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incompetence. The autopsy was made on January 24th by Dr. A. H. P. How Long Does Levitra Last 20 Mg Leuf. The pericardium was everywhere adherent, the pericar- dial cavity being non-existent. The heart, including the adher- ent pericardium, weighed thirty-six ounces. Both sides of the heart were enormously distended with blood. The mitral ori- fice was stenosed, hardly admitting two fingers. The aortic ori- fice was stenosed and the valve incompetent. The cusps of the :-ortic valve were thickened and adherent for about one third of the extent of their edges. The posterior cusp especially was thickened, and was the main factor in the incompetency. The liver was of the nutmeg variety. There was an accessory spleen of the size of a pea, with a long pedicle. A Case of Angina Pectoris. — Dr. Butler also read the fol- lowing history of a case seen at St. Mary's Hospital: F. C, a woman, thirty-five years of age, married, a native of Ireland, was admitted to St. Mary's, January 6, 1886. She had been in good health, with the exception of occasional attacks of facial neuralgia, until August, 1885, when she began to suffer with paroxysms of pain which were referred to the prjecordial region. Slight and occasional at first, they became more fre- quent and severe, until at the time of her entrance into the hospital they were excited with a varying degree of acuteness by the ingestion of food, motion of any sort, or long-continued conversation. The pain was described as commencing at a point just to the left of the lower end of the sternum, extend- ing through to the hack, and down through the shoulder and arm of the corresponding side to the hand. A sense of numb- ness and pricking in the arm and hand accompanied the pain, which was described as lancinating. In her severest attacks, a fear of immediate death and a sensation of dyspnoea were ex- perienced. Swelling of the feet and legs sometimes occurred. Her appetite was poor, her body was well nourished, and bowels and menstruation were normal in regularity. Physical exami- How Long Does Levitra Last 20 Mg nation revealed a somewhat slow pulse of high tension, so far as could be determined by tlie touch. The sphygmograph was not employed. The heart was apparently normal in size. The only auscultatory deviation from the normal was a decidedly accentuated aortic second sound. Fowler's solution and nux July 10, 1886.] PROCEEDINGS OF SOCIETIES. 51 vomica with rest iu bed, and nitrite of amyl for the relief of the. paroxysms of pain, constituted the treatment. The patient pro- gressively improved under this regimen. The paroxysms were invariably cut short by the nitrite of amyl, and, subjectively, nothing unpleasant remained but a " fluttering " of the heart, until the morning of January 23d, when she had a paroxysm, which was relieved by the usual remedy. On the afternoon of this day another attack occurred, which proved promptly fatal. The autopsy was made on January 24th by Dr. A. H. P. Leuf. A large part of the ascending portion of the aorta was athe- romatous. The anterior portion was much thickened at the base of the aortic cusps, the latter being also somewhat thickened with loss of normal curve and elasticity, but still competent. The coronary arteries were constricted How Long Does Levitra Last 20 Mg and narrowed at their origin and emergence from the aorta, the anterior coronary especially. The papillary muscles of the left ventricle were affected with fibrous degeneration. A Specimen of Pulmonary Tuberculosis, with History. — Dr. John Horn said that the specimen which he presented was from a case of phthisis in which the symptoms during life were very well marked, and in which the pathological changes were extremely characteristic. The specimen was removed from the body of Peter H., twenty-four years of age, born in the United States, laborer, who came to St. Mary's Hospital, on December 5, 1885. complaining of a short hacking cough, which had existed for about a year and a half, and which had been on the increase for a few months previous to his admission into 'the hospital. He had had night-sweats, frequent chills and eleva- tions of temperature; he had become emaciated and had lost his appetite. He gave no history of hiemoptysis or any sus- pected previous pulmonary trouble, and was not aware that he was suffering from phthisis. His sister died of phthisis; other- wise his family history could not be ascertained. Physical ex- amination showed positive signs of phthisis. He received the necessary care and treatment and got along very well until January 19th, when he expressed himself as feeling too weak to leave his bed, and he died the next day, January 20th, having, during his stay at the hospital, been able to walk about the How Long Does Levitra Last 20 Mg ward every day with very few exceptions. The autopsy, made by Dr. Leuf, revealed old pleuritic adhesions on both sides. The right lung contained a large cavity in its upper lobe. The mid- dle lobe was solid with tubercles which were becoming yellow — some were already yellow. The lower lobe was carnified. The upper third of the upper lobe formed one single cavity ; the rest consisted of smaller cavities and dilated bronchi. In squeezing a section of How Long Does Levitra Last 20 Mg the right lung it was noticed that there exuded a thick, tenacious, muco-purulent material from the bronchi ; the walls of the bronchi were thickened ; the bronchial glands were swollen and caseous. A number of nodular masses were felt on palpation in the substance of the lung; they were the so-called tubercle masses which were made up of several tubercle follicles, these tubercle masses had between them lung tissue which was very much congested. The right lung showed the various stages of phthisis very well, the lower lobe beiug in the condition de- scribed as acute phthisis, while the middle and upper lobes were in the more advanced stages. In examining the left lung it found that the wholeupper lobe wjis one large cavity ; the lower lobe had undergone How Long Does Levitra Last 20 Mg chee^y pneumoni.n, probably tubercular. A Case of so-called Hermaphroditism,— Dr. A. H. P. Leuf exhibited the body of an eighteeii-months-old child upon which he had made an autopsy at the Morgue for Coroner Menninger, who had suggested showing it How Long Does Levitra Last 20 Mg to the society How Long Does Levitra Last 20 Mg because of its sup- posed double sex. Dr. Leuf said he was particular to say so- called hermaphroditism, because he did not believe there was a true one except among the lowest order of animals. It was im- possible to imagine by what freak of nature such a monstrosity could be developed. It was easy enough to account for double- headed, or double-bodied, or four-armed, or four-legged uion- sters, but How Long Does Levitra Last 20 Mg not for a double sexual apparatus alone. What we knew of emVjryology was sufficient to set at rest any idea of the possibility of true hermaphroditism. All the cases so reported were those of pseudo-hermaphroditism, and owed their appear- ances to intercepted development or excessive growth of a part of the external genitalia. Every one of these cases admitted of a positive establishment of the true sex if a sufficiently thorough examination was permitted. In males it sometimes happened that the scrotum was fissured with or without a failure in the desceut of the testicles. If, in connection with this, there was a hypospadias so marked as to place the urethral opening at the peno-scrotal junction and the penis was poorly developed, the