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variety is likely to be unavailing, while in the inter- stitial cases ergot sometimes produces marked results, examples of which I reported in the Brooklyn Medical Journal several years since. The well-known physio- logical effect of pressure, persistently applied, pro- duces absorption, and to this influence in part must be ascribed the power of ergot in producing absorp- tion of fibroid growth and in moderating and control- ling hemorrhage. It is alleged by Emmet that the effect of ergot on intramural fibroids is liable to pro- duce excessive pain and to so diminish the blood sup- kamagra viagra generic ply as to endanger the vitality of the growth, thereby inducing sloughing and sepsis. While I have nz viagra cost never seen such results follow its use, the possibility of such effects should always be borne in mind. The uterine contractions incident upon its administration in sub- mucous fibroids and intra-uterine fibrous polypus may eventuate in their detachment, partial or entire, or the same force may expel them from the uterine cavity, thereby converting sessile growths into pedunculated ones. In fact, this extrusion of fibroids into the uter- ine cavity not infrequently takes place independently of medication and should be regarded as conservative evidence of nature's attempt at cure. When this occurs medical treatment should be sup- plemented by surgical aid for their entire removal, either by snare, ecraseur, spoon, or scissors, done under the most rigid aseptic precautions. It should be remembered that fibroid growths sometimes di- minish or disappear coincidently with gestation, and that those of moderate size disappear spontaneously. There is a susceptibility in fibroma to rapid growth and equally rapid diminution in size. Physiological causes dependent on some change in their nutrition, either the result of diminished blood supply or in- kamagra viagra generic creased activity of the lymphatics, or both, when once set in operation, result in cure or disintegration. Small fibroids developing in nz viagra cost the cervix or cervical canal are frequently sources of annoyance and dis- ability entirely out of proportion to their size. Enu- cleation is the proper treatment, and in my experience the results nz viagra cost have been highly satisfactory. Hemorrhage as a symptom of fibroma is the result of interrupted circulation, ulcerative disease, and degen- erative changes of the endometrium covering areas of the growth. In such a condition curettage often acts in the most salutary way by its alterative influence nz viagra cost on inflammatory and degenerative structures. Hemor- rhage not controlled by such measures requires more active interference. This symptom of hemorrhage is often not due so much to the size as to the location of the growth. Submucus myomas are the most frequent causes in the production of hemorrhage. In cases in which the growths are not too large and persistent and hemorrhage and pain are the prominent symptoms, two methods of procedure are open to choice apart from hysterectomy one, removal of the ovaries; the other, ligation of the uterine arteries. It is proper to mention at this stage of the discus- sion that the state and surroundings of the patient may have much to do with the method of treatment adopted. The woman of ease and opulence, who can without stint command all which medical skill has to offer, may by a prolonged period of rest, mental and physical, be carried safely past the menopause by the use of legitimate palliative treatment, while her less favored sister under circumstances of want and depri- vation would nz viagra cost fall a victim to such plan of treatment. This makes evident the necessity for discrimination as to treatment, and the suggestions hereinafter made should be applied accordingly. If there is reason kamagra viagra generic to expect in a given case that the blood supply can be diminished by ligating the uter- ine arteries so as to arrest the hemorrhage and pre- vent the larger growth of the tumor without causing sloughing, it is a proper and conservative method of procedure. It is an operation usually easy of accom- plishment, and involves little or no risk to the patient, so far as the procedure per so is concerned. It kamagra viagra generic is done as follows: having previously sterilized the vagina, the patient is kamagra viagra generic ana-sthetized and placed on her back with the knees Hexed as in the operation for vaginal hysterectomy. An incision an inch long is made on each side of the cervix through the tissues at the vagi- nal junction into the broad ligament. Gently sepa- rating these structures by the knife handle or blunt scissors and keeping close to the uterus, so as to avoid the ureters, until the uterine artery kamagra viagra generic can be kamagra viagra generic felt, a ligature of some absorbable material is carried around it with an aneurism needle or a Cleveland's ligature carrier and tied in at least three knots cut short, and the incision closed with running catgut sutures. This method does not deprive the woman cf her reproductive functions and lacks the objec- tion to mutilation, so deeply seated in a woman's heart. In cases of a severe type in which this method is not successful resource may be had to the removal of both ovaries. If, kamagra viagra generic however, the growth is large, or moderately s. 1, and there is reason to presume that there is much increase in kamagra viagra generic the calibre' of anastomosing vessels, which would in normal conditions be insignificant, removal of the ovaries for artificial production of the menopause may prove delusive and unavailing. It is, however, gratifying to note that a recent resumi by Marcy, of Boston, on the results of Battey's operation for this and analogous conditions, shows results more satisfactory than the experience of many had war- ranted. Dorsett, of St. Louis, and Martin, of Chi- cago, kamagra viagra generic both produce gratifying evidence of the utility of kamagra viagra generic the ligation of the uterine artery or arteries for such growths. This method of treatment is not applicable to large fibromas, as the impairment of nutrition might induce sloughing. Caution should, however, be exercised in not predicating too much for the patient in either method of procedure, as it may not prove successful. If resource is had to the latter method of operating, great care should be exercised that thorough work be done and no portion of ovarian tissue escape excision; otherwise the function of men- struation will not be arrested. It is held by some, and apparently upon tenable grounds, that it is better to include kamagra viagra generic kamagra viagra generic in this procedure the removal of the Fallo- pian tubes, thereby diminishing the liability to the development of subsequent disease and insuring