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on entrance, requiring operation in nineteen. Fifteen of the thirty-three had pneumonia, two suffered from sepsis, one (the only adult) was intoxicated on ad- mission. The prognosis at time of entrance was June 20, 1896] MEDICAL RECORD. 899 given as good in only two, doubtful in twenty, unfa- vorable in eleven. buy viagra poland In view of the above, the " buy viagra poland gist" of these cases selected by Dr. Winters should be about as follows: " M. C , two years old, two days sick. No membrane visible, marked croup, retraction of the chest, cyanosis. Intubation required. Prognosis doubtful. Antitoxin injected. Death on the four- teenth day. Broncho-pneumonia on autopsy" ; or, M. C , ten months old, three days sick. Throat full of membrane, covering tonsils, soft palate, uvula, and posterior pharynx; nose not plugged, but full of foul discharge; bilateral cervical adenitis; septic rash over body. Prognosis doubtful. Antitoxin injected. Death in nine days from sepsis." It may be well to give a brief analysis of two or three of these fifty-two cases of the spring months of 1895 and 189G : Case I. William Ashley, eleven years old, three days sick, admitted February 3, 1896. Large sheet of membrane covering tonsils and soft palate and push- ing forward the soft palate from behind. Odor septic. Nose plugged so that air could not pass through nor could it be irrigated; bilateral cervical adenitis. Prognosis doubtful. buy viagra poland Antitoxin injected. February 24th, hemorrhagic spots on neck and legs; retraction of chest marked, owing to obstruction of the nose by membrane and buy viagra poland of the throat by tonsils and membrane. Stiff viagra thailand cost rubber tube inserted between tonsils and breathing thus much improved. More hemor- rhagic spots in afternoon. February 25th, patient died of sepsis. ( ' \sn II. Harry Tarakosky, one and one-half years old, three days sick, admitted February 24, 1896. Croup, cyanosis, retraction of chest, and stridulous breathing; abscess of neck, which had been opened before admission; no membrane in throat. Prognosis doubtful. Intubation. Antitoxin. Death in three davs of exhaustion. The following case is given in order to show one type of disease in which antitoxin, in my opinion, should not be used : Case III. John Leddy, thirty-two years old, three days sick, intoxicated on admission, with marked tremor. Much membrane on both tonsils, uvula, and arches of the palate. In spite of intoxication prog- nosis recorded as good. On the following day the patient, who had become sober, asked to have anti- toxin injected, and one thousand units were given him, this small dose being considered sufficient. In ten minutes after the injection the patient became cyanosed and almost pulseless, and in five minutes more an urticarial rash appeared, covering the entire body with erythematous patches and wheals. Pa- tient's circulation improved under stimulants, but he became violently delirious and died twenty-four hours later. On autopsy diphtheritic membrane was found extending from the pharynx down through the buy viagra poland larynx to the lower end of the trachea, though there had been no symptoms of laryngeal or tracheal ob- struction during life. Advanced nephritis, oedema of the lungs, and cirrhosis of the liver were also noted. This case would seem to viagra thailand cost show the necessity of cau- tion in the use of antitoxin in alcoholic patients. I have gone into the above cases somewhat in detail, as Dr. Winters insists that we should weigh, not count, our cases. These cases have been both weighed and counted, buy viagra poland fifty-two in all, comprising all the fatal first, second, and third day cases, in the period selected by himself, the spring months of 1895 and 1896. Were he to select the other eight months of the sixteen dur- ing which antitoxin has been used, the buy viagra poland results would be the same. Dr. Winters also insists that we should study the fatal cases, not those that result in recovery. Therefore he has not told you that for every eight of the first-day patients who died, ninety-two recovered; and that for every twenty-four of the second-day patients who died, seventy-six recovered ; and that for every twenty-seven of the third-day patients who died, seventy-three recovered. In his paper of two weeks ago Dr. Winters stated that because of the buy viagra poland depressing effects of antitoxin buy viagra poland upon the heart, alcoholic stimulation was now resorted to to an extent which was never viagra thailand cost known in former days. The observation of the other attending physicians to the hospital is directly to the contrary. Since the in- troduction of antitoxin we have noticed that the treat- ment of the patients has apparently been much simpli- fied. There has been less need of irrigation of the nose and throat, less necessity for the use of iron and other tonics, as well as a smaller consumption of alco- holic stimulants. For fear, however, that our observa- tions were wrong and that Dr. buy viagra poland Winters was right, I have secured a statement from the clerk of accounts and supplies of the Health Department, giving the amount of alcoholic stimulants used in the Willard Parker Hospital in buy viagra poland the year 1894 and in the sixteen months since January 1, 1895, when the systematic