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central nervous system Cheapest Viagra Buy Cheap Viagra have been ascribed to the influence of the drug upon syphilitic brain lesions, in that it may cause a marked' irritation in the cere- bral tissues ; this irritation resulting in inflammation and oedema within the cranial cavity, causing the alarming pressure symptoms observed in these pa- tients, and sometimes ending fatally. Recently, a great deal has been written in con- nection with the effect of salvarsan upon the cir- culatory system. Several deaths have followed the intravenous administration,- the reports of which induced Ehrlich to publish several articles, in which he reiterated his cautions against using the drug in cases of arteriosclerosis, functional diseases of the heart, and, particularly, angina pectoris. In the earlv stages of cardiac disturbances which are di- rectly due to syphilis itself, and in which the symp- toms' of the disease are limited to disturbances of the pulse rate — arrhythmia and tachycardia, salvar- san may be cautiously administered, provided there are no indications present of weakening of the heart muscle itself. But in advanced cases of dilatation, especially when coincident with insufficiency, the drug is strongly contraindicated. Heart murmurs alone (according to Karl Grassman), when not as- sociated with marked insufficiency, permit of the use of Ehrlich's remedy, cautiously given in small doses. But in all cases of late syphilis, in which the heart disturbances are characterized by brady- cardia, the drug must be withheld, this class of cases presenting the strongest contraindication to the use of the remedy in circulatory dis- turbances. According to the same author, the ex- hibition of salvarsan is permissible in cases of syph- ilitic aortitis, sclerosis of the coronary arteries, Cheapest Viagra Buy Cheap Viagra and aneurysm of luetic origin, although great care must be exercised in its administration. In nonsyphilitic disturbances of the heart, as in cases of well com- pensated valvular lesions, the drug may be given a trial in pro])erly selected cases. On the other hand, the drug must never be used in any case of acute inflammatory heart affections, nor in any case of chronic insufficiency, in which degenerative changes of the parenchyma obtain, as arsenic itself Ijroduces parenchymatous degeneration of the heart , muscle. In cardiac weakness following pulmonary emphysema and in chronic bronchitis, the adminis- tration of the drug may result in the gra\est con- sequences. Nor is it advisable to employ the rem- edy in heart lesions due to chronic nephritis of luetic origin until a larger number of such cases have been reported as reacting favorably to the treatment. Observations by expert clinicians in all parts of the world on the thousands of cases of syphilis treated with salvarsan, have permitted the formu- lation of more or less Cheapest Viagra Buy Cheap Viagra well defined contraindications to the employment of the remedy. The importance of recognizing and of constantly bearing in mind these contraindications cannot be overestimated, especially during the period in which the enthus- iasm, both of the profession and the laity, is at white heat. Discrimination in the selection of ap- propriate cases and withholding the remedy from unfavorable cases, are sine qua non to the firm es- tablishment of salvarsan in our antiluetic arma- mentarium. Contraindications: As is the case with nearly all remedies, the actual contraindications to the use of this arsenic compound must be Cheapest Viagra Buy Cheap Viagra designated under two captions, the absoltite and the relative. Among absolute contraindications, the majority Cheapest Viagra Buy Cheap Viagra of observ- ers include the following: Aortic insufficiency, aortic stenosis, aneurysm. Diseases of the heart muscle, myocarditis, an- gina pectoris. Arteriosclerosis of the peripheral bloodvessels. Diseases of the central nervous system aft'ecting vital organs, especially when associated with de- generative changes. Cases prone to cerebral hemor- rhage. .Severe cases of retinal and optic nerve lesions. Advanced cases of pulmonary disease (except n;.j tuberculosis), and of renal disease of nonsyphilitic character. Diabetes and gastric ulcer. Among the relative contraindications may be in- cluded : Cheapest Viagra Buy Cheap Viagra Well compensated cardiac lesions in the earlier stages of syphilis. Neuroses of the heart. Diseases associated with fever (acute infectious diseases). Cachexia : chronic debilitating diseases ; old age. Pregnancy, during the last four or five months. Cases previously treated with enesol, atoxyl, ar- sacetin, arsenophenylglycin, hectin, etc. 828 Lexixgton Avenue. ^Frankel and Grouvc =EhkTs. lb.. No. 42. A NKW .\PPAR.-\TUS FOR ADMINISTERING S.\l.- VARSAN ("606") INTRAVENOUSLY. By EnG.\R G. Ballenger, M. D., .Atlanta, Ga. I:hr!ich now says that the intravenous injection of salvarsan is far superior to the subcutaneous and intramuscular methods, and consequently recom- mends that it be given in this manner unless other- Cheapest Viagra Buy Cheap Viagra wise Cheapest Viagra Buy Cheap Viagra distinctly contraindicated. When so given, if a second injection is necessary — and I think ii always is — it may be administered only with the certaintv that most of the first dose has been elimi- nated : otherwise we may have grounds to fear that THOMSON: SALVARSAN GIVEN IXTkAriSNOUSLV