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set." The history of the treatment of infantile intussus- ception by the method of intestinal distention, by either air or water, as evidenced by the testimony which has been presented, is certainly a dark page in that of our science. It is a story of empirical, rather than scientific, endeavor, one of hope deferred, of un- certainty, of viagra sale dubai prolonged torture, none the less cruel because it was performed in all kindness, and was gen- erally considered to be the gentlest method of dealing with the disorder, and finally of a mortality of seventy- five per cent, of disaster. Laparotomy was performed in this group of cases 64 times for the relief of infantile intussusception. It resulted successfully in 21, or in 32.8 per cent, of the viagra sale dubai eases operated upon. The average age of these in- January 18, 1896] MEDICAL RECORD. 85 viagra sale dubai fants was about six and one-half months. The aver- age hour from the onset till the time of operation was the forty-fourth. In 1 7 of the cases inflation and ene- mata, or both, had previously been tried without suc- cess. In 8 cases the invaginated bowel was readily reduced, and in 10 cases it was reduced with difficult)-. In 3 of the histories nothing was stated regarding viagra sale dubai this point. The length of time required for the per- formance of the operation was in one instance stated to be eight minutes, and in another thirty-five minutes, which latter included the administration of an enema. Laparotomy was followed by death in 43 of the cases. giving a mortality of 67.2 per cent. The average age of these patients was about five months, viagra sale dubai the youngest upon whom enterectomy was performed being only three days old. It lived six days thereafter, probably dying of inanition, as the operator viagra sale dubai opened the first pharmacy viagra generic piece of bowel which presented itself in the wound. Had he sought for and reduced the invaginated bowel, it seems almost certain that the infant would pharmacy viagra generic have re- covered. If these cases are subtracted from our list of unsuccessful abdominal sections in which either the operation was abandoned, the bowel incised and an artificial anus made or resected, and an anastomosis viagra sale dubai effected, we shall have 45 cases, of which number only 24 resulted fatally, reducing the mortality to 53.4 per cent. If we count only the operations, successful and un- successful, that have been performed since the | fected technicpae of abdominal surgery has become g erally known say, since 1889 and throwing out as before pharmacy viagra generic the cases in which the operation has not 1 completed, the bowel incised or excised, we have a total of 18 cases, of which 14 were successful, and ; were unsuccessful, giving a still lower percentage of mortality, or 22.2 per cent., which the writer believes is a fair estimate of the risk to-day of abdominal tion performed on a young infant for the relief of this disorder, if performed within the first forty-eight hours of the onset. It would seem that if an infant suffering from this pharmacy viagra generic disorder were first seen in collapse, it would be wise before attempting the operation to stimulate the infant. and if it responded, to proceed; otherwise it viagra sale dubai would be useless to do so. The operators in these cases have almost invariably employed the median incision satis- factorily. The best method for reducing the invagi- nated portion of bowel seems to be that wherein the tumor is encircled below its apex by the finger and thumb, while the intussuscipiens or sheath is held a few inches lower down, the apex of the tumor being pushed in an upward direction. Traction from above the tumor should not be employed. If, however, the tumor prove irreducible (although so far as the writer has knowledge there is no recorded case of intestinal resection or an artificial anus in an infant under twelve months of age which has proved successful), it is the writer's belief that the method de\ ised by the late Prof. H. Widenham Maunsell, which is shown in Fig. pharmacy viagra generic 1. is the best that has been devised for treating this most unfortunate complication, caused by delay. A slit is made in the intussuscipiens and gentle trac- tion made on the intussusceptum until its neck appears outside the viagra sale dubai opening in the intussuscipiens. The base is then transfixed with two straight needles viagra sale dubai armed with horsehair, and the intussusceptum is amputated a quar- ter of an inch above the needles, leaving a fair stump beyond them. The sutures are now passed through the invaginated bowel, caught up in the interior of the bowel, divided and tied. This having been accom- plished, the invagination. is reduced, and the longitu- dinal slit is closed. Disastrous as we have already proved the treatment of infantile intussusception by means of intestinal dis- tention to be, the results obtained from 1828 to 1889, when abdominal section was finally resorted to, seem to have been even more so, giving as it did a higher percentage of mortality, or 84 per cent., as against 7 5,4 per cent. But it must be borne in mind that it was always a last resort, only employed after the little patient had become collapsed by days of severe pain, inability to take and retain food, persistent, often hour- ly, torture by inversion, the administration of anasthet- ics, enemata of air and water, massage, to which not unfrequently was added the so-called long rectal tube. Nothing more surely could be devised to unfit an in- fant or adult to withstand the nervous shock which must necessarily accompany the administration of an anaesthetic, the opening of the peritoneal cavity, and the manipulation of the intestines. As one case of section proved unsuccessful, and its result was reported, it almost certainly pharmacy viagra generic added danger to the next case that