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dividing line between these two periods can be quite accurately drawn, and it may be taken as that period when the use of diphtheria antitoxin became quite a factor in the treatment of this disease; for, whatever may be the fate of the antitoxin treatment of diph- theria, it certainly has stimulated not only its advo- cates but its opponents to viagra price china more accurate observation of the disease, and has been the most effective means of furnishing to the bacteriologist the requisite cultures, from the study of which so many valuable conclusions have been drawn. The beginning of the year 1894 may be taken to separate these two periods. True, the Klebs-Loeffler bacillus had been known and stud- ied, and many valuable experiments made and conclu- sions drawn viagra cialis sale from these in the ten years previous to 1894, but the busy general practitioner merely read of these results. Few physicians up to that time 1 1S94) availed themselves of the aid that bacteriology ottered in the diagnosis of diphtheria, even after the establish- ment in 1893, by the board of Health of this City, of a laboratory for such bacteriological diagnosis. Let us examine first this early period of the disease. What constituted diphtheria during this period? A group of constitutional symptoms which varied consid- erably in individual viagra cialis sale cases from the slightest to the most severe, together with the appearance in the throat of a pseudo-membrane, also varying in character, po- sition, and extent. We cannot wonder, then, that there were frequent differences of opinion among physicians seeing viagra price china the same case as to whether the patient had or had not diphtheria. Some physicians would call al- most all anginas presenting any appearance of a pseudo-membrane, diphtheria. In the Scientific Bulle- tin Xo. 1, Health Department, New York City, Dr. H. M. Higgs states (page 2) that "during the year 1891 4,874 cases of diphtheria were reported to this board, and, so far as can be judged from the data at hand, at least one-diird and perhaps more of these cases were not diphtheria." On die same page he makes the statement that " in those cases in which bacteriologi- cal examinations have shown the absence of Klebs- Loeffler viagra price china bacillus, the mortality has varied from viagra cialis sale one to five per cent." We are inclined, therefore, to the be- lief that many physicians whose death rate in diph- theria in this period has been very low, would have found it necessary to exclude many of their cases had diey submitted cultures from their patients' throats to bacteriological diagnosis. On the other hand, some physicians have had a very high death rate. In view of our present knowledge of diphtheria de- rived from bacteriology, we feel sure that they have passed viagra cialis sale over many of the milder forms, which if in- cluded would have reduced their mortality rate. We may mention here that bacteriology has taught us that there are severe and fatal pseudo-membranous affec- tions of the throat in which the Klebs-Loeffler bacil- lus is not found, but which present all the local and constitutional symptoms even to the sequela paralysis, which clinicians have regarded as justifying the diag- nosis diphtheria. Without bacteriological examina- tion it is impossible to differentiate these two condi- tions, and in this early period the statistics of diphthe- ria have been made incorrect by their inclusion. What constitutes diphtheria in the late period of the disease? The discovery of the Klebs-Loeffler ba- cillus in the cultures viagra cialis sale taken from the throats of patients presenting any form of inflammation of the fauces. Park and Beebe'say: "The examination by a com- petent bacteriologist of the bacterial growth in a blood- serum tube which has been properly inoculated viagra cialis sale and kept viagra price china for fourteen hours at the body temperature, can be thoroughly relied on in cases where there viagra price china is visible membrane in the throat, viagra cialis sale if the culture is made during the period in which the membrane is forming and no antiseptic, especially no mercurial solution, has lately been applied." Koplik, among others, has shown that the secretion in the lacunae of the tonsils has been found in some cases to contain the Klebs-Loeffler ba- cillus. Again, Park and Beebe state : " We have found that children, and to a less extent adults who are brought in direct contact with true cases of diphtheria, very often receive the diphtheria bacilli into their throats, and that viagra price china these bacilli may exist and develop in these throats for days ami weeks." The same ob- servers, examining cultures from the throats of three- hundred and thirty healthy individuals, ''where there had been no history viagra cialis sale obtained of direct contact with diphtheria," found virulent characteristic bacilli eight times, non-virulent characteristic bacilli twenty-four times, non-virulent pseudo-diphtheria bacilli twenty- seven times. The finding of the Klebs-Loeffler bacilli in its differ- ent degrees of virulence in individuals who constitu- tionally and locally are apparently free from disease has led many to become sceptical as to the value of bacteriological examinations in the diagnosis of diph- theria. A broader and better view to take, however, is that neither clinically nor bacteriologically are we as yet in possession of a full knowledge of diphtheria, and viagra cialis sale that the more opportunities the practitioner affords to the bacteriologist for studying cultures from the Scientific Bulletin Xo. 1, Health Department, New York June 6, 1896] MEDICAL viagra cialis sale RECORD. 797 throat the sooner we shall arrive at the point where the two methods of diagnosis will agree. With an understanding, therefore, of what consti- tutes diphtheria, let us examine first some municipal statistics; second, some hospital statistics. In examining municipal statistics there are two im- portant factors to be borne in mind: