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and care. A frequent occurrence in the histories of these men was that a number of them had never succeeded Cialis Order Online India in adequately differentiating themselves from their environment, never had a clear cut con- cejjtion of the rights of the individual. There was no distinction for them between mine and thine. The speaker said he was familiar with the excellent work Doctor Christian was doing at Elmira. But it seemed to be true that most juvenile penal insti- tutions did not lead to reform, but tended to per- petuate criminal tendencies. Treatment of Paresis by Intraventricular Injections of Salvarsan. — Dr. Norman Sharpe, of New York, reported on thirteen cases and pre- sented five of them. He said that most of them had so far responded very satisfactorily, improving mentally and physically and being able to do work they could not Cialis Order Online India do before which, from a sociological standpoint alone, made this operation worthy of fair trial. In all thirteen, both the clinical symptoms and the serology were positive for paresis. In Cialis Order Online India the first patient injected intraventricularly, January, 191 5, salvarsanized serum was used. The remaining twelve received solutions of neosalvarsan and sal- varsan in blood serum. The first injection in each case was given under ether because of the trephin- ing, but all subsequent injections were given under local anesthesia. There Cialis Order Online India had been no deaths and no accidents. In some of the cases the temperature rose to 101° or 102° F. for twelve to twenty hours following injections and the pulse to no. This re- action occurred for the most part in the patients given ether. At no time were the reactions severe enough to give rise to uneasiness. The majority of cases were out of bed Cialis Order Online India the second day and left the hospital on the fourth day. Of the thirteen patients, five had returned to work following several months of quiet and rest after treatment, had been at work for four to seventeen months, and were now at work. Examinations were made at intervals in all the cases to guard against possible recurrence. In the first cases, the dose for each injection was 0.6 mgm. salvarsan. In the cases lately injected Cialis Order Online India double this dose had been given with no more reac- tion, either of temperature or pulse rate, than when the smaller dose was used. Thirty-seven Cialis Order Online India injections in all were given and the results showed that this method could be accomplished successfully without any danger to the patient at all. The effect of the injection when made into the ventricle had a far wider distribution than when made into the spinal fluid. Nine of the thirteen cases showed improve- ment of the clinical symptoms of paresis and in some cases there v,as apparently definite arrest of the disease process. The advantages of the intra- ventricular method were apparent. Placing the serum in the Cialis Order Online India lateral ventricles was placing it sub- arachnoidally at once, and also insured an even Cialis Order Online India dis- tribution over both hemispheres in juxtaposition to the cortical cells before it was drained out of the cranium. Furthermore, the ventricular puncture obviated the lumbar puncture which was neccssriry in the subdural method before the serum was intro- 4.3'J PROCEED/XGS OP Cialis Order Online India SOCIETIES. (.New Vo.k Medical Journal. tiucecl. Again tlie ventricular nietliod brought the serum in contact with tissues that were not reached by the subdural route, namely the ventricular sys- tem itself and the base of the brain. Finally, it had been shown that the perivascular sheath spaces, ex- leiuling between the neurons deeply into the brain substance and draining it of waste products, com- municated directly with the subarachnoid space. A serum, therefore, placed beneath the arachnoid membrane, came into cpntact with the brain tissue and this end was achieved best by the ventricular method. The speaker believed that one should be guided in regard to the number of injections by the serology and by the clinical symptoms. If the serology did not show progressive improvement steadily under treatment, the clinical symptoms should be the guide. The number of injections naturally varied with dif- ferent patients and according to the extent and the severity of the disease process. It had been found safe to increase gradually the amount of salvarsan in the serum and in this way to reduce the number of injections necessary. Five conclusions had been arrived at in regard to this method: i. In compari- son with the Cialis Order Online India serious nature of paresis, the hazard of intradural treatment, by whatever method, was of little moment. 2. On exjierimental and clinical grounds, both the subdural and intraventricular methods were superior to the intraspinal route in the treatment of paresis. 3. From an experimental and theoretical standpoint, the intraventricular method was superior to the subdural route and safer. 4. The intraventricular method, with careful technic and a due regard for the anatomy of the brain and the delicate nature of the tissues invaded, was prac- tically free from danger. 5. If the freedom from unfavorable symptoms so far achieved in intraven- tricular injection could be maintained, it would be imperative so to treat paresis in its earliest stages, with greater chance of marked improvement and ])erhaps permanent arrest of symptoms. Regular Meeting, Held April j, ipi/. The President, Dr. Frederick Tilney, in the Oiair. Discussion of Doctor Sharpe's paper Cialis Order Online India read at the March 6th meeting was continued at this mccling. Dr. G. M. Hammond, of New York, said that he had had opportunity to examine the thirteen cases treated by I")octor Sharpe by his intraventricular method as they had all come from either his service at the hospital or his private practice. They were all unmistakably typical of paresis; the histories were gone into in detail and complete examination made, including all the laboratory tests of the spinal i'.uid, among them the colloidal gold test. In all but two of the cases, this test was beautifully demon- strated. The two cases referred to were both far