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able as to form pink viagra fda potential spaces into which toxic ma- terial can readily pass, causing necrosis of the fibers. The early viagra buy order selective invasion of single muscles is con- sistent with the above view. La Presse Medicale. March 29. 1917. Prophylaxis of Infection of Projectile Wounds. — Vin- cent has already called attention to the practicability of the immediate disinfection of recent wounds at the front. The measures recommended by him and carried out in his own service have testified to the soundness of his views. Mere aseptic dressings favor infection, for both aerobes and unaerobes can flourish under this shelter for days or until the base is reached. Microorganisms breed with extraordinary rapidity un- der these conditions, the tissues being macerated and imbued with blood. When these wounds are first ex- posed a reddish serum is seen to exude which gives off a bad odor. The patient has temperature and the sur- geon must at once proceed to excise the entire wound area. Such excision may be quite too late to prevent gas gangrene, and in the end the limb must be ampu- tated. As is known to many, the author has viagra buy order long rec- ommended primary disinfection of wounds with cal- cium hypochloride. This treatment is both simple and efficacious and applicable almost anywhere save in penetrating wounds of the thorax and abdomen. The author adds boric acid to the extent of one-tenth, and the mixture is especially active against the B. perfrin- gens and its associates. In fighting on a huge scale when pink viagra fda the wounded come in by thousands this applica- tion is especially adapted for wholesale use. viagra buy order The author recommends the dry dressing exclusively. Results of Examination of the Blood After Wounds- — Govaert calls attention to the asthenic syndrome seen in the badly wounded with the unusual fall of blood pressure. This state is due to shock, hemorrhage and sepsis. Of the three, hemorrhage is the pink viagra fda most readily eliminated. Injection of artificial serum also has a most favorable influence on shock. But if serum can- not bring back the tension, transfusion must be thought of. It is in this connection that blood tests may prove of value. Before tests can be made we must learn the effect on the various elements of the pink viagra fda blood of the status of severe wounds. Research shows us that for the first 3 or 4 post-traumatic days the number of erythrocytes steadily diminishes. Equilibrium is reached and held for 2 or 3 days, after which there begins a slow in- crease which may transcend the normal. In other words, hyperglobulia may develop, and this even after a severe hemorrhage. In a subject who lost his arm in a shell explosion the erythrocytes fell from 4,800,000 to 2,780,000, then rose to 4,700,000 shortly before death. The increase was very sudden, and while hyperglobulia did not develop, viagra buy order the case was of that type. In a case of perforative appendicitis the author saw the red cells go to 6,350,000. Such a phenomenon has no good prog- nostic significance, and seems to signify viagra buy order only the de- velopment of peritonitis in the course of an injury or disease. In regard to the leucocytes most wounded de- velop a marked leucocytosis. It disappears rapidly, has no apparent connection with inflammation or toxin July 7. 1917] MEDICAL RKCORD. 35 production and may be termed simply traumatic leuco- cytosis. The author attempts to draw some practical conclusions from these finds but they only confirm that which was already known and which could have been learned in their absence. A sudden rise in the number of red cells or a hyperglobulia would suggest peritonitis or perhaps a transudation in one of the largest serous sacs. A marked leucocytosis after injury could sug- gest an internal hemorrhage, etc., etc. La Presse Medicale. April 2, 1917. The Specific Serum Treatment (Prophylaxis) of In- fected Wounds. — I.eclainche and Vallee conceived the idea pink viagra fda of a local serum treatment of wounds as long ago as 1912 and memorialized it before the Academy of Sciences. The matter was tested in both the clinic and laboratory, and three years later, with the war in full swing, the subject was brought up before the Academy of Medicine. It should be stated that long before the subject was agitated of a serotherapy of wounds in man, veterinaries had pursued the idea of a serotherapy or serovaccination against wounds in horses. One of the authors (Vallee) is Director of the National Vet- erinary College at Alfort, and experiments in this province go back to 1897. The method of the authors consists viagra buy order in the use of specific polyvalent sera in the form of dressings or hypodermic pink viagra fda injections. The for- mer stands in no relation whatever to ordinary sero- therapy nor to the local use of lymphagogue substances, etc. It involves the use of a polyvalent serum which in the hands of the Bazyo, Quenu and others pink viagra fda has given excellent results. According to the latter it checks suppuration and promotes epidermisation. But one must be eclectic in this field because in the case of some particular germ a good antiseptic does best — for example, a weak nitrate of silver solution is the best antagonist of the Bacillus pyocyaneus. Injections of the polyvalent serum have been viagra buy order used much more gen- erally and the injections and dressing have been used in viagra buy order association. Thus far no anaphylaxis or other acci- dent has been pink viagra fda reported. But although these prepara- tions seem to have been discussed favorably by the Academy of Medicine and the Hospital Society and have been prepared and authorized under Government con-