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fined to his bed through sheer weakness, ami death occurred from exhaustion about nineteen months from the time Dr. Adler first saw him. The autopsy revealed cancerous involvement of the liver and intestines. In conclusion, the author summarized the indica- tions for the operative treatment of rectal cases as fol- lows: Extirpation, to viagra half pill be considered only in those cases in which the disease admits of the hope of obtaining a permanent cure. Colotomy, when the rectum is involved above the lower three inches of the bowel and the disease has generic viagra pharmacies produced an appreciable obstruction. Curettage, or a posterior linear proctotomy, or the two combined, for those cases in which the disease oc- cupies the lower three inches of the rectum. Surgical Sterilization and Sterilizers in Private Practice. Dr. Edward Boeckmann, of St. Paul, Minn., referred to an address which he read before the Association of Military Surgeons of the United States, on "Asepsis in Military Service." He strongly rec- ommended the 120 ' F. warm and one to two per cent, strong solution of lysol for combined mechanical and chemical generic viagra pharmacies disinfection of the operator's hands and the patient's skin. Provided with lysol, absolute alcohol, and ethereal solution of sterilized lanolin, we are en- abled to disinfect the skin, the most dreaded bearer of infection, as safely as is possible at this time and with as few and as simple agents as can be demanded in operations in private generic viagra pharmacies practice. All sterilizers for streaming steam must necessarily be constructed for oversteam. Dr. Boeckman does not favor combination sterilizers, because boiling and steaming are different processes requiring an unequal time. He uses a viagra half pill combination portable viagra half pill sterilizer, consist- ing of four parts: the boiling-pan, the hood, the in- strument tray, and the steam chamber. The boiling- pan is filled with a sufficient quantity of water, care being taken viagra half pill to fill the generic viagra pharmacies groove at the same time; the hood is adjusted, and the whole placed over a good fire. While the water is heating the instruments are arranged on the tray, and the dressings, etc., in the steam chamber; needles, drainage tubes, ligating and suturing materials are put (separately) in a small metal box (sterile catgut is brought along in hermet- ically sealed envelopes). When the water boils the hood viagra half pill is removed and the steam chamber put in, where- upon the hood is replaced with a cork in the upper tube. The steam will now ascend between the hood and the steam chamber to the top. The cork at the top and the water viagra half pill in the groove and the pan acting as locks, the steam is forced to work its way through the opening in the cover into the steam chamber, through the articles contained, and out through the tube in the boiling-pan. In the course of five min- utes the instruments are surgically sterile. Dr. Boeckmann urged all surgeons to consider every wound at the end of an operation cf some duration as slightly infected, and therefore to combine their asep- sis with a judicial antisepsis. Thus, he is in the habit of repeatedly dipping his hands in a weak, sterile so- lution of lysol (one to two viagra half pill per cent., or even less). This small amount of antiseptic he has yet failed to find objectionable, and he uses lysol because it is at hand and because it is alkaline. When the operation is completed he applies next to the wound an antisep- tic dressing, not exactly the customary iodoform gauze, because its preparation requires unusual facilities; but anhydrous lanolin, first sterilized, mixed while cooling with two-per-cent. lysol, and run into sterilized tubes, this being first expressed over the wound, whereafter the ordinary dressing is applied. Laminectomy. Dr. John A. W\ETH,of New York, reported a number of cases of this operation. After a detailed description of each viagra half pill of the cases of injury to the spinal cord which have come under the personal observation of generic viagra pharmacies the author in recent years, he briefly summarized them as follows: May 23, 1896] MEDICAL RECORD. 747 In Case II. there was compression of the cord with paraplegia due to the presence of a tuberculous neo- plasm. This paraplegia had existed a little over six months. After the removal of the tumor the functions of the cord were restored. While the conductive pow- er of motion and generic viagra pharmacies sensation was suspended for six months, the ascending and descending degeneration of the cord evidently took place in so slight a degree that the conductivity of the cord was restored after the removal of the source of compression. In Cases III. and IV. there were no external evi- dences of fracture, and while extradural hemorrhage occurred in both cases from rupture of the venae basis vertebras there was no direct compression from dis- placed bone. In all the other cases either a projec- tion or depression of bone pointed directly to the seat of injury. In both of these cases the cord was very much reduced in size at the point at which the dura was incised, was pale, and more anaemic than the oth- ers. The paraplegia and the ultimately fatal results in both cases were due either to traumatic pachymen- ingitis or to general concussion and myelitis resulting in degeneration of the cord. Both generic viagra pharmacies of these patients were injured by falling directly upon the back. Of the eleven cases of fracture of the vertebra- only two were due to direct violence, one of which was a gun- shot injury and the other the result of impact of a