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7'5 Dr. J. S. Stone, of Washington, D. C, stated that while all pus is not infective, it is desirable not to soil the peritoneum, if possible. His experience in operating upon cases with pus sacs has led him to adopt the following technique: Clamps are placed upon one of the tubes, closely hugging the uterus and embracing one inch of the broad ligament. The ovarian artery is tied or clamped as near the pelvic wall as possible and a ligature is placed on each severed end, or it may be placed before section, and the incision made between the points. No bleeding can take place, and the surgeon can lei- surely enucleate the tube and ovary with its contents. It affords a great amount of space, and the tube conies prominently into view when separated from the uterus. When an infected stump is left an exsection of the cornua is demanded. The ovaro - uterine artery is ligated, the forceps removed, and another deeper liga- ture taken if necessary. The Trendelenburg position is most desirable. Flushing or drainage of the cavity is unnecessary. The advantages are cheap viagra info more space ; the larger blood supply is cut off; small silk or catgut can be used, as cheap viagra info there are no ligatures en masse ; there can be no infection of ligatures or stitches; no danger of hemorrhage, and it facilitates the enucleation by affording another point of anterior cleavage. Dr. Stone presented a specimen which he had re- moved entirely by this method. It consisted of a pus sac measuring eight inches in circumference usa viagra genuine and four- teen inches from one extremity to the other. Extra-Uterine Pregnancy Viewed from a Clinical Standpoint. Dr. W. G. Macdonald, of Albany, N. Y., said that while the surgery of extra-uterine pregnancy dates back only thirteen years, to the time when Lawson Tait performed the first operation, yet it has reached a point of development that leaves little to be desired. Vet women still die from ectopic gestation. Too much time and space have been spent in discussing the pathology of this affection and the various methods of treatment, and too little in formu- lating exact rules by which usa viagra genuine this justly dreaded acci- dent may be discovered early and the lives of many women be saved. cheap viagra info Recent work in appendicitis has given us very re- liable guides in the early diagnosis of this affection, and the same ought to be true of extra-uterine preg- nancy. As a rule, operations are performed after rup- ture has taken place, but then any delay is dangerous. The diagnosis before rupture is most important, but is very difficult. It is a fallacy to believe that some previous disease of the generative organs is necessary for the production of ectopic gestation. It may hap- pen in perfectly normal women. Metrorrhagia also in the majority of cases is not common before rupture. But any woman who has shown any of the early signs of pregnancy, such as cessation of menstruation, nau- sea, etc., and then develops any abnormal irregularity should at once become an object of suspicion. A careful usa viagra genuine examination should be made and the advice of an expert be obtained. Usually cheap viagra info this examination will reveal the presence of a small tumor at one side of the uterus. This, with the history, will often be sufficient to confirm the diagnosis and warrant an ex- ploratory incision. After rupture cheap viagra info the pain and signs of collapse from hemorrhage are sufficient. A bicor- nal uterus or the presence of fibroids may render the diagnosis more difficult. When the diagnosis is usa viagra genuine made, the operation should be performed at once, cheap viagra info as delays are fraught with grave danger. Symptoms, Diagnosis, and Time for Operation in Ruptured Tubal Pregnancy. Dr. cheap viagra info Joseph Price, of Philadelphia, cheap viagra info stated that the causes of extra-uterine pregnancy may be anatomical or moral. It may have its origin in some anatomical change in the tube or perversion of the function of the cilia, or pos- sibly may result from attempts to prevent conception. The determination of the exact cause is uncertain. The attacks cheap viagra info usually come on suddenly. A vigorous, healthy woman may be seized while going about her usual occupations, or even in bed after a quiet night's rest, and suddenly become pale and collapsed. Sharp pain generally follows, which may be quite general and accompanied by hemorrhage. These symptoms may increase in severity or subside, to be again re- peated. If there is a large effusion it can easily be recognized by the finger, but there may be only a sense of tension and resistance. Two or three days after the rupture has occurred there is no difficulty in making out the tumor. Frequently there is a history of ster- ility, some uterine disease, or an abortion occurring a month or two previous. There is also peculiar ner- vous disturbance and an absence of the usual signs of pregnancy. Vesical and rectal disturbance, such as distention and tympany, are common. Twenty-five per cent, die within twenty hours cheap viagra info after rupture from hemorrhage. The most fatal cases are those in which the rupture oc- curs close to the uterus. The only treatment is an operation, and this should be performed as quickly as possible. The chief danger is from hemorrhage, but the prompt infusion of the normal saline solution will save many lives. In those rare cases which go on until the child reaches full cheap viagra info term, there is generally very little trouble in extracting the child alive, but the great danger is to the mother in the removal of the placenta, and the operation should never be delayed to this time if it has been possible to make the diag- nosis before. cheap viagra info The child is to be sacrificed for the mother. (Correspondence. OUR LONDON LETTER. (From our Special Correspondent..) MKDrCAL QUESTIONS IN PARLIAMENT TUBERCULOSIS