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diseased tubes, probably in ten per cent, and possibly in twenty-five lowest cost viagra per cent. He was also fully in accord with Dr. McMurtry that everything possible should be left. The vaginal route has some things to recommend it in individual cases, in which the uterus is diseased as well as the tubes. But he wished to utter an em- phatic protest against patients going home as soon as the eighth day. He thought there is an analogy be- tween generic viagra vgx-100 the opening of the pelvis by either route, and much the same precautions should be used. There is no excuse for such extensive packing with gauze in the vaginal method as had been recommended. lowest cost viagra In many cases the wound could be closed as perfectly as in abdominal section, and that was the plan he had adopted with great success. Dr. K E. Montgomery, of Philadelphia, wished to say that the aim and object of all surgical proce- dures should be conservative; that nothing which has a function should be sacrificed. He claimed that the abdominal operation is a conservative one, since an opportunity is given to examine both sides. When both tubes are diseased he is in favor of removing the uterus. It has no functional value and may be- come the seat of disease. The infection involves the uterine mucosa and walls, and gives rise to hystero- neurosis. If the tubes are removed the condition of the patient will not be the same as if the ovaries were present and healthy, but by removing the uterus we take away the chances for many new symptoms. The change which the uterus undergoes after lowest cost viagra removal of both ovaries may cause compression of the nerve fila- ments in the uterus and consequent neurosis. Hem- orrhages and purulent discharges are also frequent. In his opinion the time of both operations is about the same. The necessity for separating adhesions in the vaginal operation is not so great, on account of the perfect drainage. He thought that the danger of in- juring the intestines and ureters is just about as great and occurs as frequently in the abdominal method, but there is more opportunity to repair the damage. Dr. I. S. STONE was surprised that attention had not been called to the selection of cases. Where the patient is very ill. suffering from sepsis, and cannot endure the shock of an abdominal operation, a simple incision through the vagina, as advocated by Dr. No- ble, was the only tiling to do. He thought there is less generic viagra vgx-100 shock in the vaginal operation, lie thought the time would never come when the abdominal operation for fibroids would be given up. Dr. Hall, of Cincinnati, thought that only a very small proportion of cases of double pyosalpinx re- quires the vaginal operation generic viagra vgx-100 and the removal of the uterus. In his experience the hemorrhages, discharges, etc., were readily cured. In fact, he has seen many patients get well without any treatment. Dr. Cordier, generic viagra vgx-100 of Kansas City, Mo., was surprised that no reference had been made to the difficulties of the vaginal operation. He had found that it is not so easy to do a vaginal operation as an abdominal. The difficulties are many. In a recent case an omen- lowest cost viagra tal vessel was adherent, and it having been torn in the midst of the operation the generic viagra vgx-100 bleeding could be controlled only by an abdominal section, though the patient had already lowest cost viagra been some time on the table. Drainage is not necessary by the abdominal method, we are told, but very necessary by the vaginal. Why is this? By the vaginal method it is impossible to discover ad- hesions. If the intestine is injured it is generic viagra vgx-100 either not discovered, or if discovered cannot be repaired without an abdominal section. It lowest cost viagra is possible for a hernia to occur if the mesentery is long, and if patients should be examined in the upright position after a vaginal operation, doubtless many cases of hemia into the vagina would be discovered. Intestinal Obstruction Following Laparotomy. Dr. H. O. Marcv, of Boston, Mass., stated that he was led to present this very important subject to the section because seven cases occurred recently in his own practice, five of which were fatal, and he hoped to derive some information on the subject. On account of the short time at his disposal he was obliged to omit the description of his cases and also the consideration of the anatomy of the subject, which he had written out fully. In his opinion the obstruction always occurs in the small intestine near the seat of the operation, and most frequently quite near the junction of the small and large intestine. This is important to bear in mind in connection with the treatment. The generic viagra vgx-100 important thing is the diag- nosis, for the prognosis depends largely upon the early diagnosis. But this is extremely difficult, for there are no clear-cut, positive symptoms. There is a wide difference in the symptoms from generic viagra vgx-100 those which indicate the usual acute intestinal obstruction. In none of his cases was the integrity of the intestine involved, and he was inclined to think that the generic viagra vgx-100 operation had so lowered the vital forces that paralysis of the bowel took place, peristalsis ceased, and septic poison- ing occurred through accumulation of the secretions of the bowel. The prominent symptoms in these cases are persistent vomiting, which is of much more significance when it comes on several hours after the operation and is not due to the anaesthetic; pain which might be local or general, and frequently was not severe. The temperature is not usually marked, but the pulse is rapid and there is a peculiar, anxious expression of countenance which is quite character- istic. In the treatment we are prohibited from using remedies by the mouth, since there is an accumulation of everything above the obstruction, and drugs will only aggravate the trouble. Enemata are of generic viagra vgx-100 no use, as the obstruction is in the small intestine. A careful examination of the intestine should be made at the site of the operation, then in the region of the appendix, and generic viagra vgx-100 then of the omentum, and the ob- struction will usually be found. If done early the difficulty can be corrected. In desperate cases an in- cision may be made in the abdomen, the first inflated coil of intestine seized, attached to the wound, and opened, establishing generic viagra vgx-100 an artificial anus, and thus the patient be carried along until a thorough and radical operation can be performed. As a prevention of this