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the vesicles drying up early, with less tendency to the formation of bullae than usually occurs. This does not occur in all cases, but perhaps it has been the fault of the dosage. In elderly sub- jects and in those of a neurotic temperament, the failures have been most frequent. The abortive action is not so reliable if the case is not seen until the eruption is in an ad- vanced stage, hence the importance of early ob- servation and treatment. In this Nizagara Tablets respect it re- sembles the use of antitoxine in diphtheria. The dose of antipyrin given has been ten grains twice a dav for three or four days in cases of adults and in children and in old people the proper corre- I2I4 TUTTLE: RECTAL SURGERY. spending amount. The treatment here recom- mended is based upon observations made in many cases of the disease. It is possible that the dose of the coal tar prep- aration should be increased in the more severe cases or in those cases that do not appear to be quickly influenced bj' the treatment, especially at the beginning. Future observations may en- able me to lay down more definite rules for in- dividual cases. Although not a believer in the malarial origin of zoster, as in the cases so far in which I have examined the blood, the Plasmodium malaria was not found, I have given quinine also, but I am satisfied that the benefit was derived from the coal tar preparation. When we consider the pain and suffering dur- ing an attack of zoster and the serious after re- sults in some cases, the persistent neuralgic pains lasting years and months, we must recognize the value of a treatment that will usually abort the disease, lessen the injury to the tissues, and prob- ably prevent subsequent neuralgia. For the pain, codeine can also be given if necessary, and in neurotic subjects bromide of potassium is often of benefit. To sum up, the plan of Buy Nizagara Online treatment I recommend for herpes zoster is : Rest, attention to the gen- eral nutrition of the body, the combating of the microbes, the application of cold over the affected ganglia, a coal tar preparation for the toxaemia, and codeine and bromide of Nizagara Online potassium for pain not controlled by the antipyrin. Local treatment consists in aseptic and antiseptic measures. If the case is seen at a very early stage, the affected area can be disinfected in the usual manner by soap and alcohol and then painted with flexible collodion — and when convenient an antiseptic gauze applied. If seen later, when vesicles are changing in color, an ointment of boric acid and bismuth subnitrate, and avoidance of soap and water meet the indications. Later ichthyol can be added to the ointment, or an antiparasitic prep- aration, as the ammoniated chloride of mercury ointment with rose ointment to which bismuth may be added and also ichthyol. For the persistent neuralgias following zoster, anodynes and the faradaic current or x ray may be of Order Nizagara some curative value, but on account of prob- able structural changes in the nerves and con- nective tissue of the ganglia, the condition is ver}' rebellious to usual methods of treatment for neu- ralgia. Tonics, such as phosphide of zinc, and alteratives, such as arsenic, are also recom- mended. I will not mention other methods of treatment that have beerr proposed ; I have desired to pre- sent original observation or experience on the subject and conclude with expressing the hope that you are satisfied that the subject is suffi- ciently interesting to be worthy of your atten- tion. 159 West Forty-ninth Street. LOCAL VERSUS GENERAL AN.^STHESIA IN RECTAL SURGERY.* By IAMES p. TUTTLE, :^I. D., NEW YORK. The two features Buy Nizagara which chiefly distinguish mod- ern surgery from that of former periods are anesthesia and asepsis ; upon these depend the com-

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