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decidedly toxic or infectious in character. There was, of course, a variety of jaundice caused by obstruction ; but ordinary catarrhal jaundice was always due to toxic principles viagra tablets online originating in the intestinal tract. Bacteria had repeatedly been found in the biliary pas- sages in cases of this so-called catarrhal jaundice. Obstructive jaundice was due to gall stones or tumors, although hepatic abscess and cirrhosis of the liver could also cause it. In regard to jaundice caused by gall stones, Dr. Renvers maintained that it was gener- ally inflammatory rather than obstructive. It was well known that in chronic jaundice complete closure of the bile ducts was rare. The biliary passages were usually sufficiently distended to permit the escape of some bile. It was for this reason that a correct diagnosis was often extremely difficult. Even previous attacks of hepatic colic were not always conclusive evidence of the presence of gall stones. The occurrence of ri- viagra tablets online gors and fever were likewise misleading. The condi- tion of the gall bladder was of far greater importance. In cases of stone the gall bladder was not always en- larged and very often it would be found positively smaller than normal. On the other hand, in most cases of malignant tumor the gall bladder would be found considerably enlarged. Acute inflammation of the gall pharmacy viagra jokes bladder gave rise to grave viagra tablets online symptoms closely resembling pyaemia. In these cases, too, the jaundice was pharmacy viagra jokes due to infection, and the liver became secondarily involved. Incontinence of Urine. Dr. M. J. Stumpf {Gazette i/es Hbpitaux) employs the following method with fa- vorable results. During sleep raise the pelvis of the child so as to form an angle of from one hundred and thirty to one hundred ami forty degrees with the ver- tebral column. This position offers an obstruction to the passage of the urine into the urethra and the sphincter is not excited. Dr. Stumpf has cured twelve children and one adult in this way. After three weeks of treatment there need be no fear of recurrence and the child may be allowed to sleep in the normal posi- tion. The Indications for Operation in Puerperal Sep- sis. According to views published by Dr. Lewis viagra tablets online S. McMurtry in the American Journal of Obstetrics, pre- existing pus tubes, uterine fibroid, or ovarian dermoid converted pharmacy viagra jokes by viagra tablets online the trauma of labor into activity as an infecting source, should be treated by prompt resort to abdominal section. Septic endometritis, with or without putrefactive changes in retained clots and debris, should be removed by cleansing, antisepsis, and drainage. Thorough intra-uterine drainage and irrigation in appropriate cases arrest the septic pro- cess. Curettage in these cases, when the septic focus is limited to the uterine cavity, is too extensively used. The granular area of Bumm may be broken through, closed sinuses and veins at the placental site reopened repeated chills and rising pulse and temperature marking the invasion of new areas of infection and nature's barriers to increasing infection torn away by the indiscriminate use of the curette. Plugging up the uterine cavity is positively contraindicated; drainage should be facilitated and not obstructed in these cases. Purulent salpingitis, ovarian abscesses, and suppurative peritonitis, by progressive steps, may extend very rapidly, pharmacy viagra jokes and the associated peritonitis may be circumscribed or diffuse; consequently careful and deliberate judgment must be exercised before re- sorting to cceliotomy. The time of the operation and the extent to which the operative procedure is to be carried also require sound judgment. Diffuse septic parenchymatous metritis and purulent metritis should be promptly treated by hysterectomy. Puerperal sep- sis, wherein the local symptoms are those of diffuse peritonitis without localization of lesions, but wlierein the uterus is presumably the focus of infection, is a grave condition and often justifies exploration and drainage, but hysterectomy will almost invariably prove disastrous. 73 MEDICAL RECORD. [May 23. 1896 Medical Record: A Weekly Journal of Medicine and Surgery, GEORGE F. SHRADY, A.M., M.D., Editor. Publishers WM. WOOD &. CO., 43, 45, & 47 pharmacy viagra jokes East Tenth pharmacy viagra jokes Street. New York, May 23, 1896. THE LACK OF PROFESSIONAL BUSINESS. In these times of pharmacy viagra jokes depression of professional business it is some comfort to be able, in a measure at least, to explain causes, even if it may appear to be impossible to effect cures. It is safe to assert that there is an ominous decline of patronage in every department of professional work. Very few if any of the hitherto successful practitioners are overworked. The falling off of receipts averages from a third to a half of those earned in previous years. Hard times explain viagra tablets online this in a great measure, but not altogether.