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[January 4, 1896 smaller, which, with the flow of blood and the rapid spasmodic movements of the larynx, tend to obscure the landmarks, and tax to the utmost the patience of the surgeon and his assistants. I have performed brand viagra prices thyrotomy on five adults and five very young children. My youngest subject was eigh- teen months old, my oldest sixty-six and a half years. Upon one of the adult cases I subsequently operated four times, and upon another a second operation buy viagra 1 was performed, both being for the removal of recurrent malignant growths. If I include these operations, the total brand viagra prices number of buy viagra 1 thyrotomies I have performed will amount to fifteen. In none of these cases of malig- nant growth was the operation in any way responsi- ble for the death of the patient. They all survived the operation several months. With the exception of two, all the cases have been reported. I will, there- fore, refer to them in as brief a manner as possible. The two that have not as yet been published I shall give more in detail. Case I. Epithelioma. Mr. C , aged forty- seven, brand viagra prices consulted me in October, 1875. There was a large sessile growth on the right buy viagra 1 vocal cord, covering the middle and extending into the anterior third. I removed all that could be seized with the forceps; very little remained and his voice was greatly im- proved. In November, 1876, he called for an exam- ination of his throat. Recurrence had taken place, but he did not care to have treatment resumed just at that time. In June, 1877, the stenosis was very great, producing an alarming dyspncea. Tracheotomy was performed at the Metropolitan Throat Hospital, fol- lowed immediately by thyrotomy. In consequence of the small breathing-space, no ether was administered until the cannula had been introduced. The growth was found to extend downward to the cricoid cartilage. It was thoroughly removed, the cord destroyed, and the galvano-cautery brand viagra prices freely applied to the attachments of the growth. Recurrence took place at intervals of a few months. Thyrotomy was performed in all five buy viagra 1 times. brand viagra prices He died in June, 1879, nearly four years after he first came under my treatment. I might mention that the operations subsequent to the first thyrotomy were not performed with any ex- pectation, on my part, of a radical cure, but at the solicitation of the patient, who declared that they gave him relief from suffering. The hemorrhage accom- panying the curetting was always very profuse. Case II. Papilloma Recurring as an Epithelioma. Consulted me in January, 1SS1, at which time there was a growth on the right cord near the anterior com- missure. I regarded it as a papilloma and suggested removal by forceps, which could have been done with- out difficulty. The patient declined operative inter- ference and sought treatment elsewhere. Twelve months later he again consulted me, at which time the whole box of the larynx was almost completely filled with the growth. Several large pieces were removed by means of the forceps, but as it was found to extend downward below the cricoid cartilage, and as dvspncea was becoming more urgent each day, tracheotomy and thyrotomy were performed, the growth removed, and the patient discharged in brand viagra prices a few weeks from the hospi- tal. The tumor was submitted to Dr. Heitzman, of this city, for examination, who pronounced it a papil- loma. But in his report he stated that it had grown from a highly inflamed base, and if it recurred it would most likely come as a malignant growth. A few months later, in June, just before I left for Europe the patient came to me, suffering from great dyspncea. A large amount of growth had reappeared in the larynx, on the right side. During my absence a can- nula was introduced into his trachea by a brand viagra prices surgeon in buy viagra 1 Hrooklyn; and upon my return I again operated. This time I removed an enormous amount of growth. It involved the whole of the right side of the larynx, and extended below the cricoid cartilage. Its attach- ments were destroyed by the galvano-cautery. A por- tion of the tumor which was submitted to buy viagra 1 Dr. Heitzman for microscopic examination, was pronounced to be epithelioma. Recurrence took place four months later. I then exsected the entire right half of the larynx. The patient died fifteen days after this operation Case III.- eifrht years. -Epithelioma. J. D Case presented no , aged forty- unusual features; performed at the tracheotomy and thyrotomy were Metropolitan Throat Hospital; thyroid found to be ossified. Growth was thoroughly removed and the patient left the hospital in two weeks in good condi- tion. Recurrence took place within four weeks and brand viagra prices the patient died three months after the operation. Case IV. Ecchondrosis. J. H , aged thirty; Irish ; consulted me at the Metropolitan Throat Hos- pital, at the suggestion of Dr. Moore, of Troy. About a year previous tracheotomy had been performed for laryngeal dyspncea, which had suddenly become alarming; since then has worn the cannula; has had syphilis. An examination revealed a large rounded mass on