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ly as may be, or so dilutes it that it can do harm only in a less degree ; and it will be found that the secretion actually decreases in proportion to the disappearance of the cocci from it. I think that for this reason the irrigation should be maintained for several minutes at a time — ten Tadalis 20 Mg to fifteen minutes. I would then paint the conjunctival surfaces of the upper and lower lid with a two-per-cent. solution of silver nitrate, Tadalis Tablets or even twelve per cent, if the conjunctiva is much swelled ; and, in case the latter strength is used, wash afterward with a solution of sodium chloride. The strength of the silver solution is to be regulated by the succulence and vascularity of the conjunctiva — the more pronounced these conditions, the stronger should the solution bo. This having been done, cover the conjunctiva with an antiseptic dressing consisting of boric Order Tadalafil acid [sir per cent.) m- carbolic acid [two per cent.) and vaseline. The vaseline will be retained much long- er than a watery solution would be. Tiiis dressing will, in a great measure, have the Tadalis Sx power (without injury to the cornea) of Buy Cheap Tadalis arresting the vital activity Buy Tadalis of the bacteria, of starving them out, as it were, by so changing the nutritive pabulum re- qiiirrd fill' their dcvclopiiiciil that tlicy ciiM not a|)propriatc Oct. 31, 1885.J CORSINO: SPINAL ANESTHESIA AND LOCAL MEDICATION OP THE CORD. 4S3 it to their use. The irrigation will Tadalis Online have to be repeated as often as may be indicated by the quantity and quality of the discharaje. If Cheap Tadalis there is much swelling Tadalis 20 of the eyelids, the outer caiithus should be cut. The application of cold should not be made with ice-bags. Pledgets of linen — to be buraed after use — should Generic Tadalis be laid on a piece of ice at the bedside, and this application of cold requires care and a constant attendant. In Buy Tadalis Online the severe forms of gonorrhoeal conjunctivitis — and this disease is nearly always very severe — when not seen very early and treated at once, the cornea runs great risk. The eyelids are intensely swollen, and when the ocular conjunctiva is much infiltrated the cornea is in great dan- ger of suppuration, and the treatment should be directed to the reduction of the pressure on the eyeball and diminution of the secretion Purchase Tadalafil already formed. The pressure caused by the chemosis and swollen lids compresses the vessels Tadalafil Mg which supply the margin of the cornea, causing an insufficient cir- culation. In order to remove this factor, the outer commis- sure should be divided to its fullest extent, together with the canthal ligament. The late Mr. Critchett, of London, proposed to divide the upper lid vertically to the orbital Tadalis Uk margin in severe cases, evert the flap and fix it to the skin above, and he says the cornea does not suppurate when this is done. Fuchs* has modified this operation. He divides the outer commissure to such an extent as to relieve also the symptoms of pressure. He then puts a suture through the lower lid and attaches it on the cheek, ectropionizing it entirely. He detached the suture, in the case he reports, at the end of the fifth day, and the healing was good. K the cornea is involved, it requires special attention in addi- tion to the use of atropine. A thorough removal of the secretion from the upper cul-de-sac is not possible Buy Tadalafil Online by the ordinary means; this may, however, be done by means of a simple instrument which I have deWsed for the purpose. The instrument is an eye-speculum, the arras of which are hollow and the claw deeper than in the ordinary eye-specu- lum ; it has a number of perforations for the passage of the fluid, which is supplied by a fountain syringe. It is inserted between the lids with great gentleness, and care should be taken Cheap Tadalafil not to injure the cornea with it. The lids should be gently lifted from the eyeball by means of the speculum, and the spray of fluid allowed to play upon the upper cul- de-sac. Even when the lids are extremely Order Tadalis painful, it is a relief to have them gently lifted from the eyeball and the stream of fluid allowed to play upon the upper conjunctival cul-de-sac. Of course the use of this instrument should not be in- trusted to an ordinary nurse, but the physician can at least perform the operation twice daily, and keep up the irrigation for from ten to fifteen minutes. The solution of carbolic acid in the case of adults, when the inflammation is intense, may be as strong as three per cent. — to be diluted as the ini]>rovcs; this is astringent as well a,s antiseptic. And the silver I would apply, according to the exigency of the case, in four-per-ccnt. or twelvc-per-cenf. solutions, and neutralize with salt and water, and then apply the medi- cated vaseline to the conjunctiva, and over the lids the iced ♦ "CVntialhlnit f. priikl. AupenluMlkiiiulc," 1881, p. 198. cloths. Iodoform has not met with much favor in this dis- ease. Quinine in solution has also been used, but it has no J^o.L The instrument shown in Fie:. 1 may be used for either eye, the tube with the water-supply being attached at c. and to the upper branch only in case it is desired to irrigate the upper c>jf-tie-mc alone. Fig. 2 represents a folding lid-elevator (of large and small size) designed for the same purpose as the epring-specnlum. The tube of the fountain syringe is attached at 6.* advantage over the carbolic acid. Dr. H. Linds Buy Tadalafil Ferguson (Dublin) reports cases of gonorrhoeal conjunctivitis Purchase Tadalafil Online in which he has had good results from the use of finely powdered boric acid. The bichloride of mercury has no claim to advantage over the boric acid. Diphtheritic Coxjcnctivitis. — Measures of prophy- laxis based upon bacteriology must lie in the futu»e. We must be content with the enforcement of general hygienic laws. Mr. Tweedy f used one-per-cent. solutions of quinine in this disease, and did not see any serious damage to the cornea when if was used. Iodoform does not seem to bo of much use in diphtheritic conjunctivitis. Vossius| recom- mends a four-per-cent. solution of salicylic acid in glycerin. 40 West Twenty-kourth Street, New York. SPINAL ANESTHESIA AND LOCAL MEDI- CATION OF THE CORD.

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