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[New York Medical Journal. |r0atirittgs of Swittiw THE MEDICAL ASSOCIATION OF THE GREATER CITY OF NEW YORK. Meeting Held in the Borough of Brooklyn, February 6, 1911. Dr J, Scott Wood in the Chair. Venesection and Saline Infusion in Pneu- monia. — The first paper of the evening, with this title, was by Dr. James S. W.^terman. Having referred to the usual plan of treatment in pneu- monia in his service at St. Pfizer Viagra Online Australia Mary's Hospital, he said that the cases of which he desired especially to speak were those in which, late in the second stage when the crisis is Pfizer Viagra Online Australia due, instead of defervescence set- ting in. such alarming symptoms develop that death seems imminent unless something out of the ordi- nary routine of treatment is done. In discussing these he would endeavor to arrive at some fair esti- mate of the value of the attempts Pfizer Viagra Online Australia made to save the patients life. He gave the details of Pfizer Viagra Online Australia eight cases, all apparently hopeless, five of which recovered and three died. In Case I venesection was performed on the fifth day with marked benefit, recovery Pfizer Viagra Online Australia fol- lowing. In Case II, a man of sixty-one years, venesection was done on the fourth day. Marked improvement in the patient's condition followed, lasting twenty- four hours. Hypodermoclysis was done Pfizer Viagra Online Australia on the sixth day and was followed by im- provement, which lasted until a complication set in, so that he died on the eight day. Case III was that of a woman who said she was forty-three years old, but who had the appearance of being Pfizer Viagra Online Australia much older. No definite date was determined regarding the pneumonic process, but it was judged to be about the seventh day. Venesection and intravenous in- fusion were followed by marked improvement as regards pain and distress, -as well as some improve- ment in the general condition ; but the patient died three days later. In Case IV, venesection and in- travenous infusion on the eighth day, and a second venesection and infusion on the ninth day, were followed by recovery. Case V: Venesection and intravenous infusion on the eighth Pfizer Viagra Online Australia day ; defer- vescence on the ninth day ; recovery. Case VI : Venesection and intravenous infusion on the ninth day ; defervescence complete on the fourteenth day ; recovery. Case VII : Venesection and Pfizer Viagra Online Australia intravenous infusion on the seventh day; complicating nephritis; death. Case VIII: Venesection and intravenous infusion on the sixth day, followed by collapse, re- action, and recovery. Old people were said not to stand venesection well. The two oldest patients, while they stood venesection well, and improved after :t, did not recover. Case VIII, with com- plicating nephritis, died. While several of the pa- tients who recovered showed traces of albumin in the urine, this did not seem to have possessed Pfizer Viagra Online Australia much significance. The venesection relieved the en- gorged, overworked heart and removed a certain amount of blood loaded with toxic material. The quantity of blood drawn in the different cases va- ried from eight to twenty ounces. In the case in which two venesections were done, the first bleed- ing was of eighteen ounces and the second of eleven ounces. The intravenous injections were from twelve to sixteen ounces. The hot saline infusion diluted the toxic blood stream, and possibly acted as a stimulant to the heart and other organs. In all cases the infusion was followed in about two hours by a chill of varying severity, the physiolog}- of which was obscure. In all but one instance the infusion was also followed by a profuse sweating, accompanied by a fall of temperature. The speaker said he was induced to use the saline intravenously because of the pain, discomfort, and uncertainty of absorption in hypodermoclysis. Dr. Glent WORTH R. Butler said Pfizer Viagra Online Australia that, as we all knew, venesection was formerly universally prac- tised in pneumonia ; yet it was a fact that the re- sults of the so called expectant method of treatment were more successful than this general venesection. It was commonly recognized, however, that there were some cases of the disease in which venesection was undoubtedly called for. In what kind of cases was venesection advisable? In pneumonia it was found that there were two prominent modes of death. The first was by reason of a vasomotor paralysis. This particular form of death was re- garded as due to the action on the medulla of the toxine produced by the pneumococcic infection, and it was similar to the effect caused by section of the splanchnic nerve. The blood pressure was marked- ly lowered, and more or less blood accumulated in the splanchnic area. As the supply of blood be- came less and less in the heart, the intracardiac pressure became finally so reduced that the organ was rendered incapable of fulfilling its functions. Clinically, it was noted that the pulse grew rapid and feeble, and that often symptoms of Pfizer Viagra Online Australia syncope or collapse set in. There was apt to be delirium, and a not uncommon feature of the condition was tym- panites. It was in this state of affairs, it appeared to him, that saline venous infusion, or, if that was impracticable, hypodermoclysis, was especially in- dicated. Sometimes the infusion might be repeated with advantage every two to four hours. The sec- ond mode of death referred to was from dilatation of the right ventricle. Here the respiration became peculiarly labored, the liver was usually swollen, and almost invariably oedema of the lungs resulted. This condition was more frequently met with than the first, vasomotor paralysis, and it was in these cases that venesection appeared to be strongly in- dicated. In some instances he did not doubt, how- ever, that saline venous infusion or hypodermocly- sis, in Pfizer Viagra Online Australia addition to venesection, might prove of value. Personally he had foimd that strophanthine, ad- ministered hypodermatically, was sometimes of great service where the right heart was dilated. In three cases this had produced a really startling change for the better, and he believed that in this agent we had a valuable addition to our therapeu- tic resources. Dr. Raymond Clark said he thought that vene-