amounts only to the exceptionally low value of between J and 6 per .-^s regards Sweden and Norway, the explanation of the diminishing birth rate may consequently be found in the decreasing nimiber of marriages, while it is evident a priori that a decreasing fertility must be the causing factor in the remaining European countries. But even the two Scandinavian peoples show a lessening fertility. The yearly number of births per 1,000 married women in the ages from fifteen to forty-five years amounted for Sweden during the period 1871-1880 to 300.9 against 276.1 during 1891-1900; for Norway the numbers were 322.5 and 31 1. 1, for Denmark, 286.4 and 269.8. while France presents the appallingly low figures of 201.4 and 174.4. Nov. lo, 1906] MEDICAL RECORD. 74y The decrease in the birth rate, thus shown generally to •exist, is neither caused by physiological alterations nor by an increasing poverty among the masses. On the contrary the wealth of the nations every day becomes greater; for the best authorities compute the annual sum of savings in France alone to be between two and three millions. Ac- -cording to Professor Fahlbeck it is the two-children sys- tem adhered Enalapril Vasotec to by an ever-increasing number of couples that causes the diminishing fertility. This system, if generally accepted, will, under the most favorable Vasotec 10 Mg cir- cumstances, yield a birth rate of at the utmost 13.2 per 1,000. Now the death rate is between 15 and 16 per 1,000 and cannot very well be expected to become lower than IS per 1,000. The system will consequently result in what may be called a suicide of the nation, as in the Hellas of ■antiquity, where Polybius noted its deleterious effects more than two thousand years ago. To one drawback more ccnnectcd with the said system the author draws at- tention. It would appear that if the two-children system had been generally adhered to in former days the peoples ■would have missed many of their great men, many of whom have t>een one of the latter links in a long chain •of brothers and sisters. Dr. H. T. Bing, whose investigations into the* methods for estimation of the Vasotec Iv Push blood pressure I mentioned in my last letter, has now constructed a modification of the Riva- Rocci apparatus, aiming at the elimination of the errors due to the circumstance that the ordinary apparatuses in- dicate the lateral pressure instead Order Vasotec of the end pressure in the artery. He seems to have succeeded, as a series of experiments show, that the values of the arterial tension indicated by Bing's apparatus are Vasotec Iv higher than those given by an apparatus of the original Riva-Rocci type, and that they are far less influenced by local peripheric or thermic irritants. The famous Swedish Professor of Physiological Chem- istry, Professor Hanimarsten, has just celebrated his sixty-fifth anniversary. A stately volume containing re- searches by his present and former pupils has been pub- lished in his honor. Dr. Schaldcmose will be apnointed successor to Profes- sor Wanscher, who died six months ago. The competition has been very close, not less than cieht of our most promi- nent younger surgeons having entered it. Each competitor had to publish a work of no small size nn a surgical topic of his own choosing and to deliver a clinical lecture with three hours' preparation. Three of the competitors, Drs. P. N. Hansen, Lcndorf, and Schaldemosc, were then ad- mitted to the final trials, consisting in a lecture on a surgri- cal theme, the same for all of them, and communicated to them twenty-four hours in advance. It is geri- erally reported that the judges found it very difficult to decide which of the three mentioned surgeons was most qualified to succeed to the disputed chair. Prngrras nf iipJitral Brirnrr. Boston Medical and Surgical Journal, October 25, 1906. External Eye Inflammations of Doubtful Origin. — Iv Vasotec Two cases are recorded by H. G. Langworthy. In the first case a young man of twenty-six suffered from a bilateral orbital cellulitis and exophthalmos simulating cavernous sinus thrombosis and double frontal involve- ment. The infecting organism was probably the pneu- mococcus. In the second case a young man of eighteen was the subject of acute bilateral edema of the eyelids of unknown origin. The diagnosis seemed to lie be- tween angioneurotic edema and inflammation of both frontal sinuses. Both patients recovered. The author appends a bibliography of similar cases. Purchase Vasotec The Routine Treatment of Syphilis with Intramus- cular Injections of Mercury Salicylate. — In this paper W. H. Palmer covers familiar ground. Nothing espe- cially new is brought forward. He discusses the ques- tion under the headings of advantages of the salicylate over other mercurial salts, the advantages of this method over other methods, the disadvantages of the salicylate, changes produced in the tissues at the site of injection, the preferable injection site, the suspension fluid, the question of sterilization of the solution before injection (which he does not consider absolutely neces- sary), syringe and needles and their proper care, tech- nique, dosage, and duration of treatment. He refers to an interesting case reported by Kalisch who met with a gumma which occurred at the point where an injection had been given five years previously. The gumma was incised and microscopical examination showed a minute amount of unabsorbed mercury which had probably acted as a local irritant, and in this way had determined the development of a gummatous lesion in this situation. Ne-i' York Medical Journal, October 27, 1906. Tabes Dorsalis in a Negress. — The rarity of this dis- ease in colored women leads W. G. Bowers to report a typical case occurring in a negro woman. He has been able to find twenty-one reported cases in this race, fif- teen men and six women. The history presents no peculiar features. The patient was a woman of fifty- three, with symptoms dating back three years. She was in the hospital throe and a half months and Vasotec 5mg finally died from cystitis and sepsis following bed-sores. What May Be Accomplished with Apparently Hope- less Cases of Vasotec 2.5 Tuberculosis. — Ten cases are reported by S. G. Bonney. They go to demonstrate the following propositions: (l) They are selected merely to illus- trate the possibility of arrest in far-advanced cases. (2) The cases here described represent not simply what might be regarded as decidedly unfavorable cases, but were considered without exception, by other physicians as well as the author, as being utterly hopeless by virtue of every consideration which may ordinarily in- fluence prognosis. (3) With the exception of the three cases, which are of very recent origin, the remaining seven have not simply undergone improvement with the ultimate outcome as yet uncertain, but have actually experienced a complete arrest of the tuberculous trou- ble, with entire absence of physical signs, sputum, and bacilli, with a complete restoration to former usefulness and activity. (4) The necessity for the practice of strict economy has been no insuperable barrier to the ac- quirement of complete arrest in a suitable climate and under proper regime. (5) No claim is made that the results obtained were entirely referable to climatic in- fluences. It is contended, however, that such results in equally desperate cases are impossible of attainment in what may be regarded as relatively unfavorable cli- mates, no matter how perfect the regime. (6) Vasotec Uses No spe- cial methods of treatment were employed other than Vasotec 20 Mg those Vasotec Hctz familiar to Vasotec Enalapril every physician of experience in the management of pulmonary tuberculosis. (7) No credit for results obtained is assumed other than that which may relate to an unremitting personal attention to de- tail, according to the exigencies of the situation and an adaptation of means to ends at times somewhat radi- cal. (8) No case is here reported that is not entirely subject to confirmation by the attending physicians whose names are not cited in the report. The American Buy Vasotec Aborigines from a Hygienic Stand- point. Vasotec Mg — .\. L. Benedict presents an interesting study of the early history of the Iroquois and the Confeder- ated Five Nations. They were not nomadic and not pastoral. Most of them lived jointly by hunting, fish- ing, and the cultivation of some of the more common vegetables. The degree to which vegetable food was used varied greatly according to local customs, soil, fertility, and the state of peace or war. Tobacco was obtainable only by barter and in small quantities. Wil- low bark was smoked to some extent, but smoking was not common. .Alcoholic drinks were practically un- known until introduced by the whites. Semi-starva- tion alternated with gourmandizing. Almost all animal food was eaten well cooked. As a rule, permanent dwellings, as we understand the term, were not used. Small communities existed, but their location was changed from time to time, according to the need for firewood. Whenever a village was destroyed by fire, war, or any epidemic occurred, the site was perma- nently abandoned. As a rule these Indians manifested a considerable practical knowledge of sanitary science. Their villages were well located with reference to sandy soil, good drainage, good brooks for fishing, etc. Burial places were placed at a safe distance, and not more than twenty skeletons have been found at any one place. These people were not prolific. Few remains of small children have been found. Sclerosis of the Coronary Arteries. — Harlow Brooks presents the results of a study of 270 cases noted in consecutive autopsies. The disease may occur in comparative youth, being then amenable to treatment, and is not to be looked upon as a purely senile change. The average age of the author's cases has been about forty- five years. The abuse of alcohol appears to have been the most common Vasotec 2.5 Mg exciting agent. The next most com- mon cause is nephritis. Then comes syphilis. Other causes have been tuberculosis, cancer, diabetes, rheu- matism, and myelitis. Overwork as a causative factor 750 MEDICAL RECORD. [Nov. lo, 1906 has probably been overestimated. The conditions pro- ducing gout and rheumatism may lead to coronary thickening. The most common type of the disease is that of an endarteritis in which proliferative alterations are introduced in the subepithelial layer of the intima, although certain cases appear to show primary patho- logical changes of the adventitia in the greatest degree. In the author's experience true arteritis is rare in the coronary arteries. The most frequent change in the heart muscle was fatty degeneration. All Generic Vasotec the 270 Buy Vasotec Online cases except fifteen showed lesions of the myocardium visible to the unaided eye. Brown atrophy was noted in sixty- four; fibrosis was found in twenty-four; hypertrophy was noted in thirty-five; actual dilatation demonstrable on post morf-em was presented in twenty. The author discusses the symptoms of the disease and passes on to

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