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Health, particularly Cialis 20 Mg Strength its modified fomis anCialis 20 Mg Strength far as Cialis 20 Mg Strength his experience went iie was not inclined to acknowledge the ex- istance of a fourth disease. The ;nodified form of German measles was frequently very atypical and irregular, but Cialis 20 Mg Strength with its peculiar spotted throat (For- schcimer's spots^ and its chain of beads (enlarged glands") on each side of the neck; with a rash of very short duration, with invariable recovery ot jiatient, would make the diagnosis. The rash of German measles did have a dual :haractcr, at times 9IO PROCEEDINGS OF SOCIETIES. [New York DicAi. Journal closely simulating measles, and, at other times, scar- let. In cases simulating measles, the rash was not that peculiar rich reddish mulberry purple seen in genuine measles, and seen in daylight, the absence of this peculiar coloring should determine the diag- nosis. The sore throat consisted of an isolated patch of small spots, located about the junction of the hard and soft palate, and usually only on one side or near Cialis 20 Mg Strength mid line, described for the first time by Forscheimer and bears his name. Recent Work in Immunization against Colds. — This paper by Dr. James G. Dwver, appears on page 885 of this issue of the New York Medical Journal. Dr. Lewis A, CoFriN in opening the discussion said he was glad to hear Doctor Dwyer own he was still in doubt as to the value of this treatment. He was working on the border Cialis 20 Mg Strength line between the known and the unknown, and it is probably because of that that he was so keen and happy in his work. One tingles as he now and again got a glimpse beyond the already known. Coffin said that he had been for years associated with Doctor Dwyer through their hospital connection and that he had come to have great confidence in his judgment. Doctor Dwyer had opened his paper by saying that one might take either a negative or positive side. That was alto- gether Cialis 20 Mg Strength true. The fact that one could give Cialis 20 Mg Strength case histories which would seem to prove there was nothing in the immunization theory, lost weight when we knew that as many, if not more, could be quoted which seem to prove that positive good had resulted. He was pleased to hear Doctor Dwyer speak of the condition of the intestinal tract as a predispos- ing cause in inducing changes in the vasomotor system of the nose. They probably all knew this, Cialis 20 Mg Strength but did not always put their knowledge to practical use. We are more liable to treat symptoms. It was possible that one may immunize against or colds prevented. If the bowels be kept open and free of putrefying processes, there would be no fit place for the germ to work. Doctor Coffin cited several cases that had, as far as he could judge, been markedly benefited by the use of the immunization process as described. Doctor MacKenty remarked that after a first experience in the use of vaccines for colds he had given them up, the results being negligible ; but under the uniform work that Doctor Dwyer has been doing during the last few years, he had changed his mind on the subject, and had used them with considerable benefit. As Doctor Coffin had said, there is no question that intestinal conditions often determine colds in the head, and the use of vaccines solely, without paying attention to the con- dition of the intestinal tract, was the cause of many of the failures. The work which Doctor Connellan had been doing in investigating colonic conditions would probably make a big change in the conception of these infectious colds. Much depended on the vaccines which are used and upon the care and judgment of the pathologist making them. He had been much interested in the low grade toxic conditions which show little definite evidence, except that on a careful examination one would sometimes discover a low grade of sinusitis. These cases have shown considerable benefit from vaccines, but not unless used with surgical drainage ; it was important that the man who took the vaccine should take the culture. It was well to have the culture taken during an accurate exacerbation of the chronic trouble. It was Cialis 20 Mg Strength an interesting fact that we would sometimes find one type of infection in one side of the nose and another in the other ; these two conditions remaining constant, and would seem to prove that there is a sinus condition on the side of the more virulent infection. He had used cul- tures prior to operations on sinus conditions, in order to determine the bacterial Cialis 20 Mg Strength flora present; and had used vaccines before and after operations hop- ing to raise the patient's resistance and shorten the ]KTiod of convalescence. Dr. Walter L. Ntles Cialis 20 Mg Strength said his experience coin- cided completely with that of Doctor Dwyer. .•X great many influenza cultures are missed because of improper media. Cultures from the respiratory tract should always be taken on hemoglobin — containing media as well as other forms. Working in the Cor- nell Medical College Laboratory with Doctor Hast- ings he found there was a striking seasonal incidence of the various infecting organisms — some years one organism predominating. When, however, cultures were taken from the same person in succeeding years, the same organism was almost invariably found, showing that a person's cold was almost al- ways produced by the same type of organism. It 'was, therefore, perfectly rational to attempt immuni- zation against that infection, but the vaccine should