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bral symptoms already described, no remedy equals corrosive sublimate, and if anaemia is very pronounced it can be given with the sweet spirit of nitre and the muriated tincture of iron. No remedy is so decidedly effective generic viagra singapore as corrosive sublimate against this common cause of declining health, producing premature old age. The bromide of lithium has been employed re- cently in these cases with some success. It is best given in doses of five grains three times per day. It can be combined with the benzoate of sodium in the same doses. It is a well-known clinical fact that structural de- generation of the kidneys comes on very slowly, and is always the result of renal irritation, continuing sometimes for years by imperfect intestinal digestion. We know there buy viagra easily are constantly forming in the intestines by normal processes of fermentation soluble alkaloidal poisons, which are taken up by the portal circulation and conveyed to the liver, whose function it is to de- stroy them. Now, if the liver is out of order and can- not kill these poisonous products, they enter the gen- eral circulation and produce most serious results. A large number of these poisons have been isolated, some of them resembling atropine, curare, and other powerful poisons. Healthy urine, which contains several of these, is more poisonous than the urine of diseased kidneys. It is now generic viagra singapore known that urea is not the cause of uraemia, for we often find no buy viagra easily diminution in the amount of urea in the cases of many persons who show uraemic symptoms. It has been satisfactorily demonstrated that uraemia is entirely due to the pres- ence of these alkaloidal toxins in the blood. There- fore, in every case of chronic nephritis buy viagra easily intestinal an- tiseptics should be used. Five grains of salol and five grains of the subcarbonate of bismuth are very useful for this purpose. A course of mineral waters is a very useful adjunct to this treatment, especially if begun in the early stages of the disease. When there is obstruction to the general circula- tion, caused by spasm of the arteries, the heart beat being rapid, strong, and vigorous and accompanied by an incompressible pulse, it means extreme danger. This condition is present in uraemic convulsions and puerperal eclampsia, where the pulse may run up to 130 or 140 per minute. In ordinary cases of fever a rapid pulse is not necessarily dangerous, but when the rapid action is accompanied with an incompressi- ble pulse it becomes extremely serious. This condi- tion is also found in acute alcoholic coma. General generic viagra singapore blood letting is imperative. If this cannot be done, large doses of the tincture of veratrum viride should be given. It will moderate the pulse, cause the heart to generic viagra singapore beat less strongly, open the contracted arteries, and make the pulse compressible. I have given twenty minims buy viagra easily every twenty minutes for one hour and a half before the convulsions ceased. Hypodermatic injections of morphine sulphate are sometimes very useful in uraemic convulsions. The dose should be increased from one-fourth grain up to one-half grain, and be repeated every two hours until the convulsions are controlled. SEVERE POST-DIPHTHERITIC PARALYSIS IN buy viagra easily AN ADULT TREATED BY ANTITOXIN. By GEORGE THEO. MUNDORFF, M.D., HOUSE PHYSICIAN, ST. FRANCIS HOSPITAL, NEW YORK CITY. John M , aged twenty years, single, born in Ire- land, by occupation a hotel porter, was admitted to St. Francis Hospital, service of Dr. August Seibert, March 2, 1896, complaining of general weakness and partial paralysis of the limbs. Family and previous personal histories were negative. History of present illness: On December 25, 1895, the patient took sick with a severe attack of diphthe- ria, which kept him confined generic viagra singapore to his bed for ten days. He received internal medication, but no injections of antidiphtheritic serum. A few weeks after his appar- ent convalescence he noticed his articulation of buy viagra easily words becoming indistinct, deglutition becoming embar- rassed, the swallowed drinks regurgitating through the nares, and his voice acquiring somewhat of a na- sal character. In addition, he suffered from double vision, scanty urination, and constipation. Subse- quent to this buy viagra easily walking became difficult, and finally his arms became powerless. Conscious of growing stead- ily worse, he decided to enter a hospital. The patient was over six generic viagra singapore feet in height and weighed about one hundred and fifty pounds. He was anaemic and emaciated. The muscles of the trunk and of the four extremities were visibly atrophic, particularly noticeable in the pectorals, the deltoids, and the biceps. Patellary reflexes were generic viagra singapore entirely absent. The pupils were widely dilated and the vision was slightly im- paired ; there was no strabismus. The voice was generic viagra singapore hoarse, speech indistinct, and the pronunciation of the gutturals somewhat difficult. Examination of mouth: the velum palati was partially insensible to touch and absolutely motionless. The isthmus of the fauces and walls of the pharynx were slightly anaesthetic. The uvula was motionless and atrophied. There was diffi- culty in rising. The patient was barely able to sup- port himself on his legs. The feet were cold. Appli- cation of electricity to various muscles elicited very weak response. Diagnosis: Post-diphtheritic paralysis. Treatment: Following Dr. Seibert's suggestion, an injection of the antitoxin of diphtheria (seven hun- dred and fifty units) was given above the right rectus abdominal is on March 4, 1896. There was no appre- ciable rise of temperature following this injection. 924 MEDICAL RECORD.