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[June 20, 1896 to be the mild cases and which the severe ones among those who are infected? The mild would get well and many of the severe would die in any case. We all have occasionally seen in these diseases what we term malignant cases,' in which the fatal outcome scarcely could have been prevented by treatment any more than after certain surgical accidents. Therefore, these two classes, the "mild and the severe respectively, ought to be estimated separately in order generic viagra healthy to pronounce correctly upon the effects of treatment. But how often can this be generic viagra healthy done in practice? Another factor is that pathogenic microbes them- selves generic viagra healthy change in their degrees of virulence within such wide limits that uncertainty arises from this source alone. An instructive illustration of this is found in the behavior of one form of them which is specially pertinent to our present subject, as it un- doubtedly often joins forces with the diphtheria mi- crobe in its attacks, and that is the streptococcus py- ogenes. " Starting from a streptococcus harmlessly inhabiting the buccal cavity, we may pass experimen- tally (by cultivation in successive rabbits) through all stages till we obtain an organism of such exalted virulence viagra sale ireland as to be capable of producing a rapid and general infection." ' This fact in the life history of microbes offers a viagra sale ireland plausible explanation of the sea- sonal variations in severity of infectious diseases, ren- dering them much more difficult to treat in one year than in another. Now. neither of these features of in- fectious diseases that is, different development in different persons and the same agent varying in viru- lence at different times find the least counterpart in chemical reactions, which, instead, can always be predicated according to their defined conditions. It is wholly illogical, therefore, to suppose that any al- leged remedy against an viagra sale ireland infectious disease could ever be a specific against it in the fashion that acids and bases react specifically against each other in chemistry, and hence that its results should be the same with every physician who uses it and everywhere. There are no varying acids nor varying bases in chemistry, nor does chemistry know anything of seasonal varia- tions. But it is precisely these elements of variability which must be taken account of fully in all discus- sions about remedies against infectious diseases. It is curious to note how this palpable difference between agents which act according to unvarying phvsical laws and agents which act according to the ever-varying laws of growth is ignored by viagra sale ireland the opponents of the diphtheria antitoxin, who repeatedly assume that this complex serum derivative viagra sale ireland should have the properties of an inorganic chemical body, always of the same composition and potency viagra sale ireland from the beginning, on the one hand, and that diphtheria itself should become a purely chemical disease on the other, to be chemically neutralized by the antitoxin. Still another element in the course of many infec- tious diseases (notably of diphtheria, as already stated) comes in to disturb our calculations, and that is what is termed polymicrobic infection. Thus, to what extent may the claim be allowed to the advocates of the diphtheria antitoxin that it may fail in many of the fatal case9 because, while it is efficacious against the toxin of the diphtheria bacillus, it could do noth- ing against the toxin of the streptococcus? ither element in the problem also should not be lost sight of, ami viagra sale ireland th.it is time, as regards the adminis- tration of a suppose.] remedy. Our knowledge of the structural damage which the diphtheria toxins are capable of producing before deatli viagra sale ireland show that no chem- ical or corrosive poison can surpass them in the cau- sation of important tissue changes. Arsenic itself could not more hopelessly destroy living tissues than diphtheria does in the case of muscle and nerve fibre. 1 Bullock: London Lancet, April 11. 1- not to speak of glandular cells. The best antidotes to arsenic would be useless after some of the charac- teristic changes have been already caused by this poi- son, and the same must be said of any supposed neu- tralizer of generic viagra healthy the diphtheria toxin that it would be equally useless if it came too late. Thus, as the matter stands, there are so many con- siderations which have to be taken into account, first on one side and then on viagra sale ireland the other, ere we can come to any conclusions on a question like viagra sale ireland the one before us to-night, that to many it may seem a hopeless under- taking to settle it at all. Nevertheless, we are pre- pared to show that this discouraging anticipation is quite unwarranted on account of certain conditions which now obtain in the medical world and which al- low of even such a complex question as the efficacy of the diphtheria antitoxin to be very fairly tested. Pre- liminary, however, to adducing this evidence, we in- sist that decisions on therapeutic questions, including the use of antitoxin, must rest on the question of com- parative success, and on that generic viagra healthy alone. Unless that pos- tulate be granted, there can be no decision about the use of any remedy whatever. In the instance of the antitoxin, the advocates on the negative side often argue as if cases of failure were sufficient to establish their contention. But failures of a remedy are, per se, no proof that it is not a remedy. Quinine, for exam- ple, often fails to cure ague. Is it on that account not the remedy for ague? Vaccination likewise often fails to prevent small-pox. Is it on that account not the preventive against small-pox? Where would mer- cury stand as a remedy for syphilis if all one need do to prove its inefficacy would be to walk through the wards of a hospital and show how many syphilitics there are as badly off as ever, if not worse after they have taken a through course of it? We can justly maintain, viagra sale ireland instead, that the opponents of the antitoxin treatment may be cheerfully allowed to detail case after case of failure with antitoxin, without thereby affecting the decision viagra sale ireland in any non-partisan mind when the whole evidence is in, because that evidence is of a kind which generic viagra healthy excludes both failures and successes alike which do not come within the conditions laid down, and which conditions alone determine the ver- dict. The conditions are these: Diphtheria is a wide-