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A NEW YORK PHYSICIAN AT THE MEDICAL SOCIETY OF LONDON HIS VIEWS ON AUTOTOXIS IN INSANITY LARYNGECTOMY DISPLACEMENT OF HIP-JOINT SUTURE OF VAGUS FRACTURE OF NECK OF FEMUR H^EMATOZOON OF ASHANTI FEVER HEALING OF VEGETABLE TISSUES HEALTH OF IRELAND IRISH WORKHOUSES DUBLIN APOTHECARIES' HALL CAsF CHELSEA HOSPITAL AGAIN non-prescription viagra use THE NEW non-prescription viagra use MEDICAL M.P. London, May 15, 1 Visitors from your side are always welcome, and on Monday we had the pleasure of seeing Dr. Allan Mc- Lane Hamilton at the Medical Society meeting, where he read a paper on the " Connection of Autotoxis with Certain Forms of Insanity.'' He gave a careful account of the various forms of mental derangement which seem to be associated with gastro-poietic derangement, probably produced by fermentation or putrefaction in the alimentary canal. Your readers are doubtless too well acquainted with Dr. Hamilton's views to care for a brief statement of them from this side, and it will be more interesting to them to hear that the presi- dent, Sir Crichton Browne, himself an eminent au- thority on insanity, spoke very highly of Dr. Hamil- ton's work in this specialty, and said his own attention had frequently been attracted to the association of some forms of mental derangement with defective in- testinal digestion or with diseased liver, which was unable to prevent intestinal ptomains trom passing into the general circulation. Dr. Haig argued that uric acid was the offender, but Dr. Andriezen could not see this and supported Dr. Hamilton. Dr. Hare thought the ancients were alive to the idea of buy viagra ms autotoxis, as evidenced by such terms as melancholia non-prescription viagra use and hypochondriasis, and Dr. Bower thought intestinal trouble more frequentlv the result than the cause of nervous disease. At the Clinical buy viagra ms Society meeting, after notes of a case of malingering in a boy of eleven, who had col- ored his urine to imitate hematuria in buy viagra ms order to escape non-prescription viagra use school, three cases of laryngectomy buy viagra ms were related by Mr. E. Ward, of Leeds, who had varied the usual mode of operating in order buy viagra ms to effect the shutting off of the wound from the mucous canals opening into it, and June 6, 1896] MEDICAL RECORD. 817 thereby securing union by first intention throughout. One of the patients was a man of sixty-four, operated upon for epithelioma; another, a man of forty-two, for general tumefaction producing dyspncea and dys- phagia for five months, deepening into orthopncea, stridor, lividity, etc. These two cases were treated successful ly. The third was that of a little girl, aged two years, with rapidly growing papillomata filling the larynx. She died of collapse sixty hours after the operation, and at the post-mortem the larynx was found again crammed with the growths. No prelimi- nary tracheotomy is required where it has not already been rendered necessary by urgent dyspncea. The first part of the operation was carried out on the ordinary lines, the larynx being, in preference, separated by di- buy viagra ms vision of the crico-tracheal membrane and buy viagra ms dissection from below upward, enucleation of the upper part be- ing thus facilitated. In cases of intrinsic disease the opening into the pharynx need not be more than a small vertical slit. After the larynx had been re- moved a large tube was passed from the mouth into the stomach, and the cut edges of the pharynx were carefully brought together over it by closely set sutures of fine silk, the pharyngeal wound being entirely closed. Then two discs of skin were cut out of the edge of the flaps opposite to the tracheal aperture, which was closely stitched to the circular opening thus made, and the skin wound was closed by suture throughout. Drainage tubes were inserted at each end of the cross incision at the upper part. By this method of closing the wound non-prescription viagra use the trachea and pharynx are completely shut out from it, and the trachea is so held open that no tracheotomy tube is required. The oesophageal tube is removed or left in situ for feeding, according to the needs of the case and the difficulty with which it is passed. Mr. Ward claimed for this operation: (1) That it will reduce the mortality of the operation it- self; (2) that it will considerably shorten the period of healing and convalescence; 1 ;) that it will add im- measurably to the comfort of patients, both during convalescence and after recovery; (4) that it will jus- tify attempts at radical treatment in some cases in which this is at present considered inadmissible. Mr. Arbuthnot Lane said he had adopted a similar course in a case of his own, dividing the trachea and drawing it forward out of communication with the pharynx, and the result had proved very satisfactory. In a case of papilloma of the buy viagra ms larynx, in which recur- rence took place after non-prescription viagra use removal of the growths, he had tried arsenic. By the time the dose of Fowler's solu- tion had been carried to seven minims three times a day, the obstruction had altogether disappeared. Dr. Semon protested against performing an opera- tion so grave as total laryngectomy in a child for pa- pillomatous disease of the larynx, a condition which non-prescription viagra use had been shown to be amenable to milder forms of treat- ment. Mr. E. Ward admitted that he would not be dis- posed to resort to laryngectomy again in a child with papilloma, though he knew of three cases in which the papillomatous growths recurred after removal and ultimately completely obstructed the larynx, and the