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respiration. However, it is worth while mentioning the few inefficient procedures at our disposal by which we may assist in restoring the circulation. 1. We ought to order levitra viagra keep order levitra viagra in mind that in a great many instances the very act of performing proper arti- ficial respiration generic viagra 10mg may render a direct service to the circulation. At a certain low ebb of life the failure of the circulation and that of the respiration form to gether a vicious order levitra viagra circle: when the respiration is in- efficient the blood which circulates through the cor- onary arteries is insufficiently oxygenated, whereby the contractility and conductivity of the heart mus- cles become generic viagra 10mg greatly reduced and the heart com- mences to fail. This in turn retards and lowers thts circulation within the medulla oblongata, whereby the respiratory (and the vasomotor) centers become asphyxiated. Thus the deleteriousness of the circle continues to increase until both functions finally fail. If before the final failure we could cut through the vicious circle, we may succeed in reversing the process to such a degree as to restore both functions. By employing an efficient method of artificial generic viagra 10mg res- piration we may therefore be capable also of help- ing the failing circulation and thus restore the life of the sinking individual. Thus efficient artificial respiration may be considered as a contributing factor in restoring the failing circulation. 2. Massage is sometimes an invaluable procedure in restoring the heart's action. Massage of the heart is frequently executed by rhythmically strik- ing the thorax at the region of the heart. If em- ploying the Sylvester method for artificial respira- tion generic viagra 10mg a heart massage order levitra viagra can be exercised when return- ing the arms to the thorax. In some cases massage of the heart was performed from the abdominal cavity through the diaphragm. We shall not dwell here on further details of that method. 3. The injection of adrenalin by the intravenous or intracarotid methods (Crile) may prove as a useful remedy in restoring the heart's action. In experimental work its good effect has been fre- quently observed. 4. The compression of the abdomen, as we em- ploy it in our method of artificial respiration, drives, as stated before, a part of the blood from the splanchnic region into the heart and from there into the general circulation. In experimental work we have frequently observed that this method is capable of increasing the blood pressure by 20 or 30 mm. of mercury. The old method of employing various forms of stimulations in resuscitating the apparently dead ought not to be neglected. While it is quite generic viagra 10mg probable that few of these methods, when used alone, have ever restored life, they may nevertheless render some service when used in combination with more efficient methods. The application of heat, friction, the mechanical and chemical stimulations of ;he mucous membrane of the nose, may sometimes ren- der contributory service. Stimulation of the pre- cordial or generic viagra 10mg pudic regions or of the soles of the feet frequently exert an effect upon the respiration (i.e., if the respiratory mechanism is not entirely par- alyzed) and may at the same time affect the vaso- motor centers and perhaps also the heart by the way of the accelerator nerves. While all first-aid men must be impressed with the fact that their first at- tention must be given to the respiration, it is not necessary to impress them that all the other means have no value. Anything which contributes to the resuscitation in the smallest degree should not be omitted, provided that the essential procedures are well taken care of. Before concluding, I wish to add the following few brief remarks: As it will be seen in my present paper, I omitted the advice given in previous papers, namely, that in the absence of a proper pharyngeal tube to use a mask. After a long experience and a further analysis of the conditions, I came to the conclusion that a mask is liable to do a great deal of harm by driving infectious material, usually pres- ent in the nose and the pharynx, directly into the lungs and thus produce a fatal inflammation of that organ. By using the pharyngeal order levitra viagra tube that generic viagra 10mg danger is reduced to a minimum. But I wish to emphasize here that even in this method a minimal danger is present, and therefore recommend the employment of this method of artificial respiration only in emergency generic viagra 10mg cases. When we find an individual ap- parently dead we pay little attention to the possi- bility that our attempts of resuscitation may generic viagra 10mg lead later to some disease of the victim; we would rather see the individual alive, although temporarily sick, order levitra viagra than see him dead. Nevertheless, we should reduce this possible danger to its minimum. In connection with the foregoing remark I wish to make the following brief statement. On account of the difficulties which some anesthetists meet with the introduction of the tube into the trachea, they began to advocate what they term intrapharyngeal or endopharyngeal anesthesia. I wish to go here on record that in my opinion this is definitely a retrograd step. I am not familiar with the details of the methods which some of the advocates of endo- pharyngeal anesthesia employ. From a general reading of, and occasional listening to, a discussion of that subject, I am under the impression that the methods which they employ are incapable of keeping up the respiration in case this function should fail. It seems to me that anesthetists are not familiar with the facts (or, at least, pay very little attention to it) that anesthesia reduces greatly the efficiency of the normal respiration. That patients, neverthe- less, survive the anesthetic procedure is due to the fact that the normal function is well provided with factors of safety, so that if nothing unusual hap- pens life may continue even with a low degree of respiratory exchange of gases. With my method of pharyngeal insufflation, respiration can be order levitra viagra kept up for many hours in an efficient way, but, nevertheless, I advocate its use order levitra viagra only in cases of emergency — for the above mentioned reason. From unpublished statements I learned that post-operative pneumonias