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again, and often during considerable periods of time, when sewer gases would seem to be equally present and should be equally harmful, little or nothing is said with reward to their injurious effects. The fact that for long periods but little epidemic or other sickness occurs Do You Need A Prescription For Levitra In Canada that Do You Need A Prescription For Levitra In Canada is referred to sewer gases does not necessarily prove that they are not essentially harmful. The absence of recognized morbid results from such cause during an extended period may lae accounted for by a less virulent character or a less con- centrated condition of gases during such period, by such conditions of atmosphere as favor their more rapid and complete diffusion, by more thorough flushing and sewerage which has taken place ; or, again, such temporary negative results may be due to the antidotal effects of a greater de-' gree of life in the opea air during such time. That recently discharged excreta or other organic mat- ter in an early stage of decomposition does not exhale very injurious gases general experience proves, but that very poisonous effluvia are given off from the m^atter that is long delayed, becomes stale, and undergoes active fer- mentative and putrefactive changes, and especially from old cess-pools, is, on the other hand, equally accepted. Further- more, that, under certain conditions of evolution, combina- tion, and concentration, these gases may become very viru- lent, even deadly, in their action, is shown by their effect upon the sense of smell, and by the Do You Need A Prescription For Levitra In Canada suffocation and sudden death sometimes occasioned by even a momentary inhalation of them. Therefore, varying amounts and conditions of organic waste, of sewerage, temperature, winds, and barome- ter, greater or less amounts of rain-fall, and varying charac- ter and concentration of gases, may constitute adequate causes to account for varying morbid effects during Do You Need A Prescription For Levitra In Canada certain seasons from this cause. But, notwithstanding the fact that during certain periods the apparent eftects of sewer gas are so slight as to encourage the belief by many that they are comparatively innocuous, yet, during certain other sea- sons — as, for instance, during the winter of 1882-83 — their results, specifically and in general, are so very decided and characteristic that there is no mistaking their nature and injurious action. In the absence, then, of more definite data, we must de- termine as to the causative importance of sewer gas in the production of disease by the evidence of general facts and of individual experience. In general we may with confi- dence refer to the more frequent occurrence of certain dis- eases and classes of ailment, such as occasion disproportion- ate physical, and especially nervous, prostration, and such as manifest periodic tendencies to this cause. Individually I have met in practice with acute and sub- acute pharyngitis, with amygdalitis, and sporadically occur- ring diphtheria recurring in the same apartments ; with ir- regularly exacerbating malignant remittent fever in children ; with periodically occurring subacute and acute ephemeral fevers, attended with disproportional prostration and exces- sive periodic neuralgic pains in adults ; with periodic sci- aticas, infra- and supra-orbital neuralgias, and myalgias; with daily morning headache, depressed functional condi- tions, deranged nutrition, malaise, and debility, the recur- rence of which I have been obliged to trace to local causes, which, carefully differentiated, indicated sewer gas as the offending agent. I have attended cases of puerperal (peri- toneal) fever, remittent in character (in which normal lochia and the absence of an adequate local inflammatory temperature excluded septiciemia as the cause), that devel- oped in patients occupying rooms, and sleeping in them for months before, that contained stationary Do You Need A Prescription For Levitra In Canada basins the con- ditions of which afforded sufficient evidence of an unsanitary condition, which, finally and only yielding to a treatment indicated by a malarial cause, afforded corroborative testi- mony as to their zymotic character and their origin in sewer gases. At present I am treating a case of typho-malarial fever, one of several very similar in character I have had in my charge the past season, in which the exacerbations occur daily or oftener, are attended with pronounced chills or shiverings, with fever, severe shifting, general and local neuralgic pains, violent palpitations, severe headache, main- ly supra-orbital, malaise, and marked asthenia (these symp- toms abating with each remission), that developed "with malaise, shiverings, neuralgic pains in the chest, back, and limbs, anorexia, morning headache and debility, since the patient has resided in a quite recently built apartment-house situated in a healthy locality, and done her own work in a kitchen that contains two stationary tubs and an ordinary pan .sink, and into which opens the door of a water-closet that accommodates the occupants of a double apartment this closet being one of five discharging its contents into the same soil-pipe. The fact that the general surroundinsrs 66 SCHUYLER: A NEW TRAPPING-FIXTURE. [N. Y. Mep. Jook., of this house are what may be considered sanitary excludes general malaria as the cause of her fever ; and that the pa- tient was in her usual health when she moved into the apart- ment months before excludes the action of extraneous and previously contracted causes ; while Do You Need A Prescription For Levitra In Canada the presence of a foul odor always perceived on entering the hall-way and ascend- ing the stairs ; the presence of the water fixtures and the closet, not free from an unpleasant odor, in the kitchen men- tioned, where she spent most of her time ; the markedly nervous and depressed character of her symptoms, their irregular periodicity and degree of expression, and, finall}-, the curative results of an anti-malarial treatment — strongly indicate for the disease (1) a local causation, which (2) un- doubtedly was sewer gas. Besides the more pronounced maladies that may re- sult from inhaling an atmosphere polluted with sewer gas, there can be no question that such functional troubles as morning headache in some cases, dull paiu in the back, general physical depression, anorexia, periodic malaise, an inability many experience to perform prolonged mental work, and disordered states of the secretory and excretory functions, result from this now very prevalent cause. Fur- thermore, the habitual breathing of an atmosphere tainted with sewer gas especially depresses nervous tone and leads to an impairment of the respiratory, secretory, and nutri- tive functions, which, with the greater or lesser degree of blood-poisoning that concurs, creates strong predisposing tendencies to disease, that at length is thereby more easily excited by other causes. There is no question in the mind of the writer that