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wide opening is secured for thorough evacuation. Thoracoplasty (Schede's) and "Visceral Pleurec- tomy Dr. Alexander Hugh Ferguson, of Chica- go, read this paper. Thoracoplasty, as first done by Schede, is an heroic measure for the othenvise hopeless cases of chronic empyema, and consists in the removal of the chest well. The author described the operation at some length, and stated that, in spite of this opera- tion and all other procedures for the relief of this affection, some cases are not cured. He stated that the assertion made by Schede, that amyloid degen- eration and tuberculosis do not contraindicate this operation, is true within certain limits Dr. Ferguson described Schede's thoracoplasty as performed by him (the author) in July, 1895, in which case a good result was obtained, the wound healing by first intention and the patient gaining flesh so rapidly that he was able to be about in a remarkably short time. At the end of five months' careful treatment after the ope- ration, a long central sinus not having closed, the ope- ration of visceral pleurectomy was performed, which resulted in the complete restoration of his health. The operation of viagra prescription discounts visceral pleurectomy was first per- formed in America by cheapest viagra prescription Dr. George R. Fowler, in Octo- ber, 1893, since which time several others have been performed, a brief outline of which the author gave. A number of excellent photographs and drawings accompanied this paper, showing the methods of ope- ration as performed by Dr. Ferguson. Dr. Bayard Holmes, of Chicago, in discussing Dr. Ferguson's viagra prescription discounts paper, said that he had performed three operations of this kind, and two of the patients are now alive and well. In the third case there was no improvement after the operation, and the patient sub- sequently died of tuberculosis. In one of these three cases drainage between the ribs had been instituted for over three months, and the young man had been sent home to die. After excision of the rib lie made a careful examination and decided that it would be impossible to bring the chest wall in contact with the stump of the lung. He therefore removed the chest wall by rapidly cutting in both directions, dissecting out the ribs, cutting off the parietal pleura, viagra prescription discounts which was one-half inch thick, and also the pulmonary pleura, which was of the same thickness. He then brought the surfaces together and drained with gauze around the opening, with the result that the patient made an excellent recovery. Two months afterward there was no further occasion for dressing except for the external wounds. cheapest viagra prescription The only adult on whom the speaker had operated was a man thirty-five years of age, who had been suffering with empyema which had been neg- lected for cheapest viagra prescription more than a year. In this case a similar operation was performed after two attempts had been viagra prescription discounts made to close the cavity by the Estlander operation. After the third operation the patient made a good re- covery, but it was necessary later to do two or three operations for the removal of infected bone where the ribs had become infected from a discharge of pus. A third case of empyema had been treated by the simple Estlander operation, and the patient seemed to re- cover and went home. In this case a pleural cavity was filled with pus, which existed for a long time until the patient finally came cheapest viagra prescription back. The cavity was again opened, when the lung was found to be collapsed and the pleura was much thickened. After so radical an operation as this the patient died with suppurative disease, which showed that it had tuberculosis as the 7H MEDICAL RECORD. [May 1 6, 1896 foundation. Acute miliar}' tuberculosis was present in the abdominal cavity at the post-mortem. It was a peritoneal tuberculosis. Dr. James H. Dunn, of Minneapolis, said that dur- ing the past few years he had been much interested in observing several cases of this operation, and it was his belief that the necessity for doing the operation is usually due to the failure viagra prescription discounts in diagnosis and to the want of proper drainage. However, he did think that when operations are necessary in the treatment of em- pyema and the Estlander method has been employed, the results have usually been fatal. When it has been successful, he thought that proper drainage would have produced equally good results. If a thoracoplastic operation is necessary, he believed that this one is the most desirable, but if one viagra prescription discounts thinks that the ribs prevent the chest wall from falling in, he is in error, as the ribs are not able cheapest viagra prescription to do anything of the kind. The cav- ity would be obliterated without the slightest difficulty, so far as the ribs are concerned. What does prevent the collapse of the cavity is the presence of old gran- ulation tissue. In the speaker's opinion many thora- coplastic operations have viagra prescription discounts been clone that were not nec- essary, as proper drainage would have cured the cases anyway. Of course, in some cases operation is neces- sarv, and he believed the one that Dr. Ferguson had presented was the proper one in order to get primary healing, that is, the resection of the chest wall and the removal of the granulation tissue. In speaking on this matter he referred not only to his own cases, in which he had removed ribs two or three times, but to those of his colleagues who cheapest viagra prescription viagra prescription discounts have pursued the same course. He did not mean to say that none of the patients have recovered, for one of cheapest viagra prescription his own did, but not until he had practically done cheapest viagra prescription this operation. Dr. Ferguson, in closing the discussion, said that Estlander's operation is a grave one, as also is pleu- rectomy; cheapest viagra prescription but Schede's operation is a graver one. He did not think, in looking over the statistics of the cases, that more than one or two of the operations have been performed without clear indications. As to the proper order in which these various operations should be done, he did not think that thoracoplasty should be performed until Estlander's operation has failed, as many patients undergoing this latter operation get well.