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are in the position of phonation — fixed in the middle line. The edges of the central portions of the tends are slightly bowed, owing to the manipulations to which they have been subjected since their removal from the body ; but they are in sufficiently close contact to verify the picture published in rav book several years ago. There is also some erosion of tracheal mucous membrane, with absorption of the cen- tral portion of the seventh and eighth rings from attrition by the tube, which became too long as the patient under- went emaciation toward the last, necessitating a change in the length of the cannula. Several of the microscopic sections are under the instru- ments now upon the table. They^ comprise sections from the medulla just below the calamus ; within one fourth of an inch will online poker ever be legal in the us again above the calamus; within one half inch above; and at the middle of the valve of Vieussens. It will be seen that there are no vascular changes, and no essential changes to be noted in the ganglionic cells or in the nerve fibers other than intense pigmentation. There are several sections, also, from the two pneumogastrics and from the two recurrents. Although the neurotic lesion was manifested first on the left side, the recurrent of that side is seen to be intact. In the sections through the right re- current, at about one inch beyond its point of separation from the pneumogastric, it will be seen that fully one half of the nerve fibers have failed to take the hsematoxylin stain. In the atrophic region there are from forty to fifty fibers which retain the medulla, and are stained. The hope, long entertained, that careful examination of this case after death would cast some important light on the pathology of this class of laryngeal neuroses, has not been realized. The disease is evidently central in origin. The nature of the initial lesion producing the degeneration has not been revealed. Sufficient has been shown to prove that the vocal bands can remain in a condition of tonic spasm for free online poker with your friends a long series of years, and retain that position after death. It is a remarkable circumstance that the left recurrent should be apparently intact, while degeneration should be so marked in the right nerve, which became in- voKed so much later. I may mention that I made inquiry as to whether a mistake might not have been made between the two recurrents, and was assured that no such mistake could have been made. Then, too, the atrophic condition of one set of the oblique fibers of the arytenoideus without participation by any other portion of the constrictor group of muscles is unexpected. The histological pathology of the legal online poker sites in nj spinal lesion, so far as our examination went, is that of a ease of ascending sclerosis ; yet the laryngeal manifesta- tions preceded the others by several years. I greatly regret that I did not have the opportunity for clinical study of the interesting developments of the last years, for the history gathered from the family does not warrant a diagnosis. It is also to be regretted that the entire spinal cord was not removed for study as well as some of the muscles of the extremities. The slight degeneration of the columns of Goll I presume to be secondary, though the absence of clinical studies of this condition as a primary system lesion leaves the question, like too many others in this interesting case, an open one. No lesion of the cortex was discovered, no lesion of the local laryngeal center in the medulla, no lesion pointing to an involvement of any portion of the respiratory centers. The only cerebral condition discovered that may have been connected with the laryngeal symptoms is the small cavity in the lenticular nucleus. I regret that I have no diagram of its site, nor more exact description to ofiijr. If this denotes an interruption in the course of what has been called the " hypothetical cortico-medullar tract " of laryngeal motion, it may have a bearing upon the solution of the case. Other points upon which our examination poker online legal em portugal is incomplete suggest themselves, but it is useless to recapitu- late thein. Much to my disappointment, I can only lay the facts before you, for even negative facts are of value, and defer theory or explanation to a time when more positive evidence shall be available. So far as the aetiology is con- cerned, I always suspected syphilis, though I have no evi- dence of that infection to proHFer. DISCUSSION. Dr. F. H. Hooper. — I would like to ask if the blood-vessels in the neighborhood of the recurrent nerves were examined. This is very important. Dr. Robinson, of Durham Universityj England, in his prize essay on " Endemic Goitre," speaks of the vascular origin of abductor paralysis. He points out that the posterior crico-arytenoid muscles are supplied by the inferior laryngeal artery alone, and degeneration of these muscles may result from interference with their blood-supply. In a recent paper by Baumler on "Laryngeal Paralysis is online poker legal in usa 2012 in Chronic Lung Affections," the autopsy of one case showed that the arteries near the diseased recurrent nerve were markedly changed, the tunica adventitia being thickened in all, and the media in some, but the most marked change was in the intima, which at some places was so thickened as almost to cause obliteration of the vessels. There was chronic indnrative neuritis in this case, which was the result either of intiamed bronchial glands or of inflammation derived from nutrient blood-vessels. The study of pneumonia, which has been prosecuted with so much energy ever since the dawn of free online poker tournaments for fun pathology as a science, failed until recent years to sugg-- - other conception of the disease than that of an inflam- mation of the lung, with its accompanying inflamma- tory fever. Here and there, it is true, the idea has been expressed that the fever best free online poker usa is the primary affection, and that the lung changes bear some such relation to it as the rash of scarlatina, for example, bears to the fever that attends it. The term " lung fever" is a sur- vival of this view. It has even been maintained that the process is essentially a poker online legal california form of erysipelas, modified by the peculiar structure in which it has its seat: and, again, that it is a herpes zoster of the when will online poker be legal again 2012 lung, having a nervous origin. But these suggestions found little encouragement, and the weight of authority remained in favor of re- garding the disease in precisely the same light as an inflammation would be regarded in any other part of the body. So recently as 1866. the late free online poker fake money no download Dr. Flint, in his work on the " Practice of Medicine." adopted the term pneumonitis, " in conformitv with the plan of distinguishing inflammatory affections by the suffix itis." Bacteriological investigation during the past few years has resulted in the general concession that pneu- monia is of microbic origin, and the special organism has been recognized and isolated. But it is held that the role of the microbe is to set up a local process that is still regarded as an inflammation. However, the moment we consider inflammation online poker site with most freerolls as having its seat in the lung, we are confronted by the fact that here is what online poker site has the most freerolls a condition not found elsewhere in the body unless approximately in the liven ; double circulation, one nutrient and the watch friends the one with all the poker online free other func- tional. All our ideas of inflammation in general cluster about the circulation by which the part is nour- ished. To be identical, therefore, with the inflamma- tory process as elsewhere observed, pneumonia should interest primarily the nutrient blood supply which is derived from the bronchial arteries. We should rind the walls of the air-cells swollen, infiltrated, broken down in places. In fact, in view of the intensity of the local process and the massive exudate bv which it is characterized, we should expect very serious damage to the delicate structures free online poker games no real money involved. Vet the truth is that after a few days the exudate disappears and we find the cell walls completely intact. It seems, there- fore, that the process must have to do chiefly online poker us players ipad with the functional blood supply, and that the exudation takes place from online poker a fast and powerful way to win money online or play for free the pulmonary capillaries, while, the nutri- california online poker association members ent circulation remaining undisturbed, the integrity of the structure is preserved. In this view the process could be called inflamma- tion only by courtesy. The when will online poker be legal again in the usa air-cell< are filled with an adventitious substance under circumstances that favor irritation, and there is more or less loss play poker online free no money of epithelium from their walls: but this is secondary and incidental. There is no such profound lesion of the intervesicular structures as would explain the local and general re- sults. The discover) - of the pneumococcus has enabled us to say that pneumonia is an infectious disease, de- pending upon the action of this organism. This -

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