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Dr. W. E. B. Davis, of Birmingham, Ala., thought the choice of operation depends largely upon the in- dividual; that the man who has done a great deal of successful work by the abdominal incision will be loathe to change, and vice versa. Dr. Sutton rightly emphasized the fact that the choice of method depends largely upon the decision as to removal of the uterus. But he himself did not agree with the conclusions of the last speaker. In his opinion the uterus should be left in the great majority of cases. He believed that it did have some function, and he knew that women feel better if it is not removed. He also doubted the statement that such a large percentage of cases of pus in the tubes was due to gonorrhoea; the puerperal state is re- sponsible for a great many. Many writers have stated that their viagra online tester patients were cured when the uterus was left behind, and it is a reflection on them to say that no case was really cured unless the uterus was also re- viagra online tester moved. A slow convalescence, or even a second oper- ation, is preferable to removal of the uterus unless ab- solutely diseased. It is doubtful if the uterus is so much affected by gonorrhceal pus as has been stated. The conservation of organs is in his opinion of great importance. The objections urged to the abdominal operation, viz., hernia and the scar, are not well founded. If the operation is properly done, there will be no hernia and very little scar. The viagra online tester advantages are that one can see what he is doing, and in the Trendelen- burg position every facility is offered for doing what is necessary. Dr. Kelly, of Baltimore, stated that in every case in which both tubes were diseased the uterus should be removed. The abdominal operation is the best. The operation is much viagra online tester more rapid than the vaginal and viagra cialis usa the chances of shock no greater. It also gives an op- portunity for conservatism by allowing inspection. It is never advisable to remove the uterus for a fibroid as large viagra cialis usa as a lemon or even as large as a fatal head. He has removed large fibroids by making five or six incisions into the uterus. An abdominal drain is never needed. Abscess of the abdominal wall rarely occurs, and hernia never, if the wound has been prop- erly closed. The mortality from the abdominal oper- ation is no greater than from the vaginal. He con- siders the vaginal operation a bad one on account of the liability of frightful hemorrhage, the danger of in- juring the bowel, prolapse of the bowel, and because it does not provide for the dense adhesions which sometimes occur. Neither does it provide for ap- pendical trouble, which complicates these cases in a considerable viagra online tester percentage. Dr. Bovee, of Washington, said that he viagra online tester had been doing work by both methods, but he did not think it advisable in the majority of cases to remove the uterus with the appendages. Perhaps his experience is unique, but all of his patients who recovered from the operation got well with the uterus left behind. In many cases he curetted the uterus thoroughly before operating. He thought the abdominal method simpler than the vaginal. He believed that the tubercle ba- cilli came from the abdominal cavity, and infected the uterus later through the tubes. At the present time he employed drainage rarely. Fair-sized viagra cialis usa fibroids could be easily removed by anterior colpotomy, but if they were large he thought the abdominal route the better. In all cases where it was possible, he left a portion of one ovary. Dr. L. S. McMurtry said that the real point of discussion is whether the vaginal or abdominal route is to be preferred, and everything else was subsidi- ary. He wished to announce that the first object to be attained in pelvic surgery is the greatest viagra cialis usa preser- vation consistent with thorough surgical viagra cialis usa work. It is a crude idea that the easiest way is to get rid of an organ. It is a much higher idea to attempt to pre- serve it. The vaginal route and vaginal drainage are not new ideas. What must guide viagra online tester us are the results of a very large amount of work by viagra online tester both methods. He did not think that the statistics of expert operators should be taken as a guide. The French surgeons have become phenomenally skilful in viagra cialis usa the vaginal method, but they have never done very good work by the abdominal. viagra cialis usa Hysterectomy at present is being overdone, and the impression is abroad that the vagi- nal route must be chosen. In his opinion the uterus 75 MEDICAL RECORD. [May 23, 1896 should not be removed unless diseased. On the other hand, where five or six incisions are necessary to remove a tumor, he would not leave the uterus. That is the other extreme. Everything points to the ad- vantages of the abdominal route, for the aid of posi- tive sight is given. Moreover, the results of the ab- dominal operations covering a long period of time are before the profession and can hardly be improved upon. Dr. Joseph Eastman, of Indianapolis, thought the question of accurate diagnosis in these cases had been overlooked. It was very important; we must deal with facts and not fancies. He was surprised that Dr. Kelly advocated the partial removal of the uterus in these cases, whether done from above or below. If it is diseased, the whole of it should be removed and nothing left to carry infection. The decision as to the method to be employed must depend viagra online tester on the history of each individ- ual case. He agreed with Dr. Kelly that a diseased appendix is frequently associated with these cases of