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nosis of inflammation of the base of the brain and croup. The child died at medicine viagra tablet 8:30 p.m. of the same day. These are the facts of this case of antitoxin poison- ing. I have not referred to Dr. Winters' general criti- cisms of the results of immunization, as they will be dealt with by other speakers this evening. There viagra sale shop was one curious omission in Dr. Winters' paper. Although he has attributed the death of pa- tients viagra sale shop in a number of instances to antitoxin and has described the clinical features of antitoxin poisoning, he has failed to describe the post-mortem findings in such cases. We have made an especial effort during the past year to secure autopsies in the hospital, and a large number have been made. Dr. Winters was pres- ent at many of these, and portions of the organs were obtained by him and sent to a laboratory for thorough histological investigation. I have heard of as many as one hundred and fifty microscopical sections having been made of the various organs, and I naturally ex- pected a report from him of the lesions caused by an- titoxin and resulting in the death of the patient. He has, however, presented none. It is possible that it may be contained in the portion of his paper which lack of time compelled him to omit at the meeting two weeks ago. I have been present at many of the autopsies myself, and have noted with care the ap- pearances of the various organs. I do not profess to be an expert pathologist, but I have had some experi- ence in gross pathology. Nothing was observed by myself or by any of the gentlemen present at these au- topsies which had not been seen over and over again in patients dying of diphtheria and its complications before the use of antitoxin. I believe that Dr. George P. Biggs, the pathologist of the hospital, has expressed himself to the same effect. In view of the importance of this branch of our subject I shall here give some- what at length the report made by Professor Kolisko, of the University of Vienna, of the results of seventy- five autopsies made by him on patients dying of diph- theria who had been treated by antitoxic serum. Kolisko's competency is attested by the fact that pre- vious to the introduction of antitoxin he had made one thousand autopsies on patients dying of diphtheria during viagra sale shop the twelve years from 1882 to 1894. His medicine viagra tablet con- clusions are viagra sale shop as follows: medicine viagra tablet 1 st. He is convinced that the serum influences the diphtheritic process most favorably. 2d. He states that the membranes in the throat, larynx, trachea, and bronchi are more easily separated and are often already loosened or converted into a soft pultaceous mass; he had seen the same thing be- fore the serum treatment, but never to such an extent, or with such uniformity, or so soon after the onset of the disease. It is necessary, however, that a certain period of time shall have elapsed after the injection of the antitoxin. He estimates this period as at least twenty hours. Adequate doses are also required. No such loosening of the membranes is observed after small doses. This favorable effect of the serum is es- pecially noted when the membrane is still in the crou- pous stage, lying rather superficially upon the mucous membrane. When the process has penetrated deeply into the tissues the medicine viagra tablet effect is much less, or absolutely nil. 3d. The anatomical changes in the internal organs are the same as under former methods of treatment. Purulent bronchitis and pneumonia, fatty and pa- renchymatous degeneration of the heart are constantly observed. The changes in the kidneys are absolutely the same, both as regards the grade of severity and the time of their appearance. Kolisko states that in former years he had often observed that for a period of time every case of diphtheria would medicine viagra tablet be complicated with nephritis, and then for weeks no renal changes whatever would be seen. He has had exactly the same experience since serum has been used. Cases of the largest dosage may perhaps show no nephritis, and those of the smallest dosage may present degenerative changes. He is positive that antitoxin has no effect on the kidneys. 4th. Ivolisko lays stress upon the important clinical fact that the diphtheritic process may remain localized at some hidden point, as in a medicine viagra tablet crypt of the tonsil or in the viagra sale shop nasal cavity for a considerable time, and then sud- denly break out with great virulence, with fatal ter- mination. Microscopical examination often medicine viagra tablet shows a localized lesion of several days' duration in cases of seemingly rapid course in which the disease had set in suddenly in individuals apparently healthy. Such June 20, 1S96] MEDICAL RECORD. 901 cases illustrate how we may be deceived when we be- lieve that we are injecting a case on the first or second medicine viagra tablet day of the illness. In his paper, two weeks ago, as well as in his for- mer publications, Dr. Winters attributed certain state- ments condemning antitoxin to various physicians at- tached to the hospitals of the health department of this city. The resident physician of one of these hos- pitals was quoted as savin- that he was sure that at least one of the patients under his care had died from the effects of antitoxin. I am assured by many of these physicians that they do not hold the views at- tributed medicine viagra tablet to them by Dr. Winters, nor did they author- ize him to repeat any of their viagra sale shop statements. They differ among themselves in their opinions of the value medicine viagra tablet of antitoxin, but no one of them believes that he has seen death result from its administration. The fact that Dr. Winters should attribute such statements to