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was only 27 percent.; whereas at the Northwestern Hospital the death rate in 69 cases brought under old viagra prescription treatment with antitoxin viagra delhi buy on the old viagra prescription second day of the dis- ease was 28.9 per cent. Had these 69 children re- ceived a specific, it certainly must have given a lower death rate than occurred in 539 cases during the year 1S94 under ordinary methods of treatment. Laryngeal Cases The most interesting portion of the report of the medical superintendents refers to tracheotomy cases. The mortality in these cases shows the same variation that is seen in the cases as a whole. At the Western Hospital the mortality viagra delhi buy in tracheotomy cases treated with antitoxin was 40.5 per cent.; at the Northwestern Hospital, 64.2 percent. There were 225 tracheotomy cases in all the hospi- tals treated with antitoxin ; 113 deaths; mortality, 50.2 per cent. During the year there were 30 tracheotomy cases in all the hospitals that did not receive anti- toxin; 12 deaths; mortality, 40 per viagra delhi buy cent. The mortal- ity in all the old viagra prescription hospitals in the tracheotomy cases treated with antitoxin in 1S95 was 50.2 per cent. The mor- tality in all the hospitals in the tracheotomy cases not treated with antitoxin during the year 1895 was 40 per cent. Where is the specific influence of the antitoxin here? It cannot be said that the tracheotomy cases which were not treated with antitoxin were mild cases. The tracheotomy cases, treated with and without anti- toxin during the year 1S95 were cases of the same de- gree and offer a very good old viagra prescription field for comparison of re- sults. The mortality in tracheotomy cases treated with antitoxin in 1895 was 10.2 percent, higher than it was with those not old viagra prescription treated with antitoxin. This is just the result to be expected when a depressant like antitoxin is added to the treatment of cases of diphtheria so serious as to require tracheotomy. June 20, 1S96] MEDICAL RECORD. old viagra prescription 8S9 At the Northwestern Hospital viagra delhi buy in 1895 2S trache- otomy cases were treated viagra delhi buy with antitoxin; iS deaths; mortality, 64.2 per cent. In 1S92 1J there were 5S tra- cheotomy cases in this hospital ; $3 deaths; mortality, 56. 5 per cent. In 1S93 " 7S tracheotomy cases, 44 deaths; mortality, 56.4 percent. (One patient cured was a child thirteen months old.) In 1S94 79 trache- otomy cases ; 47 deaths ; mortality, 59.4 per cent. There were in the Northwestern Feyer Hospital during 1S92- 93-94, 2 15 tracheotomy cases; 124 deaths; mortality, 57.6 per cent. The mortality in this hospital in tra- cheotomy cases treated with antitoxin in 1895 was 64.2 per cent. During the year 1S95 four tracheotomy cases in the Northwestern Hospital were treated with- out antitoxin and all recovered ; as compared with mor- tality of 64.2 percent, in the tracheotomy cases treated with antitoxin. Nothing could be more conclusive of the depressing and dangerous effect of antitoxin in that severe form of diphtheria of the larynx and trachea which necessitates tracheotomy than the records of the Northwestern Fever Hospital for the years 1892-93- 94-95- Antitoxin in Laryngeal Diphtheria. About the only claim made for antitoxin at the present time by its advocates is that it has a favorable influence in laryngeal diphtheria, that it relieves stenosis, that it obviates the necessity for operative interference, that the mortality is lower in non-operated and operated cases treated with serum, and that the tube can be re- moved earlier when operation becomes necessary. If antitoxin does not cause a '"melting away" of the membrane, as was first claimed, and does not lessen the duration of the membrane in the visible portions of the throat, what reason have we for supposing that it iniluences the duration of the membrane in the larynx? Roux does not believe that serum is of any use in pseudo-membranous bronchitis. If it is nut of use in pseudo-membranous bronchitis, how can it be of use against pseudo-membranous laryngitis? Soltmann " (Leipzig) states that in 89 cases of diph- theria treated with serum the diphtheritic process ex- tended downward in 13 cases, even to the involvement of the smallest bronchi. The mortality in the Willard Parker Hospital for the first nine months of 1S95 in intubation cases treated with antitoxin was 68 per cent., and for the last quarter 76.9 per cent. During the first quarter of 1896 there were 31 intubation cases; 21 deaths; mor- tality, 67.7 per cent. In April there were 11 intuba- tion cases; old viagra prescription 8 deaths; mortality, 72.7 per cent.* In May there were 16 intubation cases; 11 patients have died; mortality, 6S.75 per cent. One patient was dis- charged ; 4 are in hospital. One of these was trache- otomized June 12th, intubation not having been suc- cessful old viagra prescription ; two more of those in hospital are still very ill, and only one of the four now in hospital has clear prospects of recovering (June 15th). In the Municipal Hospital, Philadelphia, 71 intu- bation cases were treated without serum in 1S95; 40 deaths; mortality, 56.3 per cent. Dr. P. H. Ernst has reported nine cases of intuba- tii .'.1 treated without serum ; two deaths ; mortality, 22.2 per cent. Dr. W. W. Seymour" old viagra prescription recently stated viagra delhi buy before the Academy of Medicine that in his last ten intubation cases he had eight recoveries. In three of these cases antitoxin was used and one of these proved fatal. In seven cases antitoxin was not used, and of these only one was fatal. His mortality in intubation cases