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Aq. dastil, Syr. symplercis aa ad ? xxxij. " M. Too teaspoonfuls in water one-half hour before meals." Syphilis from an Insurance Point of View.— Dr. P. H. Maclaren, of Edinburgh, in considering this subject without reference to general mortality statis- tics, from which Vibramycin Mg it is difficult to obtain accurate infor- mation, states that he is inclined to classify for insur- ance purposes all syphilitics under the three following groups: I. If a man has been properly treated, the probabilities are that, provided he is of good constitu- tion and habits, no complications will arise, and the expectation would be that he will go through life with scarcely more appreciable risk than one who has never had the disease. 2. If proposer has not undergone a sufficient course of treatment, and applies for insur- ance before the expiration of six years, the period at whichthe disease normally terminates, and yet is not suffering from any tertiary manifestations, and is otherwise satisfactory, the chances are that he may escape the malign fonn, but ten per cent, extra should be charged until the expiration of the six years, and Vibramycin For Acne the case then reconsidered. 3. When Buy Cheap Vibramycin tertiary symptoms have developed, the proposal should be ab- solutely declined, because, while treatment may tem- porarily remove these, it cannot eradicate the tendency to recurrence; and clinical observation has shown that those so affected rarely live Vibramycin Cost beyond a term of ten years, and Vibramycin Antibiotics often much less when palliative treatment is not carried out. While his personal experience is almost absolutely favorable regarding the prognosis of the cases included in Class i, it is questionable when the cases are looked at, with the interests of the offices perfectly safeguarded, if they should not practically be treated in the same way as those in Class 2. — Edin- burgh Medical Journal, March, 1896. Medical Record A IVeekly Journal of Medicine and Surgery Vol. 50, No. 6. Whole No. 1344. New York, August 8, 1896. $5.00 Per Annum. Single Copies, loc. (Dviginal JiX'ticlcs. THE ANTITOXIN TREATMENT OF DIPH- THERIA IN THE KAISER AND KAISERIN FRIEDRICH CHILDREN'S HOSPITAL IN BERLIN, AND DR. WINTERS' OBSERVA- TIONS THEREON. By ADOLF BAGINSKY, M.D., EXTRAORDINARY PROFESSOR OF THE DISEASES OF CHILDREN Vibramycin Hyclate IN THE IM- VER5ITV OF BERLIN AND DIRECTOR OF THE KAISEK AND KAISEKIN FRIEDRICH Order Vibramycin Online children's HOSPITAL. The erroneous statements of Dr. Joseph Winters, re- cently made in the Medical Record, regarding the statistics of the antitoxin treatment for diphtheria in the Berlin hospital of which I have the honor to be the supervising physician, have compelled me to pre- sent certain facts to my American colleagues which may be of interest in the pending discussion of the real merits of the new remedy. Dr. Winters offers the following so-called observa- tions from the diphtheria Vibramycin Suspension division of the cases treated in the Poliklinik and Klinik: ' " When I first visited the Empress Frederika Hos- pital while in Berlin, I was first invited to attend the Dispensary Clinic for diseases of children, which op- portunity I availed myself of. Such care in the man- agement of cases of slight illness I do not think can be seen anywhere else in the world. The waiting- room for children is under the charge of a trained nurse. Every child has its temperature, pulse, and respiration taken by the nurse and its clothing re- moved; it is then carefully wrapped and taken before the physician. There again you see the same minute, painstaking care in every case. Noticing this great care and that Vibramycin Syrup not in a single instance was the throat examined, I thought it strange. The doctor told me that the throat was not examined in this room, because the throat of every child was examined before being brought to this room, and if there was any affection of the throat the child was referred to the diphtheria polyclinic. A clinic for walking cases of diphtheria was a revelation to me. The next hour I visited the room where the diphtheria polyclinic is held, under the supervision of the same physician. Every child brought to the dispensary department of the Empress Frederika Hospital, if it presents any throat lesion, is placed in an isolation room of the hospital which they now^ have for these cases; it is immediately injected with antitoxin, and if Loeffler's bacillus is found, it is placed in the diphtheria pavilion and receives further serum treatment. It is in this way that the enormous number of cases, as compared with previous years, is taken into this hospital for serum treatment. When there is a lack of serum or when there is no serum, these walking cases of throat affection are not detained in the hospital, as it is not deemed safe to do so when they cannot be immunized and protected against their surroundings. Generic Vibramycin It is this method of conducting the diphtheria department of the Empress Frederika Hos- pital which accounts for the reported low mortality and for the difference in mortality during periods when se- ' Medical Record, June 20, 1S96. rum is used and w hen it is not used. It was this very feature of the reports from the Empress Frederika Hospital which made the strong impression on Vir- chow. But Virchow had not studied the details; he accepted the Buy Vibramycin Online percentage mortality without knowing how such percentages were obtained." In this portion of Dr. Winters' paper there are so many false statements, perhaps based partly on faulty observations, that I find it necessary to preface these remarks with a plain description of our methods as they actually exist : In the Poliklinik (Dispensary) of our hospital we have two distinct departments, viz., an infectious de- partment and a non-infectious department. In the non-infectious department children are treat- ed in the dispensary as out-door cases or are admitted to the internal wards of the hospital as medical or surgi- cal patients. The surgical wards are under the charge of Professor Gluck, and are restricted to the reception of patients who have no infectious disease. In the infectious department only really infectious cases are treated, in so-called pavilions especially de- signed for this purpose, and only a few cases and con- valescents are treated in the poliklinik or dispensarj'. For this purpose the infectious department has a num- ber of wards (so-called " Ordinations-Zimmer"), and these are not, as Dr. Winters says, isolation rooms " which they now have for these cases," implying that they have been in existence only since the antitoxin treatment was introduced. This department has ex- isted since the opening of the hospital in 1890. In other words, these isolation wards existed long before anybody thought of antitoxin. These wards are va- riously labelled: " For scarlatinal cases," '"for diph- theria cases," "for pertussis cases," "for measles cases;" for surgical infectious cases, such as erysipe- las, phlegmons, Purchase Vibramycin Online vulvo-vaginitis, blennorrhcea neonato- rum; and, finally, we keep one room reserved for spe- cial purposes. The division, or, rather, the distribution of the va- rious new cases, is managed by one of my assistants, a physician especially named Vibramycin Acne for the position. His work consists in examining the cases and sending them to their various rooms on the strength of the diagnosis made by him. Naturally, the throat is carefully exam- ined and each symptom given proper weight. This physician, furthermore, examines the urine of the chil- dren, for it is here that we frequently observe those pathological conditions which are the forerunners of infections. Although ever)- child is strictly isolated until we arrive at a proper diagnosis, it is the invaria- ble rule in our wards to re-examine the throat of every child before treatment Vibramycin Tablets is commenced; so tliat it is un- true and improper for Dr. Winters to state that he re- cently observed anything different in Vibramycin 50mg spite of our " painstaking care." The throat of each and every case is not only examined by niy Vibramycin Indications assistants, but fre- quently by myself, and, as a rule, every important case is treated Vibramycin Antibiotic by me personally, and detained by the assis- tants if a doubtful diagnosis exists until I corroborate it or otherwise. It is to be taken for granted that I examine thoroughly all cases before giving my opin- ion. To again quote Dr. Winters: ''The throat was not i8: MEDICAL RECORD. [August 8, 1896 examined in this room." This latter is absolutely un- true, and it is equally evident that Dr. Winters has misunderstood all our methods. We could even overlook some of Dr. Winters' re- marks, were it not for the fact that Vibramycin Doxycycline Hyclate he distinctly states that a case of angina in a child " is immediately in- jected with antitoxin.'' This is such a glaring mis- statement that I find it difficult to understand how and why Dr. Winters could be willing to permit such an assertion to appear in print. In the special diphtheria room above mentioned all cases of spurious angina which simulate diphtheria are carefully e.xamined, not, as Dr. Winters puts it, "by the same [admitting] physician," but by the spe- cial diphtheria assistant, one of my assistant physi- cians, who has charge of the diphtheria pavilion: and it is he who, as specirl assistant in this disease, is re- quired by me to separate all cases of catarrhal angina from those of diphtheria. For this purpose this assis- tant of mine is required to use all necessary clinical, microscopical, and bacteriological methods in arriving at the proper diagnosis. Children with apparent diphtheria are brought in the diphtheria pavilion. It is in this separate diph- theria building that antitoxin treatment is commenced, and not, as Dr. Winters erroneously puts it, " receives further serum treatment." Other cases in which the diagnosis is not clear are disposed of in two ways; ist. They are admitted to the quarantine, which is situated on the whole of the upper part of the poliklinik or dispensarj- building, and are subjected to careful scrutiny; or, 2d. they are given out-door treatment, consisting of gargles of chlorate of potassium, quinine, and ice compresses; but the mothers are invariably given strict instructions in regard to isolation, care, diet, and medication. I should be pleased to have Dr. Winters inform me how he came to state that a child had been injected " immediately" with serum in our poliklinik or dis- pensary. Order Vibramycin The treatment with antitoxin is given only in the diphtheria ward or pavilion, in some cases in the quarantine station, but never otherwise. But it is proper, also, to state when and why we have given injections '" immediately" in our poliklinik.

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