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above the insertion of the deltoid muscle, the site being placed somewhat higher in the female than in the male, so as not to infringe upon the occa- sional mode of dress, requiring short sleeves, etc.. by the former. When patients object to this situa- tion. I select, as an alternative, the outer surface of the left leg, about six inches below the outer tuber- osity of the tibia. The site of election is carefully cleansed with soap and water. I use two per cent, mercuric iodide soap for this purpose, the soap is removed by wash- ing the surface with sterile water, the surface is 78 Oi-R READERS' DISCUSSIOSS. next cleansed with alcohol, and this removed with sterile water ; it is very essential to thoroughly re- move the soap and alcohol by cleansing with sterile water, because in the presence of these antiseptics the activity of the virus is destroyed. For the scarification I use a straight needle, which is sterilized immediately before Retail Price Viagra 100mg use, by pass- ing it through an Retail Price Viagra 100mg alcohol flame and allowing it to cool. I make a crucial scarification, going deep enough to cause pinkish serum to exude, but net deep enough to draw blood. If the exudation 'Jt serr.m is over abundant or a little blood should per- haps exude from too deep scarification I remove it witli a piece of sterile gauze ; the lymph is then im- mediately expelled from the tube on to the scarified Retail Price Viagra 100mg area, a few scratches are gently made with tht needle, and the arm is allowed to rest horizontall} for five minutes. A vaccination shield is placed over the surface to maintain the area in an aseptic condition and to prevent the clothing from coming in contact with the part. In mv work I much prefer the virus which is put up in hermetically sealed tubes in preference to vac- cine points. Dr. Lester Levyn, of Buffalo, X. )'., zcrites: The number of contrivances devised for the per- fection of the most efficacious method of vaccina- tion seem to point strongly after prolonged experi- mentation toward that which is the simplest. The instruments originated by Ume, Whittemore, Burcq, and others, all to a greater or less extent compli- cated, produce not as good results as the use of the sharp lancet. The operation while in itself Retail Price Viagra 100mg one of simplicity demands the absolute cleanliness at tlic site selected for insertion as any major operative preparation. The question of the selection of the most desir- able part for the inoculation is one the solution of which may assist in the effectiveness of the result. The locations usually chosen are the arm, leg, and lateral thorax. While a successful vaccination may he performed upon any part of the body surface, experience has given the predilection to the arm and leg. Vaccination on the thorax, although the desired immobility is attained, is contraindicated because of the heat and moisture necessarily present at that site. In very young infants the leg is pre- ferred because of the greater ease with which that part is protected, while in older children and adults the arm is the more desirable, rest being more easily maintained. The outer aspect of the left calf at the union of the middle and upper third. The outer part of Retail Price Viagra 100mg the arm at the lower insertion of the deltoid. These are the most commonly selected sites. The left arm in right handed persons and vice versa. The skin over the region in which the insertion is to be made should be thoroughly yet gently washed with soap and water avoiding the use of chemical solutions which tend to irritate the part. The skin is then well dried and again washed — now in alcohol. The arm should then be grasped by one hand of the vaccinator so as to put the skin upon the stretch. With a sharp lancet several fine parallel scratches and cross scratches are made sufficiently deep to remove the epidermis and expose the true skin over an area of about one eiglitli inch ia all Retail Price Viagra 100mg directions. This may often be done on sleep- mg children without disturbing them and is espe- cially commendable in those given to vaccinophobia. It is always well to make at least two of these scari- fications one, two or three centimetres distant from tiie other. If fresh lymph is used it should be rubbed lightly into the scarifications from the pouit of the lancet and if the preserved lymph be used, of which the Retail Price Viagra 100mg glycerinated variety in hermetically sealed glass tubes is the most valuable, it should be wiped upon the scarifications from the appliances in which Retail Price Viagra 100mg it is stored. The wound should be allowed to dry, which process is complete in from twenty to thirty minutes. No covering is to be used until thoroughly dried. It is well not to wash the limb for twenty-four Retail Price Viagra 100mg hours after vaccination. The matter of protecting the wound has been one of much discussion. The ideal dressing is one con- sisting of a few layers of sterile gauze fastened by strips of adhesive plaster Ninnerous shields have been devised for the protection of the wound but all shields are objectionable because of the warmth and moisture and often pressure on the vesicle itself may impede the circulation. Should the limb exhibit signs of marked inflammatory swelling cold, wet compresses should be applied — of salt solution preferably. These to be changed every twenty minutes until the swelling subsides Retail Price Viagra 100mg after which the wound must be kept cool, dry and clean. Cases in which rupture and discharge of the vesicle occur require washing with sterile Retail Price Viagra 100mg water, drying, and the application of a boric acid dustipg powder. If vaccination does not take after the first inocu- lation the operation should be repeated at least three times, and if then Retail Price Viagra 100mg unsuccessful a year should intervene before vaccination is again attempted. The lancets used in the scarifications must be used for no other purposes and sterilization should precede each vaccination. Cleanliness, of both field 'if scarification and instruments is a primal Retail Price Viagra 100mg factor