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use. With regard to the instrument or means of inocula- tion, any good antitoxine syringe will answer. There are many now on the market, all of which have their good points. I must speak here of a modification which might well be omitted. This is the use of a rubber tube between the syringe and the needle. After trying both with and without this, I have discarded it. It is a relic of the old rubber bulb syringe. The operation is rendered nmch easier by using the needle fast to the barrel. It is less betnovate scalp lotion painful to the patient, and the physician completes the inoculation without further difficulty. If an antitoxine syringe is not at betnovate buy online hand, a large hypodermic one will answer, if a scrum of a high potential is used. If possible, the serum should be taken directly betnovate skin cream from the containing flask, thus avoiding the risk of contami- nation. If, however, it becomes necessary to transfer the serum, great care must be taken that the new recep- tacle is sterile. The operation complete, a sterile compress should be held on the puncture for a betnovate n few seconds and then col- lodion applied. It is not advisable to employ massage, as absorption takes place rapidly in these betnovate face regions. The patient should be kept quiet for a short time immedi- ately after the operation is completed. Individuals who have been exposed may be immu- nized in the same manner, a smaller dose of the serum being used. Before proceeding to a consideration of the subject of amount to be used, I wish most strongly to advocate the immunization of every person who may have run even any risk of infection. The cases I shall quote in a few minutes will emphasize this point, but it is my firm belief that with such precautionary measures our present low death-rate may be greatly decreased. 2. Amount. — The New York board of health has determined that the average curative dose is fifteen betnovate gm hun- dred units (Behring's). I have found that in the ma- jority of cases this held good, but it is unwise to try to set any one fixed rule to cover all cases. If (ten to twelve hours having elapsed since the original dose) there is not a decided improvement, a sec- ond dose of from two thousand to twenty-five hundred units should be given. It may even become necessary to give a third one of from three thousand to four thousand units. It is seldom that a third dose is needed when the treatment is begun on the first or second day of the disease. When treatment is delayed, however, betnovate cream 0.1 it is some- times necessary to give a third or even a fourth dose. For immunization a dose of from five hundred to a thousand units is all that is necessary. The dose here is proportionate to the individual's age and strength, also to the general physical condition. I would remark that I have never seen buy betnovate cream online a patient, properly immunized with these amounts, become infected. It is unfortunate, however, that this immunity betnovate c ointment is not lasting, but passes away after a period of from five to eight weeks. 3. General Considerations and Deductions. — Before considering this topic, I desire to refer betnovate scalp solution to several cases which will serve the belter to illustrate the foregoing. Cask I. — S. C, a woman, aged twenty years. On December 13, 189betnovate gm skin cream symptoms pointing to di]ihthcria. On the next day, by means of the electric diagnostic appli- ance, I was enabled to get a view of the throat, which re- s\ilf{'d in making a culture Ihnt, on the following day, showed tlie ()rescii('e of Bacillus diphlhcriw. TJie pa- tient refused trrnlmcnt by antitoxine, and, betnovate c as isolation of the ease was impossiljle, slie was removed on the IGth to the Willard T'arUcr Hospital, where she received twen- ty-five hundred unils and made a good recovery. In the family wliicli slie served as a domestic there Jnne 3, 1899.] AMY J: AyriNOSiyE IX ES TRESIS. CYSTiri-; AND UREmBITIS. 779 were three adults and two betnovate n cream small children. Each of these persons received a thousand units of board-of- health buy betnovate cream betnovate c cream antitoxine, and, although they had been constant- ly exposed, not one was afterward Lufected. Case II. — E. E., aged three years, and A. E., aged five j-ears. These two children, together with others, were a most interesting group of cases which I saw through the courtesy of Dr. L. A. Eodenstein. E. was undoubtedlv suffering from diphtheria. A., while show- ing no throat symptoms, still seemed suspicious. The sick one was given fifteen hundred units, and the others a thousand each. E. was sitting up in bed in four days, and there was no further complaint from the others. A. was perfectly well the next time I saw him. Case III. — Mrs. E., mother of the two children mentioned above, refused inoculation when she began to nurse her son. Three days after she was attacked by the disease in a yevy violent form. She received two thou- sand units, and twelve hours later betnovate for acne three thousand more. In three days she was much better, and in a week she sat up for a short time. Case IV. — A. T., betnovate online a boy, aged eleven years. A very severe case. On March 1st he awoke with a sore throat. When I saw him that afternoon the membrane covered both tonsils and the posterior pharyngeal wall. It was evidently the third day of betnovate ointment 0.1 the disease. I at once betnovate scalp application gave the child fifteen hundred units, and isolated him with his mother, to whom I gave a thousand units. He rallied slightly with this, but his temperature remained high

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