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cases, 4 of which died and 12 of which are on hand at time viagra cialis brand of report, but 10 of them will surely get well, giving a probable mortality of 28.5 per cent." Only half of this report appears in the table. In four hospitals the mortality rose as the supply viagra buy levitra of serum failed, and fell when serum was resumed. Naturally so, as all suspected cases get serum and all moribund and hopeless ones are eliminated. When there is no serum there is no elimination of hopeless cases. A chain is no stronger than its weakest links. As a method to viagra cialis brand convince myself of the value of an- titoxin, I resolved to use it entirely in viagra buy levitra my service at the Randall's Island hospitals and at Demilt Dispensary during the following year. If it will do as claimed (Welch) reduce my mortality by one-half and give me 3.5 instead of 7.8 per cent, for 1896 I shall be glad to viagra buy levitra report myself next year a hearty advocate of the treatment. Thus far my mortality with antitoxin at Demilt has been 12.5 per cent., and at the hospital 53 per cent. This study of viagra buy levitra my personal experience will, of course, convince no antitoxin advocate; but with more than 7,000 creditable cases to agree with mine, it seems that the " behind-the-times" physician has good viagra cialis brand ground for a conservative view. For immunizing nothing is better than fresh air viagra cialis brand and sunlight. My cases last year occurred in fifty families. In only eight of them did the cases duplicate. As Rotch 2 says : " With extreme care there is viagra buy levitra not much danger of the spread of diphtheria in a household, as its ten- dency is not viagra buy levitra to disseminate itself in the surrounding atmosphere." This study of my own and others' cases convinces me of the following points: That diphtheria is very variable in extent and se- verity, both epidemically and clinically. That the diagnosis of true or false diphtheria re- quires as much care bacteriologically as clinically. That the unusual number of cases recorded is in part due to bacterial cases without symptoms and the general alertness of physicians now to viagra buy levitra report suspi- cious cases. That the same causes plus elimination give the ap- parently low ratio of deaths. That cleanliness and ventilation will immunize as well as hypodermic serum. Diphtheria is a treacherous disease under any treat- ment. Selected cases and faithful treatment of any reasonable kind lead to success. Jules Simon was correct in saying : " Efficiency of remedy not only, but fidelity in its use" give results. 2S West Thirty-Sixth Street, New Vgkk. 1 Johns Hopkins Bulletin, July, l - MEDIi m !' 1 S95, vol. xlvii. , p. 421. ted by McNaughton in Med. News. August 2; Ether Collapse. One part of camphor to ten parts of olive oil used hypodermically is effective in ether collapse. One grain of camphor may be given. 1 Wien. med. Woch. , 1895, >.o. 4. J. M. Rotch : Pediatrics, 1S96, p. S29. [une 20, 1896] MEDICAL RECORD. 907 PERSONAL EXPERIENCE IN THE TREAT- MENT OF DIPHTHERIA WITH AND WITH- OUT ANTITOXIN.' By P. H. ERNST, M.D., NEW YORK. Since May, 1895, I have treated in private practice and as visiting physician to the Demilt Dispensary seventy-seven cases of diphtheria. I report only those cases in which the clinical diagnosis was sustained by the bacteriological report from the board of health. Of these seventy-seven cases twelve were treated with antitoxin, and sixty-five were treated without antitoxin. In all cases iron was given, with the local application of peroxide of hydrogen to the nose and throat; mer- cury was not used, except an occasional dose of calo- mel to act on the bowels. I wish to say that most of these cases were of dispen- sary patients, and that their sanitary surroundings and nursing were often of the very worst. A brief account of the twelve cases treated with antitoxin is interest- ing. Case I. J. S , aged four years. Ill two days; membrane viagra buy levitra on tonsils and pharynx; some dyspnoea, showing involvement of larynx. In twelve hours lar- yngeal obstruction became so severe I resorted to in- tubation, with relief of dyspncea; at the same time I injected twenty cubic centimetres of Gibier's antitoxin. On the fourth day I removed the tube, but three hours