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kindly whether buy viagra safety buy viagra safety antibacterial measures are used or not, and even if a stitch abscess forms it does not usu- ally interfere with the success of the operation. Rag- ged holes in the lids made by scoop operations for chalazia usually heal more quickly than is desirable. Serious infection of a tenotomy wound is and always has been a very exceptional thing. Stitch abscess oc- viagra cheapest buy curs much less frequently in the conjunctiva than in the skin. The operators of twenty years ago were as much surprised to have suppuration follow iridectomy as we are to-day. And, lastly, the average percentage of loss after cataract extraction is practically the same now as before the introduction of antibacterial meas- ures, viz., about six per cent. This last statement is based upon the results of twenty thousand extractions, ten thousand cases before 1S79 and ten thousand cases since that time, and is, of course, the most im- portant item of the list. But if we had only the first table, that of Dr. Noyes, published in 1879, with its average loss of about six per cent, it would hardly be straining a point, standing at buy viagra safety this distance with our present knowledge of bacteria and their habits, to in- fer that the cataract wound is one not especially liable to become infected with bacteria; and if, after sixteen years of greater or less effort in imitating the antibac- terial measures of the general surgeon, another table, that of viagra cheapest buy Dr. H. S. Miles, 1 shows the average loss to be still about six per cent., the demonstration seems fairly complete that, so far as actual loss of eyes is con- cerned, nothing of a revolutionary nature has been accomplished by all our efforts to exterminate bac- teria." If, then, I have interpreted it aright, the evidence from the laboratory is uniform and overwhelming, viagra cheapest buy viagra cheapest buy not only of the presence of bacteria but also of their buy viagra safety power viagra cheapest buy to produce serious suppuration if they are put inside the eyeball or even into the tissues of the eyeball. But we must lay great stress upon that " if," for, with the exception of the gonococcus and the bacillus of Weeks, the unbroken conjunctiva seems very tolerant of the commoner varieties of bacteria. Indirect line is the evidence of practical results in many forms of surgery; in fact, the laboratory and general surgery have joined hands, each supplementing the work of the other. But when we reach ophthalmic surgery there is a sudden falling off in the clinical evidence of practical results. Indeed, if one wished to be extreme, it might be said that the evidence of practical results is very slight. Hence, viagra cheapest buy if we approach this question from what may be called the " laboratory and general surgery'' side alone, it is simply impossible not to believe in the great necessity of antibacterial measures. On the other hand, if we approach it from the side of clinical ophthalmology alone, ophthalmic operations are and have been for many years so successful with simply ordinary cleanliness as to furnish no loud demand for something better or that ordinary cleanliness be pushed to that greater cleanliness which buy viagra safety we call asepsis. Assuming, then, that very little has been accom- plished for cataract surgery by antibacterial meas- ures, what theoretical explanation can be offered, first and foremost, that the operation was so success- ful before we knew that the bacteria were there? The strongest force which works against the injurious in- fluences of bacteria upon the eye is probably the natu- ral and not the artificial one, and the natural protec- 1 This table was presented at the annual meeting of the Ameri- can Ophthalmological Society in July last. 2 It may be noted incidentally that there are not many opera- tions in which so large an amount of clinical material is available as evidence, and also, as there are so many small buy viagra safety collections of cases in Dr. Noyes' table (one hundred and ten items against thirty in Dr. Miles' table), it is, therefore, all the more remarka- ble that this average percentage of loss should be practically the same in both. tion is probably due to a combination of conditions rather than to any one thing. The risks from hands and instruments are, of course, less than in most of the operations of general surgery. Just why the bacteria of this field of operation do not oftener reach and in- fect the corneal wound is, with our present knowledge, viagra cheapest buy entirely a matter of speculation. The mechanical conditions surrounding the cataract wound are unique. So long as the wound remains open a gentle stream of aqueous humor flows out, and whatever viagra cheapest buy goes in must swim against the stream; and after the wound is closed, if there is any current of tears it is away from the wound if the suction is upward. Chemically, the influence of both aqueous humor and viagra cheapest buy tears, if not proved to be decidedly adverse, is at least not spe- cially favorable to the growth of bacteria. A second reason why viagra cheapest buy more has not been accom- plished is the difficulty and danger of using the more efficient of the antibacterial measures about the field of operation. Sterilization of the hands and instru- ments, though not so necessary, can of course be done as thoroughly by the ophthalmic as by the general sur- geon. But sterilization of the field of operation in cataract extraction is a practical impossibility. The skin of the lids offers many obstacles to the removal of bacteria from the loose folds. The eyebrows and eyelashes simply cannot be rendered sterile. The deeper recesses of the conjunctival sac can neither be scrubbed nor buy viagra safety is it safe to use the stronger of the an- tiseptic solutions. The solutions used in ophthalmic surgery, while by the laboratory buy viagra safety tests they may be within the area of killing power, are never very far within it, the experiments always being to find the weakest solution that will kill. And after all has been done and the dressings are on, the lachrymal passages still communicate with the nose. From information furnished by Dr. Foote and oth- ers, it is my own belief that the following experiment can be repeated indefinitely with the same result: Cleanse the lids and conjunctival sac of a normal eye by any method known to ophthalmic surgery; use the most rigid precautions with hands, dressings, etc. ; bind up the eye for forty-eight hours, and when the dressings are removed inoculate tubes of agar from the