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484 ALLl'ORT: CONTRACTED SOCKETS. { New YoRX Medical Jouknal. Calomel gr. i/6 Podophyllin, gr. i/6 Bilcin, gr. i/8 Stryclinine arsenate, gr. 1/250 I'his may be given, one every half hour for six (loses, followed with a gentle saline, if needed. I'ollowing this initial medication, the intestinal tract may be relieved daily, if necessary, by gentle enemas. Can You Really Order Cialis Online A quiet Iwwci, provided it is not dis- tended, is desirable. Watch carefully for abdominal distention, the result of a failing v;isomotor system. It is an ominous sign. Tlie time to treat it is at its beginning. Pneumonia patients differ in their ability to tolerate low teniperature, and a wise decision must be made in individual cases. Some apparently are sustained, while others are positively depressed by cold. Never expose a patient in the course of imrsing while in the ojjen. It is better to provide two rooms; one with a temperature of 65° F., to which the patient can be moved for the attentions demanded. In my judgment a continued temperature of 65° F. with frequent changing of the air tends to the best results. Never cover the chest with kaolin pastes. Each patient should have a well fitted, slightly padded jacket, oj)en at both sides, and held by ta])es which can be released without disturbing the patient. A mustard sinapism or dry heat is often advisable. Cups are of value for pleuritic pain. When pain is severe and exhausting, the patient should be relieved by morphine sulphate in small doses subcutaneously. It does no harm in my judgment. The time to treat failing heart is un- doubtedly before it happens. Solomon Solis-Cohen has aptly said: "The disappointment experienced by many practitioners in the use of remedial measures lauded by otliers is often owing to the neglect of the factor of timeliness." Always care- fully examine the heart for its inherent virtues or faults. If murmurs are present, estimate their significance and i)rognostic import. Are there valvular Can You Really Order Cialis Online lesions, aortic involvements, or cardio- vascular impairments? These should be recorded early in the treatment. Look for mitral stenosis especially ; detect the jerky action and the dispro- portion between cardiac effort and pulse result : note the feel of the artery with its slight excursion and the rapid beat. Anticipate its failure with the digitalis advocated. Watch for signs of impend- ing dilatation of the right heart, i. e., rising respira- tion, increasing pulse rate, falling systolic pressure, the appearance of increasing small, moist rales over the bases. A lifesaving Can You Really Order Cialis Online measure is to relieve that failing heart, not by whiyiyiing it unduly bv large doses of strophanthin or ch'gitalis, but by easing the circulation by the Can You Really Order Cialis Online removal of twelve to fifteen ounces of blood. In other words, bleed when in- dicated. This ancient method of treatment still has virtue in the right heart failure of pneumonia. The bleeding is not to cure the pneumonia speci- fically, but to avert heart failure and consequent death by intrapulmonary drowning. .Mcohol has no i^lace in the treatment of jmeu- monia except in cases in which as a result of its excessive use prior to the illness, delirium is Ibrcatcncd. Oxvgen cannot restore a moribmid l^atient. Its use is only of value prior to this con- dition. It is wise to make regular tabulated entries of the blood pressure on a chart. Recall that the toxemia at the onset may cause a fall of ten or more points in the diastolic pressure. Thus a low systolic pressure and the abnormally low diastolic pressure may deceive the observer into a false security of a fair pulse pressure. Remember that a low systolic and a low diastolic tend to a [xior prognosis. The systolic must be maintained and raised, if possible. Forewarned is forearmed. It is vital that the recumbent position be maintained from the onset to the termination of the critical period, and for a period of seven to ten days fol- lowing. Complications must be recognized and met promptly and positively. As all acute infections cause a myocardial involvement to a greater or less degree, inducing degenerative Can You Really Order Cialis Online changes, insist on a slow return to the upright position, and restrain the i)atient for weeks to permit restoration of the enfeebled function of tonicity. Indicated tonics shoidd be administered. Resolution, if delayed, may be hastened by radiation and iodides. The successful care of pneumonia demands a physician who is alert, accurate in diagnosis, thoughtful, resourceful, and determined, one who is ready to resort to positive measures, if needed, and who knows no relaxation till the patient has wholly recovered or the battle lost ; one who can control the case with power, and sustain the patient, family, and friends through Can You Really Order Cialis Online his vigorous and dom- inant personality. Success must be his motto. 962 Ocean Avenue. P.rooklvn. OPERATIVE PROCEDURE FOR THE RELIEF OF CONTRACTED SOCKETS. Bv F3;.\NK Allport, M. D., Chicago. Operations for the relief of contracted sockets and extensive symblepharon Can You Really Order Cialis Online have been marked with many disappointments. The ingenuity of sur- geons has been taxed and many operations have been proposed. Most of these operations have been endorsed by their proposers with reports of suc-