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color of the stomach markedly changed from a dull blue appearance to a bright red color. The author gave a practical demonstration of his method before the section. Ligation of the External Carotid Artery in Con- junction with Exsection of the Jaws. Dr. Wil- generic viagra hoax liam Perkin Nicholson, of Atlanta, Ga., read a paper with this title. The author referred generic viagra hoax at some length to patients on whom he performed the operation of ligation of the ex- ternal carotid artery and to the good results which he obtained. The incision employed about viagra pill is from two to four inches long, according to the depth of the neck, though it is better to begin with the former and extend if necessary. The centre of the incision should be at a point parallel with the Adam's apple. After the skin and deep fascia have been passed, the work is largely done with the handle of a scalpel and the finger, and in this way the vessel can be rapidly approached May 23, 1896] MEDICAL RECORD. 743 without danger. The chief obstacle to be encountered is the crossing of the vessel by the facial, lingual, and superior thyroid veins, their combined trunks making, in some cases, an enormous vessel. These can be pulled aside when the division is at the normal point, but sometimes they must be cut between forceps and tied at once. In only two cases did the author see the internal jugular vein, generic viagra hoax and this was when the common carotid was followed to the dividing-point. It must always be remembered that the external carotid is the one nearer to the median line. The point of ligation va- ries considerably. The material employed for ligature and sutures in every case was catgut. In five of the cases the only dressing applied was iodoform and col- lodion scab, and not a single case required a second dressing. The Technique of Removing the Appendix Vermi- formis Dr. M. M. Johnson, of Hartford, Conn., read a paper with this title and gave a report of one hundred cases. He described the method of preparing the patient for the operation which he is in the habit of employing in these cases. He spoke at some length concerning the incision to be made and consid- ered that the statement of Dr. Morris, " an inch and a half and a week and a half,"' contained a sound sur- gical principle to go upon. He also strongly advised as little manipulation as possible of the intestines. In chronic recurrent cases he makes an incision one and one-half inches long directly over the appendix, and when the peritoneum is reached a catgut suture is passed through it at the upper angle of the incision, so as to prevent its retraction. In finding the appen- dix he passes the thumb and index finger through the incision and seizes the colon, which he draws through the incision until the about viagra pill appendix is brought into view. When the caecum is surrounded with a pus sac, a per- forated and sloughing appendix is usually found and should be removed. It should be a fixed rule never to close up the incision without finding and removing the appendix. The treatment of the stump resolves itself into the treatment of an intestinal perforation, and the surgical rule for the treatment of this condition should not be violated in the treatment of the stump, although it about viagra pill is stated by Dr. Robert H. M. Dawbarn, of New York, in the May number of the International Journal of Sur- gery, that there are eleven different methods employed in its treatment. While these methods are popular, they are at variance with correct surgical principles, because generic viagra hoax they leave a point of infection in the peritoneal cavity which will sooner or later prove a serious complica- generic viagra hoax tion. In closing the incision we are justified in as- suming that the various layers of tissue are arranged in the best possible order, and the work of nature should be respected by leaving them as nearly as pos- sible as they were found. By making gentle traction on the catgut suture passed through the peritoneum at the upper angle of the incision, the retracted perito- neum is brought into view, and with a Martin needle loaded with No. 2 catgut a stitch is easily passed through the free borders of the peritoneum and the edges are drawn together. By removing the original suture and making gentle traction on the last stitch, enough more of the peritoneum is drawn into the in- cision to allow another stitch, and this is continued until the peritoneal incision is generic viagra hoax closed by a continuous catgut suture. The transversalis fascia and transver- sal is and internal oblique aponeurosis are secured by a continuous suture separately. The skin is put hard on the stretch by a tenaculum placed in the angles of the incision about viagra pill and the edges are united with No. o cat- about viagra pill gut in a fine needle. The author has never had a case of hernia following this method of closing the inci- sion. Catgut is used throughout the entire operation, which is sterilized by the author himself. With re- gard to multiple pus sacs and other complications oc- casionally met with, there is a great diversity of opin- ion as to what about viagra pill should be done. Gilbert Barling states, in the British Medical Journal, generic viagra hoax page 1,254, that ' if the vermiform appendix is left, little anxiety need be felt about viagra pill as to future attacks of about viagra pill appendicitis, as they rarely occur." This means that little anxiety need be felt when dead, decomposing, highly infectious ani- mal tissue is left in the abdominal cavity. A more dangerous opinion, he thought, could not be expressed, and the author related a about viagra pill case in which Barling's dic- tum was followed and in which a second operation was necessary. Upon opening the abdomen a perforation in the crecum was observed and many strong bands of adhesion were present. The appendix w as in generic viagra hoax a gangre- nous, highly infectious condition, and was removed, the patient making a good recovery. With regard to the