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time for operation, this should be decided from the standpoint of the best interests and safety of the pa- tient. In the author's opinion operative measures should be an early consideration rather than the last resort. Of one hundred operations performed by Dr. Johnson, ninety-eight resulted in recovery and two in death, of which number sixty-four were males and thirty-six females. Dr. Parker, of New Orleans, said that he was much surprised at the large number of cases of appen- dicitis in the North as compared with the South, as he did not believe half a dozen cases generic viagra thai a year were seen in New Orleans. He never saw any in the negro. He could not agree with the author as to the advisa- bility of at all times removing the appendix, and thought that in those cases in which the appendix is buy viagra seattle sur- rounded by an abscess all that is necessary is to open the abscess and drain the region. He was in favor of opening the bowel with an enema and saline as a pre- paratory procedure, but did not believe in the use of opium. The Secretary said that he fully agreed with the last speaker that the opening and draining of abscess- generic viagra thai es surrounding the appendix is in the majority of cases all that is necessary, and in the large number of cases which he had observed he had not encountered a single recurrence after this method had been em- ployed. One should no more think of treating every case of appendicitis in the same way than he should think of treating all cases of pneumonia with the same drug, and the same remark applied to the length of the incision. He thought this a matter which should be decided entirely according to the requirements of the case. The result obtained by the author of the paper was, he thought, almost unparalleled. Dr. Carpenter, of Kentucky, said that each case is a law unto itself and must be treated in that way. He believed many patients are lost by meddle- some surgery and also that excision, irrigation, and drainage are all that is necessary in the majority of cases. Dr. McRae, of Atlanta, said that, as regards the question generic viagra thai of appendicitis in the negro, he had operated on two patients, one male and one female, both of whom recovered. He was firmly convinced that it would be a very dangerous practice to state that every appendix should be removed when it is contained in an abscess wall, and he agreed with the other speakers that sim- ple drainage is usually all that is necessary. He was satisfied that the appendix could be removed at a later sitting with less danger to the patient. Dr. Alexander Hugh Ferguson, of Chicago, said that in his opinion the most favorable time to operate is between the attacks, and he considered it dangerous to operate during the height of inflammation, particu- larly when there is buy viagra seattle a tumor. The second most favora- ble time to operate is early, say w'ithin twenty-four hours, and generic viagra thai the patient's chances are much better than if left until the fourth or fifth day. In ninety-nine 744 MEDICAL RECORD. [May 23, 1896 per cent, of the cases an inch and a half and a week and a half is wrong. Upon entering the abdomen, as soon generic viagra thai as pus is found a drain should be employed, and the best way of doing this is with gauze and a glass tube. 'Dr. Haines, of Omaha, said that he did not believe that it is always necessary or advisable to generic viagra thai remove the appendix; in fact, he generic viagra thai considered that such routine practice should be condemned. Dr. Johnson, in closing the discussion, said: "When the appendix is situated in the wall of the pus sac, I think it generic viagra thai should always be removed. Al- though there are good authorities against this proce- dure, my experience is that it is the best thing buy viagra seattle to do. I have never yet had a case of peritonitis result- ing. You have generic viagra thai a highly septic matter generic viagra thai which, in my opinion, it is dangerous to leave behind. As to the length of the incision, buy viagra seattle I do not think a seven-inch incision should be buy viagra seattle required in any case, as it not only prolongs the operation but weakens the abdominal wall, which is a serious matter if your patient be a la- boring man. Experience soon enables one to perform the operation through a generic viagra thai very small incision. The Dawbarn method, when it can be employed, is an ex- cellent one and by it the operation can be done in five minutes after you get used to it. Fecal fistula? will usually take care of themselves. As to the preparation of the catgut, I do this myself by placing it in ether, changing the latter until all the fat is taken out. I then boil it continuously at a temperature of 173 F., and put it away in sterilized glass jars until I wish to use it, when I resterilize it." Illumination of the Sigmoid Cavity. Dr. J. G. Carpenter, of Stanford, Ky., made a few remarks on his method of illuminating the sigmoid cavity which he has employed for a number of years, and drew dia- grams of the instruments used. He stated that Dr. Kelly, of Baltimore, claims to have been doing a similar operation for many years, but no account of the work can be found in medical literature previ- ous to 1894. Fourth Day Friday, May 8th. Gastrostomy for Stricture of the (Esophagus Dr. Hunter P. Cooper, of Atlanta, related the his- tory of a young man who one year ago took one swal- low of pure nitric acid by mistake, causing corrosion of the entire mouth, lips, and oesophagus. The mouth