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vomiting, and diarrhoea. In one case the tempera- ture rose to 105° F., preceded by a severe chill, and followed by vomiting which lasted for twelve hours. After this ceased, the temperature returned to normal and the patient had no other unpleasant by effects excepting a Viagra Soft Tabs 100mg Review very marked herpes involv- ing the upper and lower lips. In a few cases I have noted a subnormal temperature, 97° F., and in one a slowing of- the pulse to 42 from fifteen min- utes to half an hour after the injection, gradually becoming normal again. There is less likelihood of having a reaction after the administration of the drug if the patient takes a cathartic tlie night be- fore and only a very light lunch the day of treat- ment. It has seemed to me, too, that there has been less constitutional disturbance since I have substi- tuted distilled water for the salt solution in making up salvarsan. This method is advocated by Schrei- ber, who believes that too hypertonic a solution is obtained by the addition of the saline. As part of the general reaction following the injection of the drug a cutaneous eruption Viagra Soft Tabs 100mg Review sometimes makes its ap- pearance. I have met with several types, such as herpes of the lips and of the cheek, a morbilliform and scarlatinifnrm eruption, and urticaria. In the case of a woman with a very marked macular eruption a decided morbilliform rash appeared six hours after the injection. Within twenty-four hours the roseola had practically disappeared. I have repeated the injection twice in forty-seven and three times in two cases ; in the majority at intervals varying from one to four weeks. In Viagra Soft Tabs 100mg Review a number the reaction was very much more marked after the second injection. In one case of early Viagra Soft Tabs 100mg Review tal^es to whom 0.4 gramme was administered intra- venously, there was absolutely no general reaction bevond a group of herpetic vesicles on the cheek. At the end of a week I repeated the injection. This was followed by a decided chill, rise of tem- perature to 102° F., and vomiting. His fever per- sisted for three days and then declined to normal. On the third day a marked scarlatiniform eruption developed. Other effects noted not infrequently after Viagra Soft Tabs 100mg Review the administration, especially the second dose, are head- ache and insomnia lasting several days. In some patients the reaction does not proceed to vomiting but interferes very materially with the appetite and ability to take food. This passes off in three or four days when the appetite often becomes raven- ous. The local effects following an intravenous ad- ministration depend on the perfection of the tech- nique, and secondarily on the susceptibility of the individual to arsenic and the character of the veins. If the latter are thin walled there is more danger of leakage in the surrounding tissues, and when the patient is susceptible to arsenic this may lead to pain and persistent induration, and when accom- panied by thrombosis to serious local symptoms. I have in only one case noted symptoms, follow- ing an injection of salvarsan. which gave rise to anv nnxietv : These appeared in a child, seven and a half years old. treated on March 30, 191 1, for a gummatous infiltration of the nose and upper lip with 0.2 gramme alkaline solu- tion intragluteally. On April 3d, convulsive seizures de- veloped lastmg about a minute, with cyanosis, opistho- tonus, and loss of consciousness. On the following day the convulsions were very numerous but finally controlled by chloroform, chloral, and bromides. Dr. Jelliffe exam- ined the child on .\pril 5th and reported a right sided j hemiparesis, with Babinski and loss of abdominal reflex on that side. That evening the patient was much bette: and has continued to improve so that at this time h lesions are healed and he is practically Viagra Soft Tabs 100mg Review well. The a- sumption of a lesion at the base of the brain with the development of a Her.xheimer reaction is not untenable in this case. Many criticisms directed against the employment of salvarsan in the treatment of the disease are based Viagra Soft Tabs 100mg Review upon results of inefficient and minimum sin- gle doses. In the use of arsenic as a cauterizing agent in skin lesions where a rapid destruction of tissue is brought about, absorption of the drug does not take place, its entire action being local. The same thing probably occurs with suspensions or solutions of salvarsan in concentrated form either in the muscles or in the subcutaneous tissue. In such cases where it exerts a rapid destructive effect probably only a small percentage is absorbed. This fact has recently been emphasized in a series of cases which I have seen that were treated in one of the so called "606 laboratories." Viagra Soft Tabs 100mg Review The drug was injected into or beneath the skin in the interscap- ular region and was quickly followed by necrosis of the skin and underlying tissues. Here one would expect to obtain very little if any constitu- tional effect. For criticism of the drug to have any weight the methods of observers should be identical as to preparation, dose, and repetition. Most of the criticisms have been made by inen who have had very little experience in its preparation or adminis- tration. Too much was evidently expected of the remedy in the beginning, and while all of the claims made for it have not been fulfilled, it is not fair to condemn it because of failure to obtain Viagra Soft Tabs 100mg Review results when technique and judgment in using it were im- perfect. If nothing more has been accomplished by it than the rapid cure of the early manifesta- tions of the disease, its introduction into medicine will have been worth while, for it is a well recog- nized clinical fact that the secretion from mucous patches is more potent in spreading the disease than any of the other manifestations. The rapid influence of salvarsan on these lesions is generally adiuitted. This point is well illustrated in the case of a husband and wife, who were recently admitted to my service Viagra Soft Tabs 100mg Review in the City Hospital. The wife had been infected by her husband and both were in the active contagious stage of the disease. They were exceedingly desirous of having these contagious lesions cured on account of a family of Viagra Soft Tabs 100mg Review six children at home. After the administration of the drug all outward manifestations disappeared and they were enabled to return to their home witli safety. CONCLUSIONS. In the primary and secondary stages of the dis- ease two doses of salvarsan combined with active luercurial medication, materially shorten the dura-