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MEDICAL RECORD. 81 apt to occur after parturition. Dr. Boldt then related a case buy viagra denmark which had led him to adopt uretero-cystostomy. It was one of vaginal hysterectomy for suppurative salpingitis, chronic pelvic peritonitis, and chronic metritis. The operation was very difficult, owing to the immobility of the uterus and intestinal adhesion to the pelvic organs. The abdomen was opened and the lower segment of the ureter was found not mobile, yet it was possible to dissect it without injury by the aid of the ureteral catheter. This buy viagra denmark was done viagra quick delivery for a distance of about seven centimetres, leaving the peritoneal covering, which was already attached to it by the inflammatory process. This served a good purpose by maintaining vitality. At the vaginal junction the ureter was severed, but the catheter was allowed to remain in it. The bladder was now filled about two-thirds full of sterile water, so as to permit the selection of a proper place buy viagra denmark for im- plantation, which he desired to make as near as pos- sible to the normal position. At this point he opened the bladder by an incision of about three-quarter-* 1 buy viagra denmark centimetres; next the ureter was invagi- nated through the opening in the bladder to the ex- tent of about one centimetre. Now three very fine silk sutures were placed at about equal distance, pass- ing through the entire thickness of the bladder except- ing the mucosa, and quite superficially through viagra quick delivery the ureter. The abdomen was closed. A permanent catheter was put into the bladder, alongside of the ureteral catheter, to keep the bladder empty and pre- vent pressure on the newly made opening. Recovery was uneventful. After relating his own case, Dr. Boldt referred to the few reported in literature, and to the views < < t Krause, Kelly, Penrose, Krug, Veit, and other:-. He thought that among the methods adopted lor intra- peritoneal implantation, the one applied in his own case deserved a trial, because of its simplicity, its facil- ity- of execution, and the favorable result which must follow under aseptic conditions. To sacrifice a kidney for the abolishment of the fistula should be a last resort. Even if a nephritis or a pyelitis exists, other methods should be tried. Of course, should there be so much ureter lacking that it buy viagra denmark is impossible to do implantation, there is no help for the patient except nephrectomy. Intestinal Bacteria as a viagra quick delivery Source of Infection Com- plicating Obstetric Operations, with Report of Cases. Dr. Edward P. Davis, of Philadelphia, in this paper related two cases of infection about the time of labor, in which autopsy showed that the intestinal tract was the seat of infection. The first case was that of a colored girl with rachitic contraction of the pelvis. When admitted the abdomen was tense from tympany. When labor began Cesarean section was sucessfully performed, and the child still lives. There was a tympanitic condition of the large intestine in the mother, but the gut did buy viagra denmark not protrude through the wound. The temperature remained below 100 F. several days. She then began to be annoyed by nausea and vomiting and persistence of the tympany. The abdominal wound had healed by first intention. She went on for a time with high pulse, clear brain, persistent nausea and vomiting. Finally high temperature ensued and death buy viagra denmark followed about six days after delivery. The salient anatomical points at post-mortem were immense distention of the small intestine and a mass of fibrin about the junction ot the large and small intestine, at which point the intestine was found studded with small ulcers, full of bacilli coli commune and micro- cocci pyogenes albi, which were also traced into the mass of fibrin over the intestine. Diagnosis: Lymph- angitis with absorption of ptomains and intoxication. The process had buy viagra denmark evidently begun before labor. It is the first case demonstrated by autopsy reported in obstetrics, so far as Dr. Davis knew. The second case was that of an English girl, illegit- imate pregnancy. She was constipated and showed anxiety about her condition before labor. She viagra quick delivery was delivered of a healthy boy by forceps; a slight lacera- tion of the perineum was sewed up immediately. The temperature rose to 103 F. ; pulse. 120 to 130; respirations, 36. She became maniacal. Washing out buy viagra denmark the uterus did no good. She died, and Dr. Bevin, who made the autopsy, found as the only cause of the ma- nia and other symptoms an anomaly of the buy viagra denmark intestine, consisting of a loop of about two feet in the large bowel, which contained softened and inspissated faces which had not passed in spite of calomel, etc. The pathologist made the diagnosis of auto-infection from anomaly of the large intestine, as there was no other apparent cause. The condition was new to him, said Dr. Davis, but Dr. Bevin has seen the anomaly in about viagra quick delivery eighteen out of three hundred autopsies, and the his- tory- in most of the eighteen was that of attacks of temporary mental disturbance and constipation. This extra loop, of from one and one-half to two and one- half feet of viagra quick delivery large bowel, gave a greatly enlarged mucous surface over which the contents of the bowel had to pass. The differentiation from cases of wound infection seems to be want of chill, lower temperature, pulse rapid. Apparently all that can be clone is to induce free purgation if possible. The following gentlemen discussed the paper: Drs. R. A. Murray. K. H. Grandin, P. A. Harris, and E. ( t suing. Dr. Grandin and some of the other gentle-