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Dr. Tiffany closed the discussion, and stated that forty-five operators had participated in the hundred cases reported, of which number twenty-four had ope- rated upon only one case each. He also mentioned that there is diminished sensation in these cases and les- sened lacrymation. He considers the curving of the tongue due to atrophy of the muscles, but cheap viagra cost does not understand why the perception of heat and cold should be interfered with. As to tying the carotids, Dr. Tiffany stated that Dr. Park, of Buffalo, had successfully done this in two cases. Tuberculosis of the Female Genital Organs (in- cluding tuberculosis of the kidney). Dr. Albert Yaxder Y'eer, of Albany, read a paper with this title. He stated that this subject had been neglected until recent years, and that the modern ideas and progress depend upon careful histological and bacteriological examinations. Tuberculosis of the female pelvic vis- cera is not limited to any age, the extreme limits being ten weeks and eighty-three years. External genital cheap viagra cost lesions may be confounded with tuberculosis. He- redity is important as suggesting tuberculous possibili- ties. Tuberculosis is extremely rare in the external genitals, but by no means infrequent in the uterus. Tuberculosis of the uterus cheap viagra cost can be demonstrated by mi- croscopical examination of viagra tablet dosage the discharges and by cu- retting. Gonorrhceal infection is often grafted upon tuberculosis. Sometimes infection takes place through the fingers or the instrument or cheap viagra cost the semen. Tubercu- losis originates in the tubes and infects the uterus and cervix. The uterus can be infected from without or within and the infection is aided by a lacerated cervix, pelvic peritonitis, trauma, etc. The symptoms are local irritation, a pea-sized wart near the vaginal outlet, a discharge from the uterus, etc. The differentiation be- tween viagra tablet dosage the ulcers of syphilis and epitheliomas depends on age, history, local appearances, etc. Tuberculosis of the cervix can be mistaken for cancer. Many vaginal viagra tablet dosage cases are infected from the tubes, and tuber- culous peritonitis may infect the vagina and the tubes. The author mentioned several cases illustrative of the pi nuts referred to. With regard to tuberculosis of the kidney, there may be two forms, ( 1) miliary tuberculosis and (2) caseous or true tuberculosis. The author gave the details of one or two cases and referred p.t some length to Kelly's nephro-ureterectomy. Tuberculous Peritonitis. Dr. Robert Abbe, of New York, thought it would give a fairer understanding of the multiform appearances of the disease if we view- it from the standpoint of the bacillus, rather than, as others have done, from the gross appearance, which has led to the division into the ascitic, the dry, and the case- June 13, 1896] MEDICAL RECORD. 867 ating form. A sudden tuberculous irruption into the peritoneal cavity may be as acute in symptoms and duration as acute peritonitis from other causes. A slower outbreak may result cheap viagra cost in ascitic distention in three or four weeks, and a less virulent bacillus action may occupy months in inducing ascites and wasting. In other cases, possibly due to the route of invasion (penetration through lymphatics, communicating mu- cous and peritoneal serous coats, or by follicular ulcers allowing tuberculous milk to be the medium of in- fection) a dry or cheap viagra cost adhesive form follows in which hectic cheap viagra cost and rapid wasting result. Again the bacillus pro- duces an outpouring of thick lymph and flocculent serum which rapidly become purulent, producing un- symmetrical cakes of thickened omentum, matted coils, and encapsulated purulent collections. The bacillus products rapidly caseate and ulcerating viagra tablet dosage fistula- may re- sult. All phases of the disease may be regarded as representing the life history of the bacillus and its products. Tuberculous peritonitis may be, and in the early stages often is, the only site of tubercle deposit in the patient; hence, if overcome there, a practical cure often follows. Even when other phases of infec- tion (pleural, intestinal, bronchial) are seen, an oper- ative cure of the peritonitis has often been followed by general recovery. The mode of entrance of the bacillus is directly through the intestinal wall or through ulcerating appendicitis or tubal or ovarian tuberculosis, or through the blood. The claim of a few recent authors to having cheap viagra cost cured tuberculous peri- tonitis by medical treatment were reviewed and cred- ited. The unquestioned cure of true tuberculous peri- tonitis by laparotomy is proved by two classes of patients, those who have long survived operation, and those who, having come to autopsy long afterward, have been found free from tubercles that studded the peritoneum at the time of operation. Experimental proof in animals corroborates also operation by simple viagra tablet dosage laparotomy and evacuation of the ascites; closing the dry abdomen is credited with a large number of cures. Irrigation with warm salt solution is advocated by preference. Camphor-naphthol application, as used by Rendu, is advised for bad cases. Dr. Abbe reviewed many interesting and illustrative cases in speaking of direct medication. The many theories advanced to account for the surprising cures were carefully considered, and it was said in conclu- sion that the theory that is sustained by most facts is that based on the life history of the bacillus and the capacity of the animal economy not only to suppress the activity of the organism viagra tablet dosage by encapsulating it, but to remove it by absorption. The proper opportunity for conquests is not afforded in the presence cheap viagra cost of ascitic fluid, which acts as a veritable culture bouillon and by its fluidity aids dissemination. When, however, the peritoneum has been aroused by congestion, which