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sphenoid cells cannot be extirpated. There are two important exceptions to this rule, however: 1. To re- lieve agonizing pain an operation should be done on any slight chance, for, viagra why 50mg unless the suffering can be pal- liated, the patient had better die than live. 2. In a forlorn hope, so to speak, after the risk has been fairly stated, the patient is entitled to an operation, if he wishes it, and if he takes the responsibility; here, however, the limit must be those cases in which there are one or more chances of success. Must we stop when the patient fails? Not always, for the failure may viagra canada canadian be due to the anaesthetic or even to simple nausea. viagra canada canadian In this case the surgeon should stimulate the patient and consider carefully before giving up the operation. Stopping, he says, is indicated when we come to the end of all that can be taken out for instance, in a case of malignant tumor; in an viagra why 50mg operation in the ab- dominal cavity, when a glance or a touch reveals that the tumor is not removable and that it has grown into vital parts; in an operation on the surface of the body when stopping will not imperil life so much viagra why 50mg as going on; in syncope with a pulse at 108; with sighing res- piration, and with a colliquative sweat. Concerning the fourth question, says the author, When not to stop, keep on as long as the patient breathes; it is his only chance. The contingencies are : An operation which has so far displaced and broken up a soft internal tumor as to render death from bleeding viagra why 50mg or from sepsis certain if any is left; an oozing hemorrhage; a diffi- cult tracheotomy ; a crushed skull with a pulse of 40 and Cheyne-Stokes respiration (having trephined, he says, we cannot stop until compression is removed and the bleeding checked; extravasation of urine, and a bladder to be drained; if the patient dies in the process, we must drain the bladder. If we do not viagra why 50mg do all these things, the patient dies; his only chance lies in their viagra canada canadian being done. Surrounded with these terrible chances the surgeon, like the executioner, raises or de- presses his thumb, and the patient lives or dies. There is no responsibility like this. All this should teach us, first, to be over-careful about getting in so deep that we cannot withdraw, or about meddling with what had better be left alone. Second, not to imperil life to cover our mistakes, for we all make them. Third, in self-defence to withdraw from an operation or from a case at once if our advice is not followed. To bear the responsibility, we must be absolute masters. Medical Practice in Spain. Medical organization is greatly wanted in Spain. Every week the medical viagra why 50mg journals report lists of vacancies for district medical officers for the poor, appointments of a kind similar to dispensaries in this country; but the appointment is made viagra canada canadian for viagra why 50mg a term of viagra why 50mg years ; when no term is viagra canada canadian fixed the doctor is liable to dismissal at any moment {The Med- ical Press). The payment is, as a rule, very small, as the following will show: District C, population 1,021, salary, 995 pesetas (,?39 17s. 6d.). But the advertise- ment naively states that the doctor shall be at liberty to attend wealthy families in the neighborhood. For the district of P, population 5,411, the salary is 875 pesetas, and there is no mention of any wealthy fami- lies being in the neighborhood. District V, popula- tion 593, salary 150 pesetas, for attendance on seven- teen poor families, and liberty granted to attend the 156 wealthy ones in the neighborhood the contract to be for a term of four years. By the viagra canada canadian termination of contract the district of A, which includes three towns, offers 3,000 pesetas (^120), the contract to be for four years. The advertisement states that there is a good road connecting the towns, and that the country is very beautiful. In all cases the application is to be made to the alcalde. Such conditions are not likely to advance medicine, and they have undoubtedly been injurious to the people. Under the startling heading " Dinamiteros," El Siglo Medico has published a series of long articles on the present condition of Spanish society, which that journal states is being undermined by drunkenness and clandestine prostitution, and ap- peals urgently for a better system of education, which viagra canada canadian it looks to as a remedy capable of raising Spanish women to a sense of viagra why 50mg the worth of purity. Pathological Society of Philadelphia. At the stated meeting of the Pathological Society of Phila- delphia, held on May 14th, Dr. Joseph Sailer pre- sented a specimen of carcinoma of the cardia with contiguous involvement of the liver, and also five specimens of right-sided endocarditis. Dr. A. E. Taylor read on behalf of himself and Dr. Sailer a valuable communication entitled " The State of the Blood in the Carcinomatous Cachexia," detailing nineteen cases in which careful differential estima- tions of the blood corpuscles were made. They found myelocytes in but four of the cases, while in Jjie large majority viagra canada canadian the mononuclear leucocytes and the transi- tional forms were increased in number. As a rule the eosinophilous cells were few in number. Dr. F. A. Packard presented " Multiple Tuberculomata of the Brain and Tuberculous Adrenals'" attended with epileptiform convulsions and cutaneous pigmentation. Dr. M. H. Fussell presented a number of gall stones from a case in which death had resulted in conse- quence of peritonitis in the absence of perforation. Dr. J. Dutton Steele exhibited a greatly dilated stom- ach whose capacity was easily three quarts; a liver presenting an extreme degree of cirrhosis, with pecu- liar and extensive adhesions to adjacent structures; and the caecum and vermiform appendix from an in- fant, twenty days old, in whom these parts had en- tered the internal ring of the inguinal canal, and the appendix had apparently been constricted. Dr. H. W. Cattell exhibited the stomach from a case of ar- senical poisoning due to the ingestion of "Rough on Rats" taken with suicidal intent. Dr. M. V. Ball ex- hibited an anencephalic monster. Dr. A. E. Taylor exhibited a carcinoma viagra why 50mg of the posterior wall of the stomach close to the cardia, characterized during life by intense cachexia and copious viagra canada canadian hemorrhage, and also surgical kidneys and bladder due to hypertrophy of the prostate in a man thirty years old. Philadelphia County Medical Society At a stated meeting of the Philadelphia County Medical Society, on May 27th, Dr. Lawrence F. Flick read a paper entitled "Calomel as a Specific in Diphtheria." Dr. G. Erety Shoemaker reported "Cases Illustrating Three Methods of Hysterectomy for Different Indica-