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coN'cr.usioxs. In conclusion, then, carbon dioxide locall}- gives I, definite inflammatory reaction; 2, a stimulating action ; 3, destructive action with slight resulting 830 KEXXEDV: AXTITETAXIC SERUM. scar ; 4, immediate destruction or cauterization under prolonged exposure and strong pressure. Chronic elevated lesions are those that seem to respond to this treatment. Lesions that have be- come infected respond less readily. It has been found also that often a combination of the forms of treatment will give results when a single method will not. Lupus erythematosus Comprar Viagra 100mg Online is said to respond extremely well, but, not lupus vulgaris. Prolif- erating carcinoma, _,not deep, responds; ialcerating epithelioma (rodetil ulcer) does not. Further study is needed on this form of treatment to exhaust its possibilities. IS AXTITETANIC SERUM A FACTOR IN THE Comprar Viagra 100mg Online CURE OF TETANUS ?*= By J. C. Kennedy, M. D., Brooklyn, N. Y., X'isitinK Svirgecn. St. tntlRiine's and St. Miuj's Ilosi'ltal-. Looking back over an active hospital e.xperience when medicine alone was used to combat the hor- rors of tetanus up to the introduction of antitetanic serum with its later gigantic strides in the reduction of tetantis mortality, gloom seems to have given place to hope. The following case is a type of quite a few in my hospital service within the last few years : Case. Traumatic Tetanus. The patient, eight years of age, and a native of Brooklyn, was admitted to St. Cath- erine's Hospital, July i, 1909. He had a compound frac- ture of the frontal bone caused by a kick from a horse. The wound in the soft tissues was about one half inch long and three quarters of an inch in width just over the left eye. The boy suffered from shock but had no marked symptoms of compression. With due antiseptic precaution the wound was sutured and drained. .\fter several days the probe indicated loose bone denuded of periosteum, the drains were removed, and the wound opened up when a piece of bone, about one half inch in length Comprar Viagra 100mg Online and slightly depressed situated between and including some of the supraorbital ridge, the supraciliary ridge, the temporal Comprar Viagra 100mg Online ridge, and extending in the direction of the nasal spine, was removed. Some plastic work had to be done in order to get decent skin approximation, silkworm drains were in- troduced, and the wound dressed with the usual care. On the morning of July Comprar Viagra 100mg Online loth, nine days after the operation, the patient complained of a chilly feeling with some stiff- ness of the neck muscles. The wound was immediately Comprar Viagra 100mg Online l;iid open and treated with a strong solution of bichloride 'if mercury. The dressing of the wound w-as carefully done daily thereafter. Soon after these preliminary symp- toms the patient had a convulsion with all that goes with a convulsion in tetanus, the jaws were firmly locked, the eyebrows were raised, the angles of the mouth were draw'-.i "Ut marking well the so called sardonic grin; all the mus- cles of the body seemed to be involved in tonic contrac- tion, but those of the back particularly giving the patient a condition of opisthotonus. The patient was now given subcutaneously 3,000 lun'ts of antitetanic serum with twenty grains of chloral hydrate and twenty grains of sodium liromide every three liours which was continued for sjx days. On July 15th the patient again had four convuIsions>J ,?.ooo units were again administered : on July i6th he had si.x convulsions, 1,500 units of antito.xine were given. July 17th, eight convulsions, 1,500 units of antitoxine. July i8th, eight convulsions. 1,500 units of antitoxine. July / lOth, ten convulsions, 1,500 units of antitoxine. July 20th, eight convulsions, 1,500 units of antitoxine. July 21st, / eight convulsions, 1,500 units. July 22d, four very severe/ convulsions, 1,500 units of antitoxine. July 24th, one con^' vulsion, 1.500 units, July 26th, no convulsions, 1,500 unit.s^ when the antitoxine was stopped. During his sickness hf "Read before the Brooklyn Medical Society. \ had sixty-four convulsions and received 19,500 units of antitoxine serum, twenty Comprar Viagra 100mg Online .grains of chloral and bromide were continued every three hours from July 15th to July 25th, and then reduced to five of each, until the boy was. discharged, so that he was given 1,714 grains of Comprar Viagra 100mg Online chloral and bromide during his attack. Di-icharged as cured August 19th. The value of serum treatment in tetanus is still undetermined ; the literature abounds in pros and cons. That antitetanic serum Comprar Viagra 100mg Online in its present state neutralizes to some e.xtent the toxine produced by the bacillus of tetanus, is my firm belief. That im- munizing doses of antitetanic serum in cases where wounds are fraught with danger from tetanus has virtue is also my firm belief. One writer collects from the literature 1,216 cases of tetanus with the conclusion that the mortality has been reduced from eighty to fifty per cent. .An- other writer concludes after using the Comprar Viagra 100mg Online serum that in its present state it is not likely to have any ma- terial effect upon the course of the disease. The lesions of the nerves Comprar Viagra 100mg Online and nerve centres are merely those resulting from an irritant poison pro- duced by the bacillus of tetanus, 7h2 W'lT.LOUGHBV AvEXUE. ®ttr '§inlim' Msmssian. . Ouc.^tioiis for discussion in this department are an- nounced at frequent intervals. So far as they have been decided upon, the further ijucslions arc as follozcs: ' CIX. — IVhat are the best means of reducing infant mar- ■ality? (Closed April 15. 1911.1