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94 MEDICAL RECORD. [jun e 20. 1S96 but fell the next year 724 points to 1,525. These and many marked fluctuations may be seen by any one who will consult the health board reports. Fractional reports are very misleading. Farr lays down the rule " that the determination of mortality requires an extensive area of observation, both in space and time. ... as the causes affecting life are so various that we can only hope to unravel their influence by a general analysis through a series of vears.'" ' In the reports of the health department regarding the YVillard Parker Hospital, we, as New Yorkers, may take just pride. The mortality in that institution as viagra sale liverpool published in the official reports has averaged 24.08 per cent, from 1S89 to 1S95 inclusive, the time paral- lel to my records. In 1894, 703 patients with diph- theria entered, of whom 195 died ; mortality 27 per cent. In 1895, 822 entered with diphtheria and 190 died, a mortality of 23.10 per cent. The gain is, therefore, less than 4 per cent, for 1895, an antitoxin year, as compared with the most fatal year on record. Main- tables quote a series of 32 cases treated at this hospi- tal with a mortality of 25 per cent, against a previous mortality of 42 per cent. By viagra sale texas reference to the original article J it is viagra sale texas seen that these were cases of three years and under and not representative of all viagra sale liverpool treated. By- reference to the table showing percentage of deaths to age in 1894, we find under two years 70.07 per cent, and the same in 1895, namely, 70.59 per viagra sale texas cent. From two to four years we have 46. 2S in 1S94 and 41.50 in 1895, and that with only eight months of 1S95 in the count. 3 The gains viagra sale liverpool were nearly all made in children over four years old. Much is said of the wonders of 1S95 with antitoxin and its low fatality, 23.10 per cent.; but the mortality was still less in 18S8, 1889, 1890, and 1893 without antitoxin. The hospital's best years are in the enthusiasm of the moment forgotten. Lennox Browne ' gives the statistics of the Asylums Board hospitals in London from 18S8 to 1894, the same period just quoted. Dur- ing the six years 1 1.598 cases of diphtheria were treated, with a mortality of 30.3 per cent. During 1895 the same hospitals treated 2,182 cases by anti- toxin with 615 deaths, i.e., 28.1 per cent. There were 1,347 more cases treated in viagra sale texas the same places and year without antitoxin. It is only when these 1,347 cases without antitoxin are included that the mortality falls to 22.5 per cent. The report from the Boston City Hospital for De- cember, 1894, and January, 1895.* ' s an honest example of antitoxin enthusiasm. Eighty patients were given antitoxin, with a fatality of 16 per cent. At the same time 40 were treated without serum, " partly because of the patients entering moribund in five cases, in six because the patients entered very late in the disease. It seemed wise to withhold it in favor of more promis- ing cases, but the majority of cases was mild." The treatment of these mild moribund cases resulted in 30 per cent, of deaths The health officer who came to Randall's Island hospital declined to give antitoxin to those viagra sale liverpool whom he thought would die, because "it would increase the percentage of deaths." Nor would viagra sale liverpool I in- ject such cases. The point I insist upon is that all the deaths under any treatment and all hopeless cases are compared with antitoxin, but that it is given when there is promise of _ .Its and withheld in hopeless cases. The advantage of early treatment has been insisted upon for every nut hod ever recom- 1 Annual Kept. Health Dept. , X. Y. [5. 'White: Medical News, No 1.140. viagra sale liverpool 'Park: Trans. N. V. State Med. viagra sale liverpool Associati ol. xii., p. 17?. 4 " Diphtheria and Its Associates 5 Wellington: Boston Med. and Surg. Jour., 1S95, March 14. p. 249. mended. Of course the time to put out a fire is at its beginning. Before giving my results in treatment I will quote what success has attended other remedies than anti- toxin. Huebner' reports 117 cases treated by antitoxin with 10.2 percent, mortality. He had 46 complicated cases, with 21 per cent, mortality. Yet in 18S9 he re- ported a reduction of scarlatina diphtheria from 35.5 per cent, to 10 per cent, by injecting carbolic viagra sale texas acid into the tonsils. 2 Hennig gives a collective report of 1,054 cases, with a mortality of 2.7 per cent, by the same carbolic- viagra sale texas acid treatment. 2 Seibert's mortality with chlorine injections was only 5.7 per cent, in 35 cases. 1