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section and saline infusion should be separated. There were, it would appear, special indications for each, venesection being applicable in the case of |)lethoric patients and saline infusion in cases of the asthenic type. Venesection diminished the quantity of blood in the system, and thus removed fr(im the circulation a certain amount of toxines. April 32, I9>>] PR0CEED1.\GS OF SOCIETIES. 80? riie eft'ect of saline infusion was to increase the body of fluid in circulation and to Viagra Online Pharmacy Australia dilute the toxines, and it had been shown that the more diluted the toxines, the less powerful was their effect upon muscle protoplasm. Venesection relieved the strain upon Viagra Online Pharmacy Australia the right heart. In all these cases the prog- nosis was very bad, but in two instances of asthenic type, with pulmonary oedema, he had seen great benefit result from the abstraction of a small amount of blood, followed by hot saline infusion ; the cedema being promptly cleared up. The effect of saline in- fusion was to dilute the toxines, increase the arte- rial pressure, and excite the kidneys to activity. Viagra Online Pharmacy Australia It also, by throwing the patient into a profuse per- spiration, promoted elimination by way of the skin. .A.gain, its effect upon the general vascular system was beneficial, bringing back the lost tonicity to the vessels, as well as to the heart itself. In many instances he believed hypodermoclysis was prefera- ble to saline venous infusion. It was simpler to perform, and the means were not always at hand for the venous infusion. He had seen three cases with marked toxjemia in which hypodermoclysis had been followed by the best results. In all these cases, whatever the method of treatment adopted, this should be based on Viagra Online Pharmacy Australia scientific reasoning. In- telligent selection was the secret of success. Dr. Edw.ard E. Cornwall said that he properly had no right to take part in Viagra Online Pharmacy Australia this discussion, as, per- sonally, he had never resorted to either venesection or saline infusion in pneumonia. He desired to state, however, that he would not hesitate to Viagra Online Pharmacy Australia employ either or both of these in any case which seemed to de- mand it. If we could really abort the attack by an early venesection, it would seem the proper pro- cedure, but as this was doubtful, he believed that bleeding would be of more value when undertaken later on. It would appear to be more logical to do the venesection at a time when the right heart had become overburdened. In his experience, patients died much more frequently from failure of the right heart than from vasomotor paralysis, death being preceded by signs of cyanosis. In these cases there seemed to be a septichasmia, a specific toxaemia. While the right heart was so apt to give Viagra Online Pharmacy Australia way, it had frequently been noted that the left heart gen- erally maintained itself well up to the crisis. As to saline infusion, this Viagra Online Pharmacy Australia w'ould be of no service at Viagra Online Pharmacy Australia all if the right heart were unable to carry over the circulating fluid, no odds how large the quantity of the infusion given. Again, it had occurred to him that the profuse perspiration which had been de- scribed might be only a sign of the patient's ex- treme weakness, .-^s a rule, he would suppose that saline infusion would prove to be of more value after venesection had been performed. In speaking of the routine treatment of pneumonia in Viagra Online Pharmacy Australia his service at St. Mary's Hospital, Dr. Waterman had stated that creosote carbonate was employed. He was glad to learn that the dose given was only five .grains, as this could do no harm, but he did not hesitate to say that this drug was of no value what- ever in the treatment of pneumonia. On the other hand, he was pleased to hear Dr. Butler so enthusi- astic over strophanthine, as he himself had also found it of the greatest service in maintaining the heart's action. Dr. WiLLL^M J. Cruikshank referred to the significance of tympanites, and said the condition was frequently unrecognized. It was very apt to occur in serious cases of pneumonia, and it seemed to him that by carefully watching the abdomen we might Viagra Online Pharmacy Australia often obtain valuable knowledge as to the real condition of the patient. Dr. Homer Wakefield said that in this discus- sion no mention had been made of an agent of the highest value in pneumonia. It was his firm con- viction, based on practical experience, that if ergot was judiciously administered hypodermatically, there would be no occasion to resort to either vene- section or saline infusion. This drug fulfilled all the indications in these cases and generally had the effect of averting a fatal issue. Dr. Reynold Webb Wilcox said that not long since, having been invited to speak on pneumonia before a medical society in New Haven, he had looked over some notes by members of his family who had preceded him in the profession. There he found that in 1819, when his grandfather was grad- uated from the Yale Medical School, the sole reme- dies employed in the disease were venesection and snake root. Thirty years afterward, when an uncle graduated from the same school, the same agents were used, but with the addition of tartar emetic in ver}- considerable doses. Polioencephalitis. — Dr. Joseph Merzbach, in this paper, said that an acute polioencephalitis not limited to children was first made known in 1881 by Wernicke, who described a superior hsemor- rhagic Viagra Online Pharmacy Australia polioencephalitis which he found in alcohol- ics. About ten years later acute primary encephali- tis of the nonalcoholic was described by a number of observers. In spite of much work done since then, the pathology of the disease was as yet by no means definitely settled, and this was probably due to the fact that recovery Viagra Online Pharmacy Australia takes place in a majority of instances; thus limiting the opportunity for post mortem study. It was probable, however, that hyperasmia and capillary haemorrhages were the conditions present in the milder cases, while in the graver there were more extensive h?emorrhages, with subsequent softening of the brain. The pro- cess was not necessarily limited to the gray matter,