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ence of a neuroma upon the stump in that portion which occupied the foramen rotundum. Dr. shop for viagra Fowler fully agreed with Dr. Keen as to the necessity for keeping the eye protected, and mentioned an illustra- tive viagra england buy case. Concerning the sclerotic changes in the 866 MEDICAL RECORD. [June 13, 1896 vessels, it may be that these are at the root of the pathology of these cases. Dr. Fowler referred to a case operated upon by Dr. Morton, of Philadelphia, in which Meckel's ganglion shop for viagra was positively removed, and yet the pain shop for viagra returned with all its former violence in less than two years, when ligation of the common carotid gave the man permanent relief. The author shop for viagra mentioned other cases in which ligation of the carotid had produced excellent results, and in one of which there was a deviation of the tongue toward the side operated upon. In this case the patient was unable to straighten the tongue. Dr. Fowler referred to one patient who died during an epidemic of sepsis, and stated that he saw no reason why there should not be epidemics of sepsis as well as of small-pox and scarlet fever. Dr. Parmenter mentioned the case of an elderly woman who had had facial neuralgia, and also a small aneurism of the external carotid, in whom ligation of the common carotid had afforded complete recovery. He also mentioned a case in which he had operated successfully on a man who had been subjected to three previous operations. Dr. H. S. Weeks said he doubted if a surgeon is justified in resorting to intracranial operations before an extracranial had been done, in view of the large mortality. viagra england buy The speaker's plan of operating is to tre- phine through the ramus of the jaw, seize the inferior dental nerve, and pull it away, as he considers this method much better than cutting. Dr. X. I 1 . Dandridge, of Cincinnati, mentioned a case in which he had operated two and a half years ago, since which time the man had been relieved from pain, but there is marked deformity of the face on account of atrophy of the muscles. There is also a small sinus leading down to dead bone. Dr. Christian Fenger said he prefers the extra- cranial operation, as he considers it less dangerous. He called attention to shop for viagra the fact that the mortality from ligation of the common carotid is eighteen per cent. viagra england buy Dr. Joseph Ransohoff said he does not think ten per cent, a very high mortality under all circum- stances, and that shop for viagra if all the cases are included it will be nearer fifty per cent. In Dr. Ransohoff's opinion the lesion is not located in the Gasserian ganglion, but is a central affection. Dr. Robert Abbe said the members should not be daunted by a mortality of ten per cent., as in the next hundred cases it would be much less. In his opinion preference should be given to an anterior operation in the first place. Now that we know what to steer clear of, with the improvement of sepsis and the avoidance of operating on old people, the mortality should be considerably lessened. Dr. \Y. \V. Keen said In- had omitted to mention two methods of medical treatment which have been of great service, one recently suggested viagra england buy by Dr. Dana, of New York, that of giving massive doses of strychnine, and the other suggested by Esmarch, who has spoken of the value ives. Dr. Maurice II. Richardson said he thought that the operations could be taken up in order, and that attacking the ganglion should be done shop for viagra as a last resort, especially in old people and those who are unable to stand so formidable an operation as intra-cranial neu- rectomy. In man) 1 ases a simple operation will give considerable relief. Dr. Fowler explained that the mortality viagra england buy of eighteen per cent, in ligations of the carotids included cases of aneurisms, gunshot wounds, etc. In fifty-two cases in which the vessels were not affected by disease nor complicated by carcinomatous tumors, the mortality was less than five per tent. Dr. P. S. Connor, oi Cincinnati, said he consii that the two most important points are the cause of the neuralgia and the results of operative interference. In a certain proportional number of cases viagra england buy the exemption from pain ranges from three months to three years, while in another proportion the exemption is scarcely worth mentioning, as the pain returns immediately after the operation. In some cases the loss of blood during the operation viagra england buy and the shock following it are important factors. In either event a man would rather take forty-nine chances out of fifty to get relief. Dr. T. A. McGraw was of the op shop for viagra : nion that suffi- cient investigation has not been made of the possi- bility of the neuralgic conditions being due as well to- motor as to sensory nerves, and stated that he is not at all sure that a division of some of the motor nerves may not be a great benefit. Dr. Richardson stated that this operation had been performed and had resulted in considerable facial de- formity, but no relief of the neuralgia. Dr. S. j. Mixter mentioned two cases in which merely a reopening of the old intracranial wound had afforded some relief.