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heavy stone. Two cases were in all probability caused by contre coup. The remaining cases were due either to falls from a height, diving, or blows upon the back of the head. As to the results of the treatment : Three were not operated upon. Of these one was greatly improved by extension and counter-extension, as the fracture oc- curred in the dorso-lumbar region where this plan of treatment can be generic viagra amazon satisfactorily carried out. The same treatment was undertaken cheap viagra jelly in the other two cases, but with generic viagra amazon no improvement in their ondition. l!oth patients are living, generic viagra amazon but their condition is decidedly hopeless. Of the eight patients operated upon, one was entirely cured (after the removal of a tuberculous tumor); an- other (a young man who was thrown in front of a lo- comotive) was greatly benefited by the operation, as he is still living and able to get about witli a cane and crutch. In the latter case the operatinn was performed eight months after the receipt of the injury. The other cases were not benefited in any way by the opera- tion. Of the eight patients operated upon one died six days after operation, and his death may have been hast- ened somewhat by the interference, but, on the other hand, destruction of the spinal cord at the level of the fifth cervical vertebra could not have continued without interference with the roots of the phrenic nerve. generic viagra amazon In none of the other cases could a fatal result be charged in any way to the operation. The operation of lami- nectomy involves so slight a risk to life that the sur- geon should be encouraged to resort to this method of exploration in all cases in which the symptoms point to compression of the cord. Great depression of the pulse, generic viagra amazon respiration, or temperature may be taken as a contraindication to the operation. In one of uie above cases, however, the temperature was as low as 91 F., and did not go above 96 F. in twenty-four hours. generic viagra amazon The method of operating which Dr. Wyeth employed is as follows: With the patient in the prone position, reclining somewhat upon one side in order cheap viagra jelly to interfere as little as possible with the movements of respiration, an inci- sion is made with its centre corresponding to the seat of the lesion, seven or eight cheap viagra jelly inches in length, directly over the spinal processes. Strong hooks are used as retractors, which also assist in controlling the hemor- rhage. The attachments of the muscles should be cut or scraped from the bones in order to avoid wounding any vessels. In this way the lamina; are finally exposed, and with a small rongeur divided and removed one after an- other, until the dura is sufficiently exposed. Oozing of blood may be controlled by pressure with sterile gauze. After the wound is entirely dry the dura is opened by a sharp-pointed knife in the middle line. Through the primary puncture a grooved director should be introdued and the dura divided exactly in the middle line as far as necessary. When the fluid escapes cheap viagra jelly the edges of the dura can be held apart by mouse-toothed forceps and the cord inspected. A light probe should be passed up and down from the point of opening to determine if any compression of the cord exists at those points. The dura should then be closed by fine interrupted catgut sutures about three- sixteenths of an inch apart, and the muscles of generic viagra amazon the two sides stitched together with strong catgut sutures. Silkworm-gut sutures are used for the skin. It is al- ways wise to leave a twist of catgut projecting from the level of the dura at the inferior angle of the wound, as some oozing is apt to occur which may exercise compression on the cord. Most careful asep- sis should be practised. The patient should remain upon the back for the first week or ten days cheap viagra jelly after generic viagra amazon the operation. The wound should be dressed so that the patient suffer no material inconvenience from the re- moval of the laminae of two or three vertebras. SECTION OX OBSTETRICS AND DISEASES OF WOMEN. J. Taper Johnson, M.D., ok Washington, D.C., Chairman. Second Day Wednesday, May 6th. Gauze Drainage in Pelvic and Abdominal Sur- gery. Dr. Milo B. Ward, of Topeka, Kan., urged the importance of drainage in a large number of cases following operation. He said it was idle to contend that drainage is necessary only when the operation is imperfectly done. The only consideration is what is the best kind of drainage. While no one kind can meet all cases, yet his own experience led him to urge the claims of gauze drainage in the large majority of cases, as it meets two indications, viz., the control of hemorrhage and drainage at the same time. Of course drainage is not necessary in every case, but where there is any septic condition he thought drain- age should always be used. The objections to the use of gauze were the facts that a large opening is necessary in order to remove the gauze and the pain caused by the removal. In his experience he had never seen any ill effects from the use of iodoform gauze, though others had reported cases of poisoning. He had nothing new to offer in regard to technique except to say that the gauze should be used freely. In answer generic viagra amazon to the question as to what kind generic viagra amazon of cases re- quired drainage, he would say that it should be used in almost all seriously complicated cases or when the intestine is involved, and in all cases in which an opening is made in the vagina. In conclusion, he thought many patients would recover by means of drainage who otherwise would not survive. Dr. Kelly, of Baltimore, in opening the discussion, said that now he very rarely drains, and that his work has improved very much since he has ceased using drainage in the majority of cases. generic viagra amazon In the first four hundred out of fifteen hundred abdominal sections he used drainage cheap viagra jelly in seventy-three per cent, of the cases, in his last one hundred in only eight per cent., and the mortality decreased in proportion. When drainage is necessary he thinks the gauze drain the only one to use. He condemns the glass drainage tube, because it does not drain properly and because it introduces sepsis. He no longer uses drainage in cases of generic viagra amazon tuber-