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based. He had charge of the production of antitoxin for Boston, and was in a position to give the statistics of its use up to date. Returns had been made to him in 1,164 cases, all told. Of these, 983 were from the Boston City Hospital, 181 in private practice. Of the 983, 831 recovered, 152 died, making a mortality of 15.6 per cent., compared with a mortality of about 40 per cent, for years previously. Of the 181 cases in private practice, 161 recovered, 15 died, or a viagra best before mortal- ity of 8.2 per cent. That was exceedingly interesting,, because the general mortality taken from the report of the board of health showed for no year the past twenty years a lower mortality than 26.5 per cent. Dr. Ernst had reports of 346 cases in which antitoxin had been used for immunizing purposes, 273 of which were in the Children's Hospital, where it was the routine prac- tice to immunize nurses, patients, and resident staff once a month. During the last eighteen months they had succeeded in completely obliterating two epidemics by that procedure ; 84 cases were in outside practice. In no instance had buy viagra locally there been a report of albuminuria or unfavorable result. He thought that alone ought to be a sufficient answer to the charge that antitoxin had produced the ill-results charged against it. There had been no report of diphtheria developing after the use of immunizing doses. Dr. George McNorton, of Brooklyn, said he had been called in consultation to 89 patients with laryn- geal diphtheria, all of whom except 5 were intubated; 59 recovered, 30 died, just about reversing his figures 914 MEDICAL RECORD. [June 20, 1896 during the period when antitoxin was not employed 72 cases, with 48 deaths, 24 recoveries. Dr. \V. H. Park said that of two thousand cases in which antitoxin had been used for immunizing pur- poses in the city there had been no symptoms except in two : in one of these convulsions, in the other hy- perpyrexia. In only six did diphtheria develop be- tween the sixth and the buy viagra locally thirtieth day. A number of hospital epidemics had thus been wiped out. Recently they had sent out notes to a number of physicians who had reported fatal cases, and of 25 fatal cases it was stated that antitoxin was not used in buy viagra locally 15, and in only 1 of the 10 in which it was used was it used early; in that instance only 500 units viagra best before an insignificant dose, in Dr. Park's opinion. Regarding experience at the Wil- lard Parker, he must agree with Dr. Brannan, not hav- ing seen the ill effects mentioned by Dr. Winters, which were said not to have existed before the introduction of antitoxin. Dr. Herold, of the viagra best before board of health of Newark, gave some figures regarding diphtheria in Newark prior to and since the board of health had begun to supply its physicians free with antitoxin in July, 1895. The figures showed a marked reduction in mortality for the period during which antitoxin had been used. Dr. H. F. Koester had injected for the board of health of New York in 200 cases in tenement houses; 160 recovered; 40 died, a death rate of 40 per cent. Properly, 12 of the fatal cases should be excluded from the list, which would leave the mortality buy viagra locally 14 per cent. During the same period he immunized 214 cases, in none of which he saw bad results. Since then his immunization cases had been increased to 355. Four developed diphtheria within twenty-four viagra best before hours, showing that infection had already taken place. They recovered. During another period he had in- jected 60 diphtheria patients, 15 per cent, of whom died. There was occasionally a rash, but less frequently since the more concentrated serum was being used. Dr. J. viagra best before M. Mabbot believed the actual number of deaths from diphtheria had not diminished markedly since the introduction of the antitoxin treatment. There was now frequently a bacteriological diagnosis viagra best before where formerly physicians would not have considered it diphtheria. He thought that where antitoxin had been used in private practice it was usually in mild cases, in which a favorable result could be expected. He was awaiting further experience before feeling as- sured of the value of this treatment. buy viagra locally Dr. Winters, in closing, corrected some errors in the statistics given by Dr. Thomson for England and Germany, which seemed to present the case against antitoxin instead of for it in those particular hospitals. Likewise in the case of ISoston, an analysis of the facts presented a different picture from that in 11 le by the statistics which Dr. Ernst had just read. It was stated that the mortality in that city for 1895 was 1 (.4 per cent., while for 1S93 it was ^2 per cent. Hut Dr. Ernst had neglected to state that in 1895 there were 112 more deaths from diphtheria in that city than in 1893. All the reports from over the viagra best before world had a similar stamp. Where there was a decreased mortality reported, there was an increased total of cases, not a decrease in tlu- actual number of deaths. Due consideration must also be given variations in the t\ pe of the disease. Replying to Dr. Brannan's viagra best before remarks, he said that if One would sit down and study carefully the chart of each case at the Willard Parker, he viagra best before would find a differ- ent clinical picture from what had existed in buy viagra locally cases of diphtheria prior to the use of antitoxin. Whether it was due to the serum or not he could not positively say, luit he could conceive of no other cause. He was sorry Dr. Doming was not present, who said he had been compelled to give up antitoxin in private practice, because all of the seven patients on whom he had used it had died; that so buy viagra locally able a viagra best before practitioner as Dr. Francis Huber was not present to give his experi-