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and the cavity diminished. The right ventricles were hypertro- phied, the walls shading off into fatty degeneration. Between the layers of the pericardium there was a sack which contained a purulent fluid. The left auricle was small. There was athe- roma of the aorta down to and below the abdominal portion. There was cedema with hypostatic congestion of the left lung. The lower lobe of the right lung was collapsed ; the upper lobe was sohd and appeared as if it was about to break down. The capsule of the left kidney was slightly adherent. There was chronic interstitial nephritis of both kidneys. The liver was pale Buy Levitra 20 Mg Online but not friable. The clot extended from the beginning of the subclavian artery at the aorta to and into the ulnar and radial arteries, where it had not broken down; it was a solid, black clot. Tricuspid and Mitral Stenosis and Regurgitation.— Dr. HoEN also related the history of the case of Eliza M., aged thirty- two, a domestic, who was working up to five weeks before ad- mission to the hospital, when she complained of cough, and of pain in the cardiac region and head. She expectorated a dark, yellowish sputum, and had dyspnoea on slight exertion. On admission, she had a slight elevation of temperature, was very anfemic, and slightly jaundiced, and had cedema of the feet and legs, a soft compressible pulse, and a marked carotid pulsa- tion. The apex-beat was at the fifth intercostal space, one inch to the left of the nipple. The Buy Levitra 20 Mg Online first sound was very feeble and was preceded by a murmur. There was a distinct bellows murmur at the apex and a very feeble second sound. The urine was acid, of a sp. gr. of 1'012, and contained albumin and some granular matter, but no casts. She came to the Buy Levitra 20 Mg Online hospital on February 2Tth, and was put to bed and stimulated. She felt very comfortable the next day, but became comatose four days after, and at about 1 a. m. on the fifth day after admission she died. Autopsy by Dr. Leuf eighteen hours after death : The body was faii'ly nourished. Rigor mortis Buy Levitra 20 Mg Online was well marked. There were recent pleuritic adhesions on both sides. The heart was enlarged and anasmio. The mitral and tricuspid valves were thickened and retracted. The aortic valves were slightly thick- ened. All of the abdominal organs were very ana3mic. Both kidneys were enlarged and very fatty, and the capsules were adherent. Cardiac Hypertrophy and Dilatation with Chronic Dif- fuse Nephritis. — Dr. Hokn also exhibited a specimen which was taken from Henry B., forty-eight years of age, who came to St. Mary's Hospital with the following history : For several years he had been treated alternately for kidney, liver, stomach, or heart disease. About four months before, his legs and scro- tum become very cederaatous. He had pain in the lumbar re- gion, dyspnoea, and orthopnoea, and he very frequently had pe- culiar spasms, during which his breathing would assume the character of Oheyne-Stokes respiration. These spasms rarely came on while he was conversing with anybody, but, as soon as he was alone and his attention not occupied, he would throw his head backward, close his eyes, and almost unconsciously moan very loudly for a few minutes, during which the Cheyn'e- Stokes breathing would occur, after which he felt relieved. These spasms had existed for some time. He passed a normal quantity of urine daily, had a poor appetite, and was very much emaciated. His urine was acid, of a specific gravity of 1'017, al- buminous (one fifth), and contained hyaline and granular casts. The apex-beat was not discernible ; there was a strong epigas- tric pulsation. He was made very comfortable with hypoder- , mics of pilocarpine, hot baths, and infusion of digitalis, and his spasms were relieved with morphine. The quantity of albumin in the urine gradually diminished. His edematous prepuce and scrotum were punctured, and twenty-one ounces of fluid oozed out in about twenty-four hours. On March 6th, sixteen days after admission into the hospital, he began to fail rapidly, became cyanotic, and died quietly the next day. On March 8th the autopsy was made by Dr. Leuf. Rigor mortis was marked. The skin of the upper portion of the body was jaundiced ; there was oedema of the lower Buy Levitra 20 Mg Online portion. The apex of the heart was located at the sixth interspace, one inch to the left of the nipple. There was hydropericardium, and the heart was enlarged and dilated and weighed twenty-one ounces. The aortic orifice admitted two fingers and there was a slight 82 REPORTS ON THE PROGRESS OF Buy Levitra 20 Mg Online MEDICINE. [N. Y. Buy Levitra 20 Mg Online Med. Joob., thickening. The valves seemed competent. There was athe- roma of the aorta, which extended into the common iliacs. There were pleuritic adhesions on both sides. There was hjdro- thorax on the right side. The lower lobe of the left lung was collapsed. There was a hremorrhagic infarction in the lower portion Buy Levitra 20 Mg Online of the npper lobe on the inner side. The lower lobe of the right lung was also colla[)sed, and it contained a hsemorrhagic infarction near its outer side. There was pneu- monic consolidation of the right apex. The left kidney was enlarged and weighed ten ounces and a half. The capsule was not adherent; the pelvis and infundibula were dilated. The Buy Levitra 20 Mg Online right kidney was very much smaller and weighed two ounces and a half. It was nodular, the capsule was thickened and ad- herent, and its surface was granular. Both kidneys were float- ing. The pancreas was normal. The stomach was tubular; the pylurus was contracted and adherent to the left side of the gall- bladder and to the lobus quadratus of the liver. The liver weighed sixty-four ounces. There Buy Levitra 20 Mg Online was interstitial hepatitis. The gall-bladder was contracted and contained one lai-ge stone and several small ones. The spleen was hard and congested and adherent to the diaphragm, and its capsule was thickened. The urinary bladder was dilated. Tlie prostate was not enlarged. The Peestdent reiuarked that the last case was of special interest because of the adherence of the stomach to the liver near the gall-bladder and the dilatation of the kidney, ureters, and bladder, without prostatic enlargement or stricture, and he asked what caused the retention. Dr. HoEN suggested that a marked oedema of the prepuce that was present might have interfered with the proper tiow of urine. Dr. Rockwell called attention to the inter-ureteric bar, com- posed of muscular tissue, and made prominent by muscular con- traction. It was not very evident post mortem, although large enough very often during life to cause urinary retention. It was simply a ridge passing along the has fond between the ori- fices Buy Levitra 20 Mg Online of the ureters. He desired to know if it was present in this case.