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army added to this probability, Iml the man's answer,-* on the jMiint of primary infection wort! most uiiHiitisfaclorv at I hi- time of his illiipsH, although porfeclty exphcit aftiT liis roluni from the nsylum. Wo liad no distigiirinj; marks or cicatrice* on any part of his Ixxiy to aid in diagnosis, nor was his hair in am- way lessened. The mania was extremely violent, coupled with wild hallu- cinations, and was always worse at night. During the day his state was rather that of dementia, with constant suspicious watchfulness, as if fearing some injury from the members of his family. His improvement after re- moval to the asylum was rapid and continuous, but whether from the buy benoquin cream change of surroundings and better nursing, or from the antisyphilitic treatment, I am not prepared to say. How long it may be before he has further manifestations, and in what form they will appear, are interesting questions to be answered later. DIPHTHERIA: THE SERUM TREATMENT IN GENERAL PRACTICE.* By palmer heath LYON, M. D. Theke have appeared from time to time various buy benoquin articles which, if they do not altogether condemn, dis- parage the use of antitoxine in the treatment of true diphtheria. The writer has been fortunate enough to see a num- ber of cases in which he has felt positive that had not antitoxine been used nothing could have saved the pa- tients. These patients received the serum and all re- covered. Upon such benoquin online evidence as this I have ventured to present a few arguments and observations which, while not new, seem to have a definite bearing upon the subject. In the first place, I wish it to be distinctly under- stood that I am in thorough accord with those who maintain that the curative value is greatly diminished if the treatment is not begun in the first three days. After that it is almost useless to undertake to administer the serum — the time has passed. However, it is my firm be- lief that up to that time, in every case in which it is not absolutely contra indicated, it should be tried. \Yhile it will probably be of no avail, it should be tried even after that period is past, and it should not be done in a hasty or cursory manner, when other means have been fairly tried and failure has resulted. The gen- eral consideration of this subject naturally divides itself into three main channels: When, where, and how to ad- minister the antitoxine. Along the first of these groups our introductory re- marks have carrietl us. and we will jiass on, simply re- marking that the earlier the remedy is used the benoquin vitiligo l)ottor the results. The first day is, therefore, the best time, liut very excellent result* have l>eon obtainotl in cases in which the inoculation did not take place until the second or third day. The BCH'ond division admitii of little discussion. It is only natural that a site of o|)eration should l>e selected • Rrail iMforo llio WMhlngtmi IIpIrIiu MoIImI Hudeljr, March SO, IH»9. 778 LYON: SERUM TREATMENT IN DIPHTHERIA. [N. y. Med. Jodr., that will provide ready absorption, inasmuch as on this depends much of the success of the treatment. For this reason there are two portions of the body admirably adapted. They are the surface of the abdomen in the lumbar region (either left or right; personally I prefer the left), or the external surface of the thigh. Of these, the former benoquin cream is, when practicable, benoquin cream for sale the better. In the case of very small cliildren, however, the latter mode presents fewer obstacles; therefore it is advocated when the monobenzone benoquin other and benoquin price favorite method can not be adopted. Since tliis benoquin monobenzone cream paper was started there have appeared several articles by distinguished writers upon the subject of oral administration of antitoxine. A serum may be produced in the future which will be suited to such a method, but certain it is that at the present day the hj'podermic method is the one for which the various serums are prepared, and, until we have benoquin cream 20 some better reason to discard it than we have at present, it is the one for us to retain. We have reduced the necessary quantity to a minimum benoquin 20 by increasing the potential of the serum. Were we to use it per os, a much larger quan- tity would certainly be required. But this in passing. The next channel along which we direct our investi- gation is that of how to administer the antitoxine, and this I propose to divide into three portions — viz. : 1. The method of administration. 2. The amount to use. 3. General considerations. We will proceed in the order mentioned. 1. buy benoquin online Method. — The very first consideration is invari- ably absolute asepsis. Instruments, receptacles, dress- ings — in fact, ever}i:hing used — must be absolutely ster- ile. The skin of the patient must be washed with some efficient disinfecting solution. For this purpose I prefer a solution of Ij'sol of a strength of four per cent. After this in several cases I found it advisable to produce local anassthesia by means of either the ether or ethyl chloride spray. It is conjectural, however, whether this is really advisable with small children, as the cold and discom- fort of such a procedure, to my mind, are greater than when the needle is carefully and quickly introduced. Still, in adults and older children it is often of much

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