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and rectal alimentation became necessary to sustain the fagged-out wholesale generic viagra system. 7:30 p.m., Thursday, July 5th. Forced respiration was again resorted to, as it had been conclusively proven in this, as in many other cases, to wholesale generic viagra be the only agent which could with certainty be regarded as a life sustainer. I made up my mind to keep it under way until the end came, "be it what it might." The result was marvellous, although improvement came slowly. wholesale generic viagra The temperature, without other treat- ment than the forced respiration viagra 40 mg and oxygen with sus- taining measures, came down from 104. 25 to 100. 8 C F., the cyanosis passed away, and the pulse improved in force and lessened in rapidity just so long as we kept our breathing-apparatus viagra 40 mg under way. Fourth day. Toward the middle of the afternoon of Friday, the fourth day and third night since my method was used, we again gave the patient an oppor- tunity to attempt his wholesale generic viagra own breathing. The apparatus was used for five minutes and then the patient was allowed two or three minutes at auto-respiration. This was kept up for a short period, as it was evident even at this late time that the respiratory centres were wholesale generic viagra not in sufficiently vigorous condition to control and keep up auto-respiration. It was very fatiguing for the pa- tient to make these efforts, and he would hail with satisfaction the relief afforded by the forced respira- tion; being perfectly conscious he could not with all his energy keep up auto-respirations. After a time the working of viagra 40 mg the apparatus wholesale generic viagra became unpleasant to the patient; the rushing of the air into the trachea appeared to bother him. The fact, how- ever, began to dawn upon us that he was getting into condition to breathe for himself, and at ten o'clock on May 30, 1896] MEDICAL RECORD. 763 viagra 40 mg the evening of Friday, July 6th, we gladly relinquished to Dr. Williams his undoubted right to do his own respirator)' work. The third and last continued period of forced respi- ration in this case began Thursday at 7 130 p.m. and terminated finally at 10 p.m. Friday, or twenty-six and one-half hours. The total time during which the ap- paratus was in constant use was nearly eighty hours. The tracheotomy tube was removed from the neck, the wound closed antiseptically, and the patient made as comfortable as possible. For some time during the use of the apparatus nutrient enemata were used, the urine was drawn by catheterization, and food and medicine were administered by the mouth. The following physicians, all engaged in regular practice, were present during the active continuance of the case. Many had not before witnessed a case of forced respiration, and all were interested in watch- ing the progress in so unusually prolonged and valiant a fight for the life of a brother practitioner: Drs. Archie Drake, W. C. Earl, Thomas Bagley, Sydney A. Dunham, Barrick, Dwight G. Hubbard, Charles Albertson, Francis M. Rich, Benjamin Lo- throp, Clinton A. Sage, George W. T. Lewis, Earl Lothrop, Taylor, Frederick Preiss, Kaiser, Hoffman, Walsh, Nash, John Cronin, ex-president of the New- York State Medical Association, and others whose names I did not obtain ; also Mr. Thomas Stoddart, of Stoddart Brothers, druggists, and Mrs. Edmunds, nurse. Members of the family and friends from the neighborhood assisted in working the bellows. To Dr. Earl Lothrop, Dr. Talyor, Mr. Stoddart, and Mrs. Edmunds I am particularly indebted, as they wholesale generic viagra stood by and assisted, hour after hour and day after day, when it seemed a useless task. Hardly one of them thought it possible that the patient could recover or that the means adopted would prove so efficacious. The re- sult was, indeed, an interesting revelation to the medi- cal world. As stated in the first part of this paper, the Fell method of forced respiration has saved many lives. That it has not saved more has been owing entirely to the difficulty of introducing new methods, to unjust and unreasonable conservatism in a progressive age, when old things are passing away and a new and bet- ter, based upon truer knowledge, are taking their place. The value of the method has never before received so severe a test as in the case of wholesale generic viagra Dr. Williams. It offers possibilities never before contemplated in surgical procedures, such as the opening up of the thoracic cavi- ties under conditions which we dare not consider with- out the possibility of systematic forced respiration, and in conditions wholesale generic viagra of shock, in drowning, and in many other contingencies. The longest time during which the method was used prior to this case was at the Continental Hotel, Buffalo, in my practice. The respirations were kept up con- tinuously twenty-one and one-half hours and in all twenty-four, before the patient could wholesale generic viagra breathe for him- self.' He is now living in Pittsburg, Pa. Numerous cases have taken place in viagra 40 mg which the respirations have been under way for from eight to fourteen hours with favorable results, and in which the face mask was used instead of tracheotomy. Nothing like Dr. Wil- viagra 40 mg liams' case had ever been reasonably contemplated as a possibility. That a human being, by the ad- ministering of poison accidentally or with a mis- taken knowledge of its effects, could place himself in such condition that the respiratory centres could be inhibited for days in the performance of their func- tions, and that it might be possible to respire by me- chanical methods in such a condition for days at a 1 Dr. Wm. P. Northup in British Medical Journal, September, 1894, reports a case which required twenty-five hours of forced