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was easily reduced. The time occupied by the oper- ation was twenty-five minutes. The infant's convales- cence was uneventful. Case XXI. Dr. Howitt, in a paper read before the www viagra online American Association of Obstetricians and Gynecolo- gists, 1894, records a case of intussusception of the ileo-caical variety occurring in a male infant, aged six months, which came under observation on the second day. Cathartics and enemata had previously been un- successfully employed, as was Sena's plan of rectal in- sufflation with hydrogen gas. The infant's condition was bad. Laparotomy was performed, and the inva- ginated gut was difficult of reduction. The infant's bowels moved the same evening, and its convalescence was uneventful. Remarks. The total number of cases of infantile intussusception collected and reported in this paper is 103. Of these nearly 50 per cent, occurred during the fourth, fifth, and six months, in nearly equal pro- portions ; 75.4 per cent, of the cases occurred in males, and 89 per cent, were of the ileo-cascal variety. Pritchard in his paper on intussusception called at- tention to the probable part played by external vio- lence in the causation of this disorder during early life, particularly the careless manner in which infants are picked up cheap viagra california and doubled over the arm of those car- ing for them, thereby injuring and causing a cheap viagra california tempo- rary paralysis of some portion of the www viagra online intestinal canal. Jacobi has also called attention to this matter, particu- larly to the way in which infants are violently jumped up and down to quiet their cry. This seems to have been the prime factor in the causation of the invagi- nation in the www viagra online writer's case. The age during which the infant is most liable to be affected by this disorder seems to substantiate these views. In one case the in- vagination was caused by an intestinal tumor. In these cases there seems to be nothing of unusual interest in the symptomatology to record. The dis- order manifests itself by means of www viagra online a sudden onset of severe abdominal pain, followed by vomiting and the passage of stools containing blood and mucus. Tenes- mus was present to a marked degree only in those cases where the cheap viagra california gut portruded from the anal orifice, or where the tumor was clown in the rectum. The symptoms varied in intensity in the usual manner, in direct pro- portion to the degree of constriction the bowel was sub- jected to, as indicated by the character of the pain and the amount of blood passed from the anus. The sign of the disorder, an abdominal tumor, was seldom ab- sent, as was to be expected in such a large proportion of cases of the ileo-cacal variety. Several of the re- porters call attention to the necessity in all suspected cases of this trouble of making a conjoined abdominal and rectal examination, for in some instances a tumor was revealed by this means after abdominal or rectal palpation alone had failed to discover it. A protruding anal tumor occurred in the usual pro- portion about six per cent, of the cases. Cure by sloughing, which is exceedingly rare in these cases, was met with twice, in Beeston's case and in one recorded by Mr. Cripps in the St. Bartholomew's Hospital Reports for 1892, of which a few particulars will here be given, it not www viagra online being included in the collec- tion. The case occurred during r882, in a female, aged three months, which came under observation on the fourteenth day, with a gangrenous mass of gut protrud- ing from the anus, a portion of which was removed. The rest www viagra online sloughed off, and the patient recovered. Thirty-nine of the cases were treated only by means of inflation, or enemata. or both. Of these, sixteen, or forty-one per cent., recovered. cheap viagra california The average hour after the onset when the treatment began was the forty-first. The histories of these cases www viagra online are so deficient as to the details of the quantity of fluid or the amount of pres- sure employed that no deductions can www viagra online be drawn in re- gard to these points from this group. In two cases, eight ounces of water were used; in two cases, one pint ; in two cases, one quart with a head of from three to four feet; and in one case, three quarts under a head of five feet was reported as having been the amount injected into the intestinal canal of an infant seven and one-half months of age. In one case, nine enemata were required to bring about a permanent re- duction of the invagination, www viagra online as evidenced by the dis- appearance of the tumor and the subsidence of the symptoms. Chloroform cheap viagra california narcosis was employed in three cases while the distention of the bowel was being effected. The cases of this group which terminated fatally were twenty-three in number, a mortality of fifty-nine per cent. The average age of the infants was about five months. The average hour following the onset when treatment was begun was the sixty-ninth. In one case while the enema was being administered under chloroform narcosis, and in the inverted position, the infant cheap viagra california vomited, inspired the vomited material, www viagra online and died. In several cases, collapse followed the admin- 84 MEDICAL RECORD. [January 18, 1896 istration of the enema, and in nearly all cases there is the same story of the inefficiency and uncertainty of the method, the tumor disappearing only to return after a short interval, and the treatment repeated again and again, the occasional repeated administration of chloroform with alternating injections of air or water combined with massage, often roughly applied, till finally death mercifully came to the infant's relief. In all of these cases where notes of a necropsy were found,