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men thought it might be well to caution general prac- titoners against attributing to auto-infection those cases of sepsis attending labor in which their own hands or instruments were the cause. generic viagra levitra ( ases of the kind related by Dr. Davis must be rare as compared with the number in viagra inhouse pharmacy which infection was viagra inhouse pharmacy introduced from without, and the cause stated should be if possi- ble attested, as in these generic viagra levitra two instances, by autopsy. Treatment of Intra-Ligamentous and Retro-Peri- toneal Uterine Fibromyomata. Dr. William H. Wathen, of Louisville, said the purpose of his paper was to describe the method of operating when these tumors are too large to be removed by the vagina, and are so wedged in the pelvis as to make abdomi- nal operation difficult if not dangerous. By the meth- od described he ligates generic viagra levitra the uterine arteries from below, since if this viagra inhouse pharmacy is not done they cannot be reached from above by abdominal operation until after extensive enucleation. The operation is com- pleted from above. Dr. Wathen thought no portion of the cervix should be left in performing hysterectomy in this class of cases, as it only invites future trouble. The paper was discussed by Drs. Cushing, Harris, Gordon, J. T. Johnson, and The President. The President spoke of ligation of the arteries in abdom- inal hysterectomy, out at the side of the pelvis, far enough to prevent hemorrhage from all the branches supplying the field of operation the viagra inhouse pharmacy ovarian, uterine, etc. Caesarean Section ; Suture generic viagra levitra of the Uterus versus Total Extirpation. Dr. Henry C. Coe, of New York, read the paper. He related his experience with Cae- sarean section in three cases and extirpation of the uterus following Cassarean section in a fourth case, and gave reasons why he thought that in many in- stances, if not usually, it is best to remove the uterus after incising it and removing the child. Among the 814 MEDICAL RECORD. [June 6, 1896 women on whom he had found Cesarean section nec- essary, it was of doubtful advantage to the patients themselves as well as to society to leave them in a state generic viagra levitra in which a subsequent Caesarean section might become necessary. In the instance in which he removed viagra inhouse pharmacy the uterus he was led to this course from the generic viagra levitra fact that the viagra inhouse pharmacy patient's condition was such as to make it extremely doubtful whether she could survive any operation, and he regarded her chances as better after removing the uterus' than after suturing that organ. The operation was shorter and there was less danger, of course, from septic infection. The woman rather unexpectedly sur- vived. Among reasons for extirpating the uterus in similar cases "are: Less danger of infection when there have been attempts at tie livery : shorter operation ; the fact that many of these people are pregnant ille- gitimately, are stupid, are liable to be away from skilled attendance in future labors, and have not the high motive to raise a child. Of course, there can be no universal rule to remove the uterus. The following gentlemen discussed Dr. Coe's paper: Drs. Grandin, Noble, Harris, I >avis, Boldt, Gar- rigues, R. A. Murray, Harrison. Ur. Davis agreed with Dr. Coe, but most of the other gentlemen thought he was too radical. They believed in removing the uterus only when there is a positive indication for it, particularly septic infection. Drainage of the Stump in Abdominal Hysterec- tomy. Dr. Henry T. Byi-ord, of Chicago, in this paper described his method of draining when, after removing the uterus by the abdominal route, a little of the cervix is left. It consists in making an an- terior vaginal incision and inserting a drain between the peritoneal folds and cervix, extending out through the vaginal opening. Drs. Harrison, Noble, and Baer made some re- marks upon this paper. Dr. Harrison gave credit viagra inhouse pharmacy to Dr. Emmet for having done the first operation, remov- ing the uterus except a small portion of the cervix by the abdominal route. Dr. IJaer said he did not wish on this occasion to discuss the priority of this operation, as it had already been considered on former occasions. The point of importance was its viagra inhouse pharmacy value to humanity. Myomectomy, Fatal Secondary Hemorrhage, with Rise of Temperature. Dr. Henrv D. Fry, of Washington, related a case of myomectomy in which the patient died after twenty-four hours of continuous bleeding due to slipping of the ligature. The point of interest was rise of temperature, pulse after some hours becoming rapid. While internal hemorrhage was suspected, he was in doubt because of the rise in temperature, as generic viagra levitra the books stated that in hemorrhage there was a fall of temperature. The paper was discussed by Drs. Grandin, Bai dy, and BOIES. They paid less attention to the tempera- ture than to the pulse in hemorrh tge. New Instrument Dr. Clement Cleveland, of New Vork, showed a small electrode which he en- closes in the ligature on arteries in hysterectomy ;es, and after about thirty-six hours attaches to it the battery, pasM/s the current, and severs the ligature (silk 1. Surgical Injuries of tha Ureter. Dr. J. M. Baldy, of Philadelphia, in this paper described the two methods oi operating for repair of surgical in- juries to the ureter, one consisting in uniting the severed meter by uretero-ureteri 1 anasti imosis, the other in inserting the ureter into the bladder, called uretero- cystotomy. He thought the division was usually near enough to the bladder to allow of the latter operation,