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for a successful vaccinative result and often the result depends upon the obsen,'ation of these pre- cautions Dr. Walter E. Hays, of New York, says: \'accination is one of the most simple operations that the physician in general practice is called upon to perform. Yet not infrequently the result is un- satisfactory, either because of too deep scarification, faulty technique in the matter of cleanliness, or neg- lect in directions as to postoperative care. So often I have heard physicians say, "Oh, you'll be all right. Vour arm won't give you any trouble." The busy or thoughtless physician will dismiss a young mother with no directions as to the care of her baby's arm. My procedure in practice is as follows : The left arm of the patient, because I am right handed, is carefully scrubbed with soap and water. This is followed Get Viagra Online Prescription with alcohol and ether with brisk rubbing to remove fatty and epithelial debris and to leave a reddened, succulent skin surface. The arm is gentlv scarified very superficially, so as not to draw blood, with transverse and longitudinal Get Viagra Online Prescription scratches of a sterilized needle over an area about one quarter of Get Viagra Online Prescription an inch square. The vaccine, which Get Viagra Online Prescription comes most conveniently in a fine glass pipette, sealed at both CORRESPONDENCE. 79 ends, is released by breaking both ends of the pip- ette and gently blown out on the scarified surface bv means of a small rubber tubing attached to the glass pipette, care being taken not to blow any sa- liva from the operator's mouth. The vaccine is then thoroughly rubbed into the denuded area with a sterile toothpick. Ten minutes of drying will usu- ally result in a firm blood crust and the absorption of the vaccine. Subsequent treatment consists in lining the shirt sleeve with freshly ironed linen or tlannel. Mo shield or bandage should ordinarily be used. Get Viagra Online Prescription Lym- phangeitis usually responds to hot applications. Sometimes an infected arm will require prolonged treatment, but no infection ought to occur if clean- liness is observed and the crust is carefully protected against breaking. Dr. Alexander Isaacson, of AVic York, remarks: Before entering upon the actual technique of vac- cination as I perform it, I would like to preface a few remarks : In order to be a successful vaccina- tor one must consider various relative conditions. Of utmost importance, in my estimation, is first to secure a virus of standard quality, and we may well depend upon the vaccine virus prepared by our Board of Health, being careful to notice that the virus is not over three months old and that it has been kept in a cold place. Secondly, it is essential that the strictest precautions are taken as to sterility of field of vaccination and paraphernalia used ; and, thirdly, the cleanliness of vaccinator. My technique is as follows: I prepare my virus for use in the following manner: With a piece of sterilized gauze or cotton I break off both ends of the glass tube containing the vaccine virus, and then insert one end into a small piece of rubber tubing. I then proceed to sterilize the surface tn be vacci- nated, usually selecting the left arm, particularly in right handed adults, the actual point of vaccinati 'n corresponding to about from one inch to one and a half inches below the insertion of the deltoid muscle, I carefully scrub the arm with tincture of green soap, and follow by absolute alcohol. Having my field perfectly sterilized, I blow out the virus from the glass lube container upon Get Viagra Online Prescription the flat end of a slip of wood Get Viagra Online Prescription (sterilized toothpick), and Get Viagra Online Prescription with a sterilized needle scarify the surface about from one sixteenth to one twelfth inch in diameter, sufficiently to bring a little serum to the surface (it is not necessary to pick a deep hole in the skin), and then rub the virus II the flattened end of the toothpick) over the I rifled area very thoroughly ; I allow it to dry, .mil the vaccination is complete. I have the vac- cinated surface <-overed for protection by suspend- ing a piece of sterilized gauze over it — (I do not be- lieve in a regular vaccination mask). f^r. Charles Haase, of Elmira, N. Y., states: \Vhilt the patient is baring his left arm and re- • ii"ving all clothing or bands that may be constrict- ing his arm and causing hypcraemia, I place an ap- plicator, sterile cotton, vaccine Get Viagra Online Prescription tube and bulb, vac- iti'in shield and adhesive plaster, lance, and the lowing solutions in bottles: Fifty per cent, tinc- I 'ure of iodine, pure carbolic acid, alcohol, and boiled water on a freshly laundried towel. Get Viagra Online Prescription Over the in- sertion of the deltoid muscle 1 paint an area, the size of a silver dollar, with fifty per cent, tincture of iodine. When this surface is dry I wipe it with a pledget of cotton moistened with water, then wipe it dry." A one fourth inch squdre of skin is carefully scraped from the centre of the painted area, so that only serum oozes. If possible avoid drawing bloc!, and this Get Viagra Online Prescription can usually be done by avoiding hyperemia of tile arm, by gently painting and wiping the sur- face to be vaccinated, by gentle scraping, and by not making cuts with the lance. The iodine solu- tion makes it easy to remove the scarf skin, as after being painted with iodine it scrapes ofif readily in one layer. For scraping I use a small chisel pointed lance, one Get Viagra Online Prescription like that used in performing von Pirquet's tuberculin test. The lance is sterilized in pure car- bolic acid, then dipped in alcohol, and then in the boiled water and dried. The individual vaccine tube is passed into the rubber bulb, wiped with al- cohol, boiled water, and dry cotton ; then both ends broken off, the virus expelled and gently rubbed into the denuded surface, avoiding the flow of blood. Now fasten with good adhesive plaster a large, high crowned celluloid Get Viagra Online Prescription shield over the site of vaccination.