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minute vesicles, which may proceed to pustulation. The local redness and irritation continue for Comprar Levitra Generico Brasil about four days, and then begin to decline. If vesicles have been formed, they dry up and disappear speedily, though a purplish-red discoloration of the skin may persist for several weeks. The eruption is not unlike that produced by croton-oil ; luit I have never observed umbilication of the thapsia vesicles, nor in any case have cicatrices remained after their disap- pearance. There are two principal Comprar Levitra Generico Brasil objections to the use of the thapsia plaster: 1. The remarkable tendency of the erup- tion to spread, making it difficult to confine the sphere of its action within desired limits. 2. The occasional severe and painful character of its local action. These draw- backs may be partially overcome by prescribing a piece of the plaster much smaller than the surface desired to be acted upon, and, if it is a first application, by counseling the patient to remove it within six hours. Of course, if the plaster is being used on a patient for the second or third time, and he has been found to possess no idiosyncrasy to its action, it may be allowed to remain much longer. It is 42 CROOK: PROPERTIES OF TBAPHIA PLASTER. [N. Y. Med. Jolb., my belief that a tolerance is acquired for tbapsia after re- peated use. This has certainly been the case in ray own person; in Comprar Levitra Generico Brasil three experimental applications of the plaster the irritation progressively diminished with each applica- tion. Patients have also informed me that it did not seem to " draw so well " after using it two or three times. In every case I have seen in which the plaster produced Comprar Levitra Generico Brasil un- pleasant effects, it had been allowed to remain in situ from eighteen to twenty-six hours. If the irritation produced by the plaster is unusually severe, an inunction of olive-oil, or glycerin and rose-water, or simply pulverized starch, will usually give relief. Patients should be cautioned to wash the hands after handling the plaster, as the resin may be con- veyed to other parts in this way ; I have several times ob- served an erythema of the face produced by it, and in one case a mild conjunctivitis was developed. The therapeutical properties of the plaster can be shown by presenting sketches of a few illustrative cases. My at- tention was first called to it, Comprar Levitra Generico Brasil in the autumn of 1885, by a patient at the Clinic for Diseases of the Chest at the Pos1> graduate Medical School. The patient, a man, aged thirty- four, had been treated at the school several months before at the clinic of Dr. William H. Porter. He informed me that he had suffered for several years with lumbago, and was rarely free from pain in the lumbar region and stiffness of his back. He had used various liniments and plasters with very little relief. On applying at the dispensary be- fore. Dr. Porter had prescribed a plaster which had caused considerable irritation, and had brought out a profuse rash. It had given the patient immediate and marked relief, and he had had no return of the lumbago until a few days before his appearance at the Clinic for Diseases of the Chest, when he had taken cold from undue exposure. Since then Comprar Levitra Generico Brasil he had had a mild attack of bronchitis, and had felt a gradual return of the lumbar pains. On his own recommendation, I prescribed a renewal of the plaster without any internal treatment. The patient returned to the clinic within three days with the information that the plaster had again been successful. According to his state- ment, the pain and stiffness had completely Comprar Levitra Generico Brasil disappeared Comprar Levitra Generico Brasil since the application Comprar Levitra Generico Brasil of the plaster. This relief remained while the patient was under observation — a period of about two weeks. Since treating this case I have prescribed thapsia plaster many times, chiefly in dispensary practice, and have carefully watched its effects. An account of some of these cases is subjoined. Case I. — I. F., laborer, aged sixty, applied at the Post- graduate School for treatment January 26, 1886. He had se- vere intercostal neuralgia of long standing, which had failed to yield to various applications whieli had been made. A thapsia plaster was ordered Comprar Levitra Generico Brasil to be applied over the seat of the pain after a thorough friction with spirits of camphor. The patient returned to the clinic after two days and s.-iid that the plaster had given liim great relief within twenty-four hours after its application. It brought out an abundant rash, but the irritation was not severe. This patient wa:^ not seen again, hence it can not be stated how long the relief lasted or whether it was permanent. Case II. — J. F., aged twenty-six, applied at the Post-gradu- ate School for treatment February 25, 1886. He was liypo- chondriacal, Comprar Levitra Generico Brasil somewhat debilitated, and complained of an inde- finable sense of weakness and distress in the muscles of the left lumbar and dorsal regions. This had troubled him a long time, but he had used nothing for it but friction, which usually gave him temporary relief. The muscles in this region were found to be somewhat tender on pressure, but no other abnormal con- ditions could be detected. Tonics were ordered internally with thapsia plaster locally. The patient applied the plaster at bed- time on the evening of February 25th, but removed it after three hours and a half, as it gave rise to considerable itching and prevented him from sleeping. Notwithstanding the brief application, the characteristic rash produced by the plaster was found to be well developed on the 27th, when the patient re- turned to the clinic. Comprar Levitra Generico Brasil He expressed almost entire relief from the painful sensations in the muscles. He.continued to improve for ten days, when he disappeared from observatii'n. Case III. — J. McH., a man, aged thirty-five, came under treat- ment at the Post-graduate School February 25, 1886. He had intense pains and stiffness Comprar Levitra Generico Brasil in the muscles of the right axillary regicm, which had persisted for seven or eight weeks in spite of several jjatent plasters which had been applied. A thapsia plas- ter was applied over the muscles. The patient was entirely re- lieved within two days. He was last seen early in May ; up to that time there had been no evidence of a return of his tronlile. Case IV. Comprar Levitra Generico Brasil — A. D., a man, aged thirty-five, applied May 1, 1886, for treatment for chronic bronchitis. He had a constant, irritative cough, with a sensation of heaviness and oppression across his chest. There was considerable debility. Tonics were ordered internally, and a thapsia plaster to be applied across the front of his chest; no cough mixture. May Jfth. — The patient apphed the thapsia plaster Saturday afternoon. May 1st, and allowed it to remain forty-eight boors, as it did not cause great irritation. To- day (Tuesday) the char- Comprar Levitra Generico Brasil acteristic rash and local redness are present to a marked degree, hut there is no vesication or pustulation. The patient states that the irritative cough is greatly relieved. During Sunday he