Mens Health Forum Generic Viagra | OVERNIGHT Delivery!







































824 RAMBAUD: RABIES. [Xew Vork Medical Journa clusively. In his experience necrosis followed in twent}' per cent, of his cases. Since adopting the intravenous method he has not had an\- unpleasant results. Marshalkof warns us that subcutaneous and in- tramuscular injections have no lasting curative ac- tion. In patients Mens Health Forum Generic Viagra under observation from two to four months, he found recurrences in fifty per cent. He thinks that salvarsan given by the intravenous route, supplemented by mercury, is the technique of the future. Among others who now believe that the intra- venous method should Mens Health Forum Generic Viagra be used are Schrieber, of JXIagdeburg, ^^'eintraud, of Wiesbaden, von Nott- haft and Mens Health Forum Generic Viagra Wechselmann, of Berlin, and Ehrlich him- self. The preparation of the solution for intramuscular injection is a very tedious, slow process of neutral- ization ; the solution for intravenous injection, on the other hand, is quickly and easil)' prepared. One hundred c.c. of hot distilled water will promptly dis- solve the salvarsan. without the use of the glass beads : two hundred c.c. of hot normal salt solution is added. To this is now slowlv added four and two tenths c.c. of four per cent, sodium hydroxide solution until the mixture is clear. If the apparatus has been thoroughly flushed in every part with distilled water after sterilization, and the sodium hydroxide has been kept in a glass stoppered bottle, there will be absolutely no sedi- ment. All preparations can be easih- completed within a half hour. The unfortunate who submits to the intramuscu- lar injection has just cause to regret it immediately the irritating fluid reaches the tissues. The intense pain, swelling, cedema, and exquisite tenderness last for days, very often for weeks. During the past month I have investigated two cases in New York City in which a general septic condition developed after local necrosis. One patient died, and the other will probably not recover. Compare this picture with the results of the more modern intravenous method. The patient notices nothing in the least uncomfortable during the oper- ation. I require him to lie still for several hours, after which he may walk about the hospital. With- in forty-eight hours he usually goes home. It has been my custom to cocainize the skin and make an incision one and a half inch long over the median l^asilic vein. .\ sharp needle is used and the vein is not ligated afterwards. Two Mens Health Forum Generic Viagra stitches close the skin. The apparatus, consisting of a twenty c.c. glass syringe, a stop cock, and a graduated cylinder, has' proved more satisfactory than any gravity con- trivance, because the solution is more surely under instant control, and, most important of all. the solu- tion can be kept at a constant temperature, while the fluid in the gravity apparatus becomes consid- erably cooled before the operation is completed, es- pecially as the fluid is injected very slowly in order to obtain the best results. It is my belief that the chills reported after the injection nf salvarsan were due to the solution being used too cool. The same chill follows the intraven- ous injection Mens Health Forum Generic Viagra of normal Mens Health Forum Generic Viagra salt solution unless the proper temperature is carefully maintained. The cases of facia! paralysis and optic neuritis reported have been due to the administration of doses of over five tenths of a gramme of salvarsan. Some instances of facial paralysis are more than probably due to minute emboli, which of course re- flect on the operator's technique. Prolonged bad effects from the intramuscular in- jections are very frequent, a very considerable pro- portion causing enough necrosis to require incision. To obtain satisfactory results from chemico- therapy in bacterial diseases, a maximum dose must be exhibited at each treatment. Small doses given frequently will soon cause the specific organism to become tolerant to the action of the drug. Then even the largest doses are without eft'ect. Arsenic is easily demonstrated in the necrotic masses following intramuscular injection. It has been found as late as three months after it was used. The hard masses are at best very slowly absorbed, cicatricial tissue almost invariably lasting more than three weeks, even in the most satisfactory cases. In other words, the intramuscular injection al- lows a slow absorption of salvarsan in small doses, continued over weeks. The spirochretje are apt to iiecome arsenic fast (tolerant to arsenic). Realiz- ing this, it is not surprising that Marshalkof reports relapses in fifty per cent, of his cases before he adopted Mens Health Forum Generic Viagra the intravenous method. The recurrences after the intravenous injections have been estimated at four per cent. It is usual to give a second injec- tion about four weeks after the first. Nearly all authorities agree that it is advisable to administer mercury as a routine measure after sal- varsan has been given. I intend to report, later, sev- eral cases which had had a very thorough course of mercury salicylate injections without satisfactory results. These cases promptly cleared up under sal- varsan alone. In the majority of cases, however, mercury is a valuable adjuvant. - RABIe5: What Mens Health Forum Generic Viagra Has Been Accomplished in Diagnosis ami I leat- ment.