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speakers that the conservative plan of treatment was the wisest. It was obstruction that called for operation. He then narrated a case in which, after removing two lobes of the prostate, he found there was still obstruction, and the cause of this proved to be two prostatic calculi at the entrance of how to win big at casino slots the urethra which shut of¥ the bladder. What is Rheumatism? — In this paper Dr. Herbert C. de W L'ornwell said that the term rheurnatism was a most loose one and supremely unsatisfactory. It was used indiscriminately, no\v to describe a symptom and again the actual disease, as well as to cover our ignorance of some unknown conditions ; likewise to qualify diseases having noth- ing in common with rheumatism e.\-cept a similarity of symptoms. He thought it would be also more in keeping with our idea of the real nature of the af- fection to speak of rheumatic arthritis, rather than articular rheumatism, in the same manner that we spoke of rheumatic endocarditis. We had been ac- customed to look upon the disease as online casino games with best odds primarily an affection of the joints, whereas it bore all the ear marks of a constitutional infection. Thus, the on- set was acute and febrile, and the course a definite one, as a rule, and self limited, while the attack was characterized by a general intoxication with local manifestations in the tonsils, joints, and muscles, in the endocardium, pericardium, and, less frequently, other serous tissues. I\Iost men to-day were in- clined to the idea that it was caused by a specific germ, and, indeed, there was fairly good scientific support for the application of the germ theory. Excellent observers had identified a diplococcus, to which the name Diplococcics rheumaticus had been given, and !hey had isolated this infective agent from practically all the tissues subject to clinical evidence of the disease, including the tonsils, and, in the case of chorea, from the cerebrospinal fluid. Having referred to the important relationship be- best and worst casino games odds tween chorea minor and rheumatism, the speaker said that the germ had been grown on broth cul- tures and had been injected into a large number of rabbits, with the production of all the essential symptoms of rheumatism, including arthritis, endo- carditis, and even chorea. It was hardly probable that the infection was a mi.xed one or an expression of a mild py?emia caused by any one of several vari- eties of pyogenic organisms, best odds casino games wiki as had been held by many ; for in experiments on rabbits with pyogen- ous germs, by these same observers, the results on the whole were so different from those obtained with the supposed specific organism that casino slots bukkit tutorial few were now inclined to doubt the aetiological influence of the Diplococcus rheumaticus. A further argument in favor of this diplococcus was the production from it of a vaccine which, by comparison with other organisms in the treatment of the disease, showed a percentage of cures far too high to be ascribed to natural causes. As to the channel of invasion, the existence of amygdalitis before and during systemic attacks in from twenty to twenty-five per cent, of aristocrat casino games for pc the cases was a strong argument as a focus of primary infec- tion, but whether all cases of rheumatism arose by way of the tonsils, or whether there was another as yet undiscovered avenue of entrance, was still a indian gaming casinos in california matter of active debate. The close association of tonsils and rheumatism was indicated by free no deposit casino bonus chips the fact that persons subject to repeated attacks of the dis- ease were more apt to be free after removal of the tonsils, while those with normal tonsils were less subject to attacks than those in whom the latter were soft, congested, and spongy. Moreover, his- tologically the tonsils were lymphatic glands, and the disease found its favorite expression in serous and synovial membranes, and in the lymphatics of muscles. While the endocardium might not be a lymph space histologically, it was his belief that lymph spaces within the musculature of the heart were in close relation with its lining membrane. This observation rather tempted one to regard rheu- matism as a disease of the lymphatics, and if one did, it would simplify our understanding of its distribu- tion very materially. Still, the matter of localiza- tion online casino free bonus chips brought up the issue as to why certain joints or tissues were more frequently invaded than others, and this we must for the present relegate to the un- answered problems of the disease. While in adults the arthritic phenomena were more common and striking, with a diminution of heart disturbances directly proportionate to slots of vegas online casino no deposit bonus codes the age of the patient, there could be no question that chil- dren were more susceptible to rheumatic infection than was generally supposed. In them the onset of the di'^ease frequently escaped recognition, yet the focal symptoms appearing how to be a sure winner at casino slots later might be as se- vere and lasting as if the febrile attack had been profound and prolonged. As to free casino slots online with bonus the production of the chorea, between which and rheumatism a close relationship had long been observed, the diplococci were sujjposed to produce the expression of minor chorea by causing a mild leptomeningitis. The germ theory had been and was still denied by not a few authorities whose opinions could not be lightly passed over; some of them indicating with great force the influence of diet in predispos- ing to or even bringing on attacks, as well as in the treatment. We could not doubt the relationship of casino games odds of winning nutrition to rheumatism, and, he believed, could explain it in no other way than by the assumption that the diplococcus found its most favorable soil under conditions which were brought about by a definite nutritional state. On the other hand, if there were no bacteriological evidence whatsoever of the nature of the affection we could with prac- tical certainty ascribe to it a bacteriological origin on the basis of analogy. Having traced out this analogy between rheumatism and other specific dis- eases. Dr. Cornwell said, in conclusion, that he thought, therefore, that in speaking of rheumatism wc should never employ the term in the description of a symptom, but should limit its application to the conception of an acute, constitutional, self lim- ited infectious process, with a practically incon- testible bacterial aetiology, a proneness to find focal expression in the joints (arthritic type"), or the en- docardium ( endiicardial type), and to a li^'-"« ■'■'-- PROCEEDINGS OF SOClEl'IES. tent in other tissues, and with a tendency to react specifically and characteristically to medication by the salicylates. Dr. Fraxk H. Daniels said he agreed with the reader of the paper that the word rheumatism, as commonly employed, was a most vague term, ip- cluding a vast number of conditions which had lit- tle in casino games w best odds common. ^lost of these could be assigned to their true cau-^es. and thus, by a process of elimina- tion, we might finally get super slots casino free download down to free casino game downloads for blackberry 8520 something which was really scientific. Rheumatism was almost al- ways preceded by some acute attack, and it had been pointed out that this might be influenza, pneu- monia, scarlet fever, typhoid fever, or an infected wound. We seemed justified in considering the en- larged and free casino slots no downloads bonus rounds painful joints met with in rheumatism as svmptoms of an infection, but whether we could confine the term rheumatism to one form of infec- tion due to a specific diplococcus was as yet an free online casino slots no downloading no registration open question. To his mind it did not seem alto- gether justifiable thus to limit the disease. He thought it would be preferable to give up the name rheumatism altogether. The difficulty in many in- stances was to discover where the infection came from. Even now this whole question was in a very unsettled state. The conclusion at which he had arrived was that rheumatism, so called, always de- pended upon an infection, and it behooved us to try to find out what the infection was. As to the treatment, it was a casino games odds ranking fact that the results obtained

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