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outside the human body, and even in the alveolar spaces themselves. Its use should be guided by certain laws, and given in proportion to body weight. A stated amount equal to 0.024 gram to a kilogram of body weight seemed to keep within Cialis 20 Mg Reviews the toxic action of the drug. The first dose given early should be large, and smaller doses given at three hour intervals. It is given in capsules. Personally, I have used the drug extensively and administered it in doses of 7.5 grains three times a day. While transient amblyopia has been noted, and should be kept in mind, this has not happened in my experience. This drug undoubtedly proves valuable in the treatment of croupous pneumonia. It has the endorsement of Rockefeller Institute. J. The Seibert mclhod. — The use of large doses of camphor as proposed by Dr. August Seibert, of New York, merits consideration. The most im- portant therapeutic indication in croupous pneu- monia is to prevent, or to modify, the effects of toxemia. Realizing the condition of bacteriemia existing, Seibert seeks to overwhelm the pneumo- cocci in the blood stream, thus causing a subsidence of the vicious inflammation by lysis instead of by crisis. This he firmly believes can be accomplished by large doses of camphor, the action of which, theoretically, is said to be antimicrobic, there being evidence of the destruction Cialis 20 Mg Reviews of the pneumococci both in the blood stream and lung tissue. By the destruction of the causative germ, lysis results. This camphor method seems to be new and original with Seibert. As soon as possible after the chill, ten c. c. of camphor in oil, equal to thirty-six grains of pure camphor is Cialis 20 Mg Reviews administered hypodermically in the tissue along the outer side of the thigh and re- Cialis 20 Mg Reviews peated every twelve hours, except in bilateral cases and in severe toxemia, when it Cialis 20 Mg Reviews should be repeated in eight Cialis 20 Mg Reviews hours. The site of the injection should be ])ainted with iodine and the injection made very slowly, taking ton minutes, if possible, for the ten c. c. The injection is practically painless, and if care is taken, produces no abscess. Seibert's results, thirty-six cases with thirty-five recoveries, are most striking. He advises this treatment in all forms of croupous and irregular pneumonias with consolidation and toxemia. The method is used as the dominant treatment Addi- tional treatment directed toward the various symptoms and cardiac failure is always recom- mended. The earlier the camphor is used the quicker is the response. This method may also be considered as following the lines of chemotherapy. Seibert thinks that Cialis 20 Mg Reviews the camphor has a semispecific action upon the pneumococcus analogous to salvarsan over the spirochetes. Personally, 1 have had some experience with the remedy, and outside of the production of one abscess, saw no evil ef- fects, and believe that it exerted a great influence for good. In three cases of great severity, with empyema complicating in two, and intense jaundice from hepatitis in the third, all recovered. 4. The Solomon Soils - Cohen method ii-itk massive doses of quinine. — This method, hkewise, follows the theory of chemotherapy. Cohen advises, as soon as the diagnosis is verified, that the patient, if fairly strong, receive an intramuscular injection of from fifteen to twenty-five grains of the drug, quinine and urea hydrochloride, in a fifty per cent, solution of hot sterile water. Chil- dren, and aged and feeble subjects receive smaller doses. The injection is repeated with fifteen grains every three hours until the temperature falls and remains below 102° F. Associated with this plan, special attention is given to the blood pressure which is taken very carefully every three hours. To control the blood pressure, cocaine hydro- chloride in 0.5 grain doses, or pituitrin, one mil, is injected hypodeniiically and repeated every three hours until the curve representing the systolic blood pressure in millimetres of Hg taken on the arm remains above the curve representing pulse frequency in beats a Cialis 20 Mg Reviews minute. This latter practice is founded on the obsen'ations of the late G. A. Gibson, of Edinburgh, concerning the prognostic Cialis 20 Mg Reviews Cialis 20 Mg Reviews significance of the relation between pulse frequency and pulse pressure thus charted. Though present opinion lays less stress upon the Gibson law than formerly, still the prognosis is more encouraging if the pressure is maintained. No maximum or minimum limit has been fixed to the number of injections of quinine, cocaine, or pituitrin, which may be used in place of the cocaine, but Cohen does not think it wise to con- tinue the three hourly injections beyond the first twenty-four hours. In cases where the desired effect, as indicated by Gibson's blood pressure rela- tion, has not been reached in twentj'-four hours, the interval is Cialis 20 Mg Reviews increased to six hours. \\'hen the desired effect is gained, the repetition depends upon its maintenance. In general, the object is to give as much quinine as is necessan*' and can be safely borne witliin the first twenty-four hours, and as little cocaine or pituitrin throughout the treatment as is possible. The quinine is stated to be anti- toxic. This conclusion is further strengthened by the absence of cinchonisni, notwithstanding the large quantitv given and absorbed. Theoretically, March 16, 191 S.J IVES: CROUPOUS TYPE OF PNEUMONIA. 483 there is supposed to be a mutual neutralization of the quinine and the pneumonic poison. Cohen states: "I'his plan is superior to any other proposed. The control and Cialis 20 Mg Reviews relative ease of the respiration is wonderful to behold. . . . The whole clinical picture is changed." Cohen uses as little as one injection or as many as fifteen injec- tions. In an ordinary case, however, the number of injections will be five or six, and the number of cocaine or pituitrin injections three or four each. Experience proves that the efifect of the quinine