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tubal disease the uterus should be removed at the same time, no matter what its condition. The pendulum has swung clear over, and this axiom has been ac- cepted in many quarters as a universal law. Against this he wished to protest. Have the pathological conditions found borne out the clinical phenomena? The mortality is no greater than when the tubes alone are removed ; but the treat- ment must be based upon pathological grounds and the uterus should not be sacrificed unless it is so dis- eased that it cannot be cured. If it is not enough that it is diseased, it must be beyond help by other means. He agreed with the statement of a distinguished writer who said that many uteri have been removed generic viagra pune which could have been saved. It is possible that the gon- ococci might penetrate below the mucous membrane into the deeper tissues buy viagra sf of the uterus, though only one observer had ever found them, and he was willing to grant that twenty-five per cent, of cases of salpingitis were gonorrhceal : but he did not believe that every case of gonorrhu-al infection of the uterus is incur- able. If the disease is tuberculous in character he thought the uterus should be removed, as the nature of the disease makes it incurable. It is necessary to bear in mind that there are two classes of cases of bi- lateral disease of the appendages. The first variety is chronic, with large pus sacs and many adhesions and characterized by recurrent attacks of pain. Here the indications are to remove the uterus. In the other variety the tubes and ovaries are purulent or cheesy, the attack is acute, and the uterus is perhaps a little large, but freely movable. In these cases it is a grave question whether it is advisable to remove the uterus. In conclusion he wished to emphasize the fact buy viagra sf that there can be no universal law in these buy viagra sf cases, that each must be studied by itself, and that the condition of the uterus at the time of the operation should be the guide as to its removal or not. Vaginal Fixation. Among two hundred and seven patients operated upon by Dr. Diihrssen for vaginal fixation twenty have had children. Of these three, or fifteen per cent., have had difficult labor. 752 MEDICAL RECORD, [May 23, 1896 ovvcspondcncc. OUR LONDON LETTER. (From our Special Correspondent.) EXHIBITION OF CASES MAMMARY ABSCESSES THE MIDWIVES QUESTION THE LIVERPOOL LYING-IN HOSPITAL generic viagra pune DEADLOCK A JUDICIAL SCANDAL SMALL- POX THE LATE VV. SQUARE, E. D. m'.MCOLL, AND A. F. WOOD THE PLAVFAIR CASE SETTLED. London, May 1, 1896. Among the cases exhibited at the Clinical Society generic viagra pune last Friday were buy viagra sf two of deficient development, of which it would be interesting to study the results in the light of the new photography. One patient was a buy viagra sf little boy of five years of age, in whom three ribs (eighth, ninth, and tenth) on left side were absent. The eleventh rib on this side was also smaller than on the opposite, though the twelfth was larger. The movements of the spleen and diaphragm were visible. The other was a lad in whom the deficiency was in the lower end of buy viagra sf the tibia occurring after transverse fracture. There was marked curving outward, throwing the internal malleolus into prominence. The lower end of the fibula was hvpertrophied and bony ridges were formed. The line of fracture was some distance from the epiph- ysis. A delicate-looking boy of three, with an enor- mous sacro-coccygeal tumor, was also shown. The tumor seemed to be a cyst with some solid matter round the base. The sacrum and coccyx buy viagra sf could be felt over the tumor, which commenced between the rectum and coccyx. In contrast with buy viagra sf this case was that of a wo- man, aged twenty-six, with spina bifida, the position of this being of course outside the sacrum. It was remarked that operations on these cases were always fatal before the antiseptic era. Since then some cases had been successfully operated on. It was also sug- gested that the mortality of the earlier cases was the result of operating at too early an age. A girl, aged fourteen, was shown as a marked example of pseudo- buy viagra sf rickets. She had been under observation two years and submitted to the new photography, which had shown the exact state of the joints. She did not seem to have had rickets as a child, and the bony lesions were not accompanied by the usual sweating, restless- ness, and painful sensations. Sequels to cases previously exhibited were also shown, among them a lad, aged thirteen, with a curious defect of speech. It was suggested that such cases could be well recorded by the phonograph, and verbal descriptions are certainly of generic viagra pune little use. At the Medical Society meeting on Monday Mr. Shield read a lengthy paper on " Abscess of the Breast." Me generic viagra pune thought most of the cases buy viagra sf were due to infection through sore nipples and were therefore preventable. When fully formed, he advocated thorough operation, lie makes an incision through which he passes the finger to explore the whole cavity, and, having found the most dependent part, makes there a second in- cision. The abscess cavity is then evacuated and cleansed, and the original incision closed with horse- hair sutures, over which collodion is applied to pre- vent scarring as much as possible. Should a sinus form and prove intractable to scraping, he would ex- a wedge of gland tissue, including the sinus and