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ing from the straws which show the way the wind blows. The next paper was by Dr. Joseph W. viagra picture pill Stickler, of Orange, N. J., viagra picture pill entitled An Experience with Antitoxin with Instructive Results. The writer first related a clinical case in which the serum was used in increasing viagra picture pill laryngeal stenosis, membrane being demonstrable by the laryn- goscope and the depression making rapid progress. Recovery began at once and was complete at the end of a week. In Case II. the Klebs-Loeffler bacillus was demonstrated. The depression was great, the system was profoundly poisoned, and the patient died twenty-four hours later. This case showed the futility of using the serum when the economy is profoundly affected. It is only indicated in a case similar to the first. A paper viagra picture pill was read by Dr. Loris Fischer on Some Practical Points on the Effects of Antitoxin and Intubation, with Especial Reference to Infant Feeding in Malignant Diphtheria In making the injection, those parts of the body should be selected where there is no danger of injecting air into a large vein. Intubation should be made use of to avoid asphyxiation in severe stenosis. It is imperative to overcome dangerous symptoms, such as high tempera- ture, as quickly as possible, but antipyretics should not be given. Enemata and water should be used and remedies given hypodermatically as much as possible. In malignant cases the respiration may reach as many as a hundred per minute. Its fall indicates an viagra generic paypal im- portant improvement, viagra picture pill just as does the disappearance of albumin from the urine. In the discussion of these two papers Prof. Ed- ward Klebs, of Zurich, spoke first. He said Dr. Lee took the view that the bacilli were not surely proven to be the cause of diphtheria. He thought we viagra picture pill must at the present day admit, even from clinical experience alone, that the disease is an infectious one. It is true that the bacilli are often found in the throats of healthy persons, but it is probable that in such per- sons they are exercising only their non-poisonous ef- fects, viagra generic paypal as is observed in very many other organisms. viagra generic paypal Children often are taken sick just after catching cold. In such cases the organism has been previously present, but exerts no deleterious effect until the process of catch- ing cold causes some viagra generic paypal change in the tissues of the body which permits the previously innocent bacilli to de- velop. He had lost a child of his own in viagra picture pill such a way. Dr. Stickler's cases, giving one viagra picture pill favorable and one negative effect, are in keeping with the history of all remedial measures. Our results are not uniformly successful by any measures. The speaker advocated fair play in the antitoxin controversy. We must first consider the experimental foundation for the whole question. There is an anti-poison- ous effect from these substances this we must admit. The experimental observations must be admitted and accepted as they relate to man. The preventive :nrlu- May 30, 1S96] MEDICAL RECORD. 779 ence must not be confused. We have better ground for saying that preventive injections cannot have a good influence than for saying that they have, since these substances are found to be good culture media. Antitoxin has no immunizing power, so far as the speaker is aware. Statistics always have ele- ments of error connected with them. In the past year there has been a very great diminution in the death rate. This must be taken into viagra picture pill consideration. The danger alluded to by Dr. Lee requires carefully pre- pared statistics. Evidently children have been killed by injections. This imposes so great a responsibility upon the physician who uses the method that the ques- tion requires much viagra picture pill discussion. It is a bad plan to in- ject in the region of the chest in the subclavicular re- gion, for example, where the veins are large and form a plexus. Then, too, it is not well to inject so near the centres of respiration. The gluteal is a much better region. The vessels are smaller and the injection can be made directly into the muscle. The shock of the injection alone might be responsible for the sudden deaths in some cases in which no air is found to have been injected into the veins. The cause of death must reside in the poisonous substances which exist in the fluid, but how do they come to reside there? He be- lieves that the poison gets accidentally into a single bottle in the process of tilling. An occasional bottle may be spoiled; this often happens in bacteriologi- cal work, as every one know s. We conclude then that we can never be sure. Per- sonally, he would always inject a guinea-pig before using a new bottle on a child. He strongly advised giving up preventive injections. He admired the bac- teriological management here in this country, with the viagra generic paypal board of health examinations made gratis. In Europe the authorities refuse to do this, on the ground that it is too expensive. He thought without flattery that the Americans were in this respect more liberal. Some antiseptic should be added to antitoxin which does not itself coagulate albumin, but which will prevent any other organism from growing in it. He spoke of a new antiseptic, chinosol, much stronger than carbolic acid and existing as a very soluble powder, which he thought might be employed. He had found it very efficacious as an external viagra generic paypal antiseptic in eczema, etc. He intended proposing it to those interested in antitoxin preparation. Dr. E. Casselberry, of Chicago, said intubation had been in his hands very unsatisfactory in stenosis. Patients coming to the stage of operation during the past year have been saved by the use of antitoxin. In- deed the latter has resulted in a saving of patients ex-