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* It has been stated (New York Med. Jour., February 15, 1- ,M that hcg viagra online the mortality for operative cases in 1S94 was -? per cent.; but it is impossible to give the exact mortality of the opi .'1 :s in the year 1894, because viagra manufacturers usa many of the histories of the inst'tution are missing and are not available. treated with antitoxin hcg viagra online was 23-3 P er cent., and in intubation cases not treated with antitoxin 14.2 per cent. YViderhoefer 17 gives a mortality of 43 per cent, for in- tubated cases (before serum treatment). Yon Ranke'" gives in 326 intubation cases a mortality of 57.4 per cent, (before serum treatment hcg viagra online 1. Meisenbach " reports a mortality in tracheotomy cases of 57 per cent, (before serum treatment 1 in the Philadelphia Children's Hospital. In Strassburg 1 '" in 397 tracheotomies (1891-94) the mortality was 44.3 per cent. In Geneva 61 from 1872 to 1888 the mortality in tracheotomy cases was 49 per viagra manufacturers usa cent. In Basel '"' in 333 tracheotomy cases there were 197 deaths; mortality, 59.2 per cent. In the University College Hospital '" 3 (London) the mortality in tracheotomy cases in 1894 (non-antitoxin hcg viagra online year) was 47 per cent. Sonnenburg M states that in 13 tracheotomy cases treated with serum the mortality was 37.8 hcg viagra online per cent., but during a period when serum could not be ob- tained the mortality in 35 tracheotomy cases was 37.1 per cent. slightly better without serum. This state- ment by Sonnenburg shows the very great importance of taking into consideration the character of viagra manufacturers usa the epi- hcg viagra online demic in estimating the value of a mode of treatment. Kohts r ' i (Strassburg) reports a mortality of 29.1 per cent, in tracheotomy cases treated with serum, and a mortality of 25 per cent, in tracheotomy cases treated without serum. Is not the very high mortality in intubation cases treated with serum in the Willard Parker Hospital when compared with the viagra manufacturers usa results in intubation cas.es without serum in the Municipal Hospital, Philadel- phia, and in intubation viagra manufacturers usa cases reported by YViderhoefer and Von Ranke before serum treatment, and in tra- cheotomy cases in Philadelphia and in all parts of the world before serum treatment, a most positive warn- ing against the use of this treatment in this serious and dangerous form of diphtheria? The divergencies in the results in laryngeal c.ses treated with serum is opposed to the theory of there being a specific agent at work. For instance, in Soltmann's " intubation cases treated with serum the mortality in June was 16.7 per cent.; in May it was 88.9 per cent.; in February 22.2 percent.; in March 28.6 per cent.; in April 42.9 per cent. If serum had any influence on the low mortality in Line of 16.7 per cent., it should be shown as well in the month of May; whereas, during that month we find a mortality of 88.9 per cent. The low mortality of June is due to the character of the cases (see Dr. Ernst's results without serum) and not to the viagra manufacturers usa serum treatment. If the antitoxin could bring about this low mortality in one month it certainly could in an- other. In Soltmann's report we find viagra manufacturers usa the same variations in mortality in diphtheria of throat and nose. The mor- tality in these cases treated by serum was in February, 5 per cent. ; March, 60 per cent. ; April, 7 per cent. ; May. 21.4 per cent.: June. 14.3 percent.; July, 25 percent. If the mortality viagra manufacturers usa of 5 per cent, in February were due to the action of a specific agent, we should find the same mortality in all uncomplicated cases of diph- theria of throat and nose throughout the entire period reported by Soltmann; whereas viagra manufacturers usa we find a variation ranging from 5 per cent, to 60 per cent., which varia- tion is clue to the character of the cases. I mean the low mortality of 5 per cent, was due to the character of the cases treated, and not to the treatment applied. It must be necessary to a method of treatment for it to be accepted as a specific, that its results be uniform in all parts of the world when applied to severe as well as to mild epidemics. Any considerable lack of uniformity of results in a method of treatment shows 8go MEDICAL RECORD. [June 20, 1896 that the treatment fails to exert any influence when applied to severe cases, and we may suppose that the id results are due to the character of the epidemic and not to the treatment. A very striking feature of the serum treatment' is a lack of uniformity of results, according to the day of disease on which treatment by serum is begun. Heub- ner'' 7 reports that in cases in which treatment was be- gun on the second day the mortality was 6 per cent.; Soltmann, 4 per cent; The Southwestern Hospital '" (London) in 52 cases, 3.8 per cent.; Seigert, 59 20 per cent. ; the Willard Parker Hospital "' in 130 cases, 25.1 percent; the Northwestern Hospital (London) in 69 cases, 28.9 per cent. In cases in which treatment was begun on the third day, Heubner's mortality was 4.5 percent; Willard Parker Hospital in 116 cases, 34.1 per cent. ; Southwestern Hospital (London ) in 45 cases, 33.3 per cent. From these varied results we are led to believe that the day of disease in which the patient is brought under treatment has much less to do with