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higher by the court; that the hypothetical question which is supposed to embody the facts in a case, in reality is often distorted, disingenuous, and is ruthlessly handled and more or less emasculated be- fore the witness is allowed to pass judgment upon it. Dr. Howard A. Kelly confirmed the general views stated by Dr. Kirkley, but thought that usually the surgeon in a large hospital who takes ordinary precau- tions will have that moral support of the community which will prevent unjust suits for damages, or cause a verdict to be rendered in his favor. Gynecology and General Medicine ; Their Recip- rocal Relations. Dr. Chauncey D. Palmer, of Cin- cinnati, read this paper. He said there is no purely local disease ; every organ of the body has its consti- tutional relations. These differ in cheap viagra mexico intensity, quan- titv. and duration. The nervous relations were first considered. Many neuroses of a functional kind chorea, epilepsy, hystero-epilepsy, hysteria, neuras- thenia, neuralgia, and mental disorders like mania and melancholia are often connected with or de- pendent upon female pelvic diseases or are aggra- vated thereby. How does the female organism modify the manifes- tations of disease ? He thought we must accept the view that cheap viagra mexico menstruation is not a local function of but a few days' duration, but that it is a systemic change ; a tide, the stages of which extend over twenty-eight days. Preceding the menstrual flow there is increased vascular and nerve tension, with increased bodily and cheap viagra mexico mental function, while the re- verse condition follows the flow. In consequence, there are phenomena which modify existing symp- toms cheap viagra mexico of disease, if they do not give rise to new ones. Local diseases tend order viagra direct to become constitutional, and constitutional diseases to become local. Local dis- eases produce secondary constitutional changes or consequences, rather than the continuance of them- selves. Local phenomena without adequate local cause mean bad constitutional condition, as do con- tinuation of symptoms after removal of the exciting cause. There is scarcely a disease of the general system of considerable importance which does not in- fluence the circulation and the innervation, and. of course, the functions of the pelvic organs. On the other hand, almost every gynecological disease re- quires some, a few need exclusive constitutional treat- ment. The inevitable trend of modern gynecology has been largely to surgery, yet the gynecologist must survey the system at large while recognizing the true significance of special symptoms. He who seeks the truth should be of no country and belong to no sect, for all truth is full, round, and complete. The paper was discussed by Drs. John Byrne, Wil- lis E. Ford, S. C. Gordon, and A. W. Johnstone, cheap viagra mexico all of whom were impressed with the necessity for rec- ognizing the reciprocal relations between gynecology and general medicine. The Clinical Importance of the Intermenstrual Wave. Dr. Arthur W. Johnstone, of Cincinnati, in this paper referred to what in England has come to be June 6, 1896] MEDICAL RECORD. S09 known, he cheap viagra mexico said, as Stevenson's wave, as it was brought prominently forward by Stevenson, of Glasgow. This wave phenomenon manifests cheap viagra mexico itself in all female ani- mals, in birds the crest of the v ne being seen before the molting period, in women before the menstrual period. Its trough represents the intermenstrual period. One who fails to recognize this wave and its clinical significance will at times be led to do things which are dangerous, while at other times he will be needlessly alarmed cheap viagra mexico at trivial matters. In- termenstrual pain, which formerly was a conundrum, is now explained, as it takes place in the trough of the wave, and is due to shrinking of the ovary to its smallest diameter. For the laparotomist cheap viagra mexico this law is more valuable than any other, and it teaches him never to operate just before a period if it can be avoided. During this time there is greater danger from hem- orrhage. By this law are explained many cases of disordered digestion, vomiting, symptoms of gall stones, temporary glycosuria, and reflex manifi tions. The menstrual wave undoubtedly has a good deal to do with the pathological metabolism of the body. Its influence on Basedow's disease is com- mon knowledge. It explains the monthly loss or change of voice in some women. Many conditions in the specialties of rhinology, neurology, etc., are also explained by it. The paper was discussed by Drs. A. J. C. Skene, Buckmaster, Engelmann, Palmer, the author clos- ing. The value of the law described by Stevenson was recognized by the several speakers. Aids in Obstetric Teaching.- Dr. J. Clifton Ed- gar, of New cheap viagra mexico York. In his introduction Dr. Edgar stated his conviction that while the best method order viagra direct for a student to learn obstetrics is the personal care of par- turient and puerperal women, still much of this ex- perience order viagra direct will prove useless unless he has cheap viagra mexico an intelli- gent appreciation of his work, based upon a previous thorough training in the principles of the subject. It is this training of reason and perception and the aids to it which have largely taken the place of the old the- oretical lecture with which the author's attention is occupied. He order viagra direct is a t'mu believer in the advantage of models "possessing the third dimension of space" over elaborate description and illustration in the form of diagram. The rachitic pelvis, injuries to the pel- vic floor, the relations of the uterus to surrounding parts are far better understood from casts and paper reproductions than from charts, however well executed.