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January buy viagra nhs 25th, tube coughed up at 3:30 a.m.; rein- tubated at 3 :3s a.m. January 28th, viagra usa suppliers tube coughed up at n :is a.m.; rein- tubated immediately. January 28th, tube coughed up at 12:10 p.m.; rein- tubated immediately. February 5th, temperature, 104. 2 F. ; rash over whole body ; patient restless. February 6th, temperature, 102.8 F. ; free perspira- tion. February 7th, had a restless night. Antitoxin was given, two doses of 3,000 units each. December 17th, patient was transferred to North Brothers Island, and subsequently died. Case XXXVIII. Aged five years; admitted No- vember 14th; illness began November 13th. Croup. Prognosis unfavorable. Antitoxin, 3,000 units, on ad- mission, poultices to neck, calomel, fumigation, etc. Admitted at 12:35 p - M -i croup, in spite of treat- ment, increased. Patient was intubated at 3:30 p.m. November 15th, antitoxin, 3,000 units; tube re- moved at 2 a.m. November 15th, died at 7 p.m. Cause of death, heart failure. Case buy viagra nhs XXXIX. Aged sixteen months; admitted May 19th; illness began May 18th. Dirty white viagra usa suppliers membrane on each tonsil, general hyperaemia, moder- ately croupy; K. L. B. Child viagra usa suppliers well developed and nourished. Prognosis doubtful. Antitoxin, 7.5 c.c, 1 to 1,500, injected on admission. May 20th, 7.5 c.c, 1 to 1,500, injected. June 12th, child died. Case XL. Aged eleven months; admitted Decem- ber 1 6th; two days sick. Dirty white membrane on both tonsils, thin white membrane on uvula, naso- pharyngeal discharge, croup. Prognosis unfavorable. Antitoxin, 2,000 units, on admission. Decemer 17th, intubated at 1:50 a.m.; 6 a.m. a note states on chart: "No urine since admission." December 17th, antitoxin, 2,000 units; 5:25 p.m., tube removed; 6:35 p.m., intubated; poultices to kid- neys constantly. Cream-tartar water, diuretin, etc. December 18th, child died at 2 :3o a.m. Case XLI. Three years old; admitted June 30th; illness began June 28th. Nasal obstruction, thick dirty white membrane covering both tonsils, uvula, and soft palate, extending back toward pharynx; glan- dular enlargement. Prognosis good, no complication. Antitoxin, 13.5 c.c, 1 to 1,500, injected on admission. July 2d, 13 c.c, 1 to 1,500, injected. These histories are of cases brought under treat- ment in the early part of the disease many of them on the first and second day. They had full doses of a supposed specific, and yet we do not find recorded in the clinical historv one statement which would in- dicate that this specific modified in any particular a single manifestation of the disease, either in the laryn- geal or non-laryngeal cases. Not one item in the clinical records can be found to indicate that any one of these patients was in any way benefited by the an- titoxin. This is particularly noticeable in the laryn- geal cases. Patients brought in without evidences of very marked croup and after receiving full doses of MEDICAL RECORD. June 20, 1896] antitoxin had to be intubated twelve and twenty-four hours after hypodermic use of this so-called specific. The clinical records of these cases are totally against the viagra usa suppliers use of antitoxin in the treatment of diphtheria. A careful study of these records will, it seems to me, convince one who is familiar with diphtheria that there are clinical features here recorded which are due to the treatment and not to the disease. These fea- tures are referable to the kidneys, nervous centres, temperature, and respiratory organs. Injurious Effects of Antitoxin. At the beginning of this treatment Behring told us that an injection of his serum was as little injurious as an injection of a phvsiological solution of chloride of sodium. The records of serious complications and results which have followed the injection of antitoxin in many known cases warrant careful consideration. In cer- tain individuals who show a special susceptibility to antitoxin, the gravest symptoms or death may result from a relatively small dose. The predominating symptoms of these cases are referable to the nervous centres, kidneys, heart, pulmonary organs, and the temperature of the body. One feature of these un- toward manifestations following the use of serum, especially when the respiratory organs are involved, is the lateness of their appearance. The cases of Professor Langerhans' sixteen-months- old son, and Miss Valentine, of Brooklyn, are buy viagra nhs too well known to need more than mere mention here. In neither of buy viagra nhs these was any cause for death found by post-mortem examination. In the case of Miss Valen- tine, the coroner's physician, Dr. viagra usa suppliers John M. Clayland,' reported " Cause of death, convulsion, due to the in- jection of diphtheria antitoxin." In the Journal of the American Medical Association viagra usa suppliers is buy viagra nhs reported an instance which occurred in viagra usa suppliers the practice of Dr. Halderman, of Portsmouth, O., in which a sleeping boy, five years old, was viagra usa suppliers given a preventive dose of