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tending fibroma are so many and so diverse that the technique suitable to a simple case must be subject to variation. It is desirable to leave the stumps of the broad ligament with some free border, so that if they cannot be turned under when stitching together the antero-posterior peritoneal flaps, their peritoneal edges can be united by running suture, thereby covering in all raw surface. After complete hysterectomy both the vaginal surfaces and peritoneal flaps can be ap- proximated by catgut sutures. Should drainage for any reason be deemed necessary, iodoform gauze can be carried through a portion of this opening from above downward into the vagina. and as much left in the peritoneal cavity as seems necessary to cover any viagra european pharmacy raw surfaces 50mg viagra effect not otherwise pro- vided for. In all cases of cceliotomy in the 50mg viagra effect female, 50mg viagra effect the vagina should be sterilized so as to be in proper condition for drainage should emergency so require. I have adopted this method of downward drainage after cceliotomy for various conditions, those primarily septic and those in which the peritoneal cavity became accidentally infected by the 50mg viagra effect rupture of pus tubes or abscess cavities, with the 50mg viagra effect most gratifying results. Un- less infected, the peritoneum is closed without drainage. It is well in allowing the patient to resume the horizontal position after having occupied the Tren- delenburg posture, to do so slowdy and to watch care- fully that the changed blood pressure does not cause hemorrhage. By so doing the risk of secondary hem- orrhage can be greatly lessened and probably elimi- nated. No reference has been made to vaginal section for fibroids for the reason that unless the growths are small they cannot Lie delivered through the vagina without morcellation. When small, it may be the bet- ter method, as it is usually attended with much less shock than the abdominal method. The steps are the same as those in ordinary hysterectomy and need not occupy our time. At the present time the adoption of ccelio-vaginal hysterectomy for large fibroids with broad attachmu ts is finding favor, and promises in properly selected cases more rapid accomplishment with the minimum of shock and hemorrhage. It is accomplished by first tying the uterine arteries and severing the base of the broad ligaments. There are forms of subperitoneal fibroids which may be removed by myomectomy if pe- dunculated or sessile; the peritoneum covering them may be incised, the arteries tied, and the peritoneum carefully approximated. No reference has been made to treating uterine fibroids by Apostoli's method, for the reason that there is little or no evidence that it has any power to promote absorption of fibrous structures, though its efficacy in reducing the size of cedematous fibroids is not dis- puted. The danger of its use in the presence of dis- eases associated with fibroids more than outweighs any of the advantages therefrom. Fibro-cystic growths of the uterus are infrequently June 6, 1896] MEDICAL RECORD. 801 met with, and like solid fibromas may be large or small. They sometimes attain very large dimensions. Palliative methods of treatment promise little or nothing, and galvanism is positively contraindicated. They may spring from almost 50mg viagra effect any portion of the uterine body, but very infrequently from the cervix. In a recent hysterectomy for general fibroma I found, attached to viagra european pharmacy the uterine body, a fibro cystic growth which was sessile and intraligamentous. Nothing short of radical surgical measures holds out promise of successful treatment. 291 Hancock Street. CONGENITAL OCCLUSION OF THE URE- THRAREPORT OF OPERATION FOR ITS RELIEF.' By CHARLES W. ALLEN, M.D., NEW 50mg viagra effect VORK. Gentlemen: I wish to report briefly an instance of a rather rare condition. On April 19, 1S95, their was born in the Maternity Hospital on Blackwell's Island a male child. Upon the following day. April 20th, it was reported to the visiting surgeon, Dr. Marx, that no urine had passed. Examination showed that there w.is no meatus urinarius externus. An incision was made in the expectation that this would open into a channel, as is the case ordinarily. No opening was found, however, and the cut was extended somewhat deeper, and numerous attempts were made to force a passage through with a fine probe. Dr. Walsh then saw the patient, and, likewise after careful examination, made ineffectual efforts to enter the canal. These gentlemen then kindly referred the case to me, I being at the 50mg viagra effect moment the only member of the ( ily Hospital staff on 50mg viagra effect duty. After a vain attempt to bore through from the external opening, and not knowing how far back the absence of the urethra might extend, 1 pro- posed to do an external perineal section, to which Drs. Marx and Walsh assented. The operation was some- what tedious, viagra european pharmacy as the urethra was not easily distin- guished from the other tissues, and never having be- Eore operated upon a subject of 50mg viagra effect this age, I preferred to go slow rather than to go wrong, and besides I wished to keep the perineal wound as small as might be. Having entered viagra european pharmacy the bladder and allowed the ai cumulated urine to escape, and after irrigation, I