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•Read, by invitation, at Pittsfield, Mass., on February 23, 1911. fore the Berkshire District Medical Society. effects that ofttimes resist the most skilful treat- ment and last through best online casino european roulette life. Between 1890 and 1890 about twelve hundred cases were treated at the Hospital for the Ruptured and Crippled in New York, or about two hundred new cases a year at this hospital for a decade. In 1907 and 1908 the number of cases estimated for the greater New York european roulette free bonus alone in that epidemic year was about three thousand. . In 1909 and 1910 the disease has been epidemic in several States. Your play free european roulette game own State ( free online european roulette game Massa- chusetts) has suffered as well as Connecticut. Our national capital has been affected. States south of the Mason and Di.xon line have reported epidem- ics. The middle West, the far West, and our neigh- bor, Canada, have numbered themselves among those who have been afflicted by this dread invader. Cuba, particularly in the province of Santa Clara, iias had an epidemic of this disease. The countries iif Etirope european roulette play for fun have likewise been visited in the present widely spread visitation of this death dealing and maiming scourge. You see, therefore, the study of it and the devising of ways and means to check it, to treat it, and to overcome the disabilities it leaves is no local matter, but a c|uestion of inter- national importance. JF.fiology: We have advanced far ennugli in our study of this disease to say that the actual cause is a bacillus. The exciting cause is anything that puts the normal resistant power of the body below par and makes european roulette free online games it susceptible to the virus of the invader. Among these might be mentioned exposure to vary- ing conditions of heat, cold, or dampness. Sudden change from heat to cold or dampness causing a chilling of the body and thereby a lowered vital re- sistance. Overfatigue might also be mentioned for the same reason, because this is a disease that oc- curs usually at a season of the year when exercise means also free perspiration. Chilling of the stom- ach by copious draughts of ice water, or worse yet. the chilling of the stomach by cooling mixture-' which also cause indigestion, any and all of these things weaken the natural defenses of Nature against the poison of this disease. In some online european roulette simulator cases traumatism of various kinds seems to be the direct excitant factor. By some the various contagious diseases are considered factors. But in this re.gard I repeat what I said in 1908, when discussing this disease before the Practitioners' Society of ( )range, N. J., that they are only to be considered in this light because they are diseases which, in running their respective courses, have taxed the european roulette play for free bodily re- sistance most sorely and left it in a weakened state against further invasion. Constipation with its accompanying putrefaction must be considered, as must also certain forms of diarrhcea. The poisons generated in these condi- tions are certainly, on absorption, very play european roulette online for fun strong de- stroyers of bodily vitality. In many cases no excit- ing cause can be found. Children who are to all appearances perfectly healthy may be victims of the disease, and ofttimes in the worst form. The chil- dren both of the well to do and the poor are affect- ed, and if the latter more than the former, it is be- cause the former are the fewer in number. In my own private and clinical practice, I have known of only one case in the nc,gro race play free european roulette game online and that child was STEINHARDT: AXTERIOR POLIOENCEPHALITIS. a mulatto. play european roulette free no download Inquiry among several of my colleagues seems to show also that the negro children are not as often attacked as the white children. By a. very slight percentage the male sex seems to be roulette free game european the more susceptible to the poison of the' disease. While or- dinarily one attack seems to render the victim im- mune, still there are several seemingly well authen- ticated cases on record where a child has had a second attack at a sufficiently elapsed length of time from the first one to absolutely consider it as such. The disease may attack several in the same family with intensely fata! or serious results to all, or its virulence may vary with the different members, so that in one family light and also serious cases may be met with. As free european roulette game download I mentioned before, children seem to be the most susceptible to the virus of this dis- ease, even nurslings not being exempt. european roulette free game 777 During the first three years of life the great majority of the cases occur, although in our recent epidemics older children have suffered greatly, and, also, many adults are to be numbered among the victims. One fatal case has been reported where the victim was an adult, sixty-six years old. The second year of life is the one that furnishes the greatest number of patients. Season: The epidemics of this disease usually occur from May to October. This is not constant. however, free european roulette game download for pc endemic cases have been reported at all seasons of the year. Pathology: The virus of the disease is very in- tense and seems to have a strong affinity for the brain and spina! cord. The latter, perhaps, more than the former, but, again, in recent epidemics. bulbar involvement has been very common, and it is these cases that have furnished the material on which our free flash european roulette game now fairly accurate pathology of this disease is based. The primary pathological changes are therefore in the central nervous system. Very fortunately, most of the changes are confined to the spinal cord, but in many cases the pathologi- cal process spreads to a higher plane and attacks the brain proper. Morse, of Boston, has, in a re- cent article, summed up the pathology in a few words which I will quote: ''Wherever the virus enters it has a predilection for the nervous system. The first lesion is a leptomeningitis. Cellular in- filtrative changes are set up which are most marked in the circumvascular lymph spaces of the arteries entering the nervous tissues. The vascular lesions constitute the primary causes of the lesions of the nervous tissue, the severity of which is determined by the jjarticular vessels affected and the intensity of the involvement." Secondary lesions occur in the intima, which result in oedema and haemorrhage. The anterior horns are the most afifected because the arteries are larger ; the lumbar and cervical en- largements because the blood is more abundant. .\\\ parts of the central nervous system ma\- be in- volved, both the gray and the white matter. The peripheral nerves show parenchymatous degenera- tion. "In the severe or fatal cases the entire cord with its pia mater, the entire medulla oblongata and pons,- the basal ganglia, and often the cortex of the brain are involved, the play european roulette for free no download degree of the involvement varying in different instances. In the mild cases the' process is much more extensive than was for- merly supposed. All gradations between the mild, serious, and fatal cases are found pathologicallv." Bacteriology: The disease is caused, according to our present knowledge, by an organism so smah that it cannot be seen under the microscope and can pass through our finest and most delicate filters. It is very resistant apparently to many of the usual agents and conditions which destroy bacteria. How- ever, heat, hydrogen peroxide in as low as a one per cent, solution, menthol, and other simple disin- fectants have play european roulette online for free a destroying effect on it. It seem- ingly secures entrance to the body through the naso- pharyn.x. .A.t least so the studies of Flexner and I^ewis would tend to show. Onset and symptoms: The onset is very apt to be abrupt and without previous signs of disturbance. In some cases unaccountable diarrhoea or stubborn constipation may be noticed for a few days before- hand. Owing european roulette free bonus no deposit to this state of afl^airs we cannot say definitely as to what the incubation period is in hu-

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