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74 8 MEDICAL RECORD. [May 23, 1896 culous peritonitis, for he has found that the patients all get well ; but those cases in which drainage is used required an average of fifty-nine days viagra online net for convales- cence, while those in which no drainage is employed recover on the average in thirty days. He thought viagra online net drainage should rarely be employed for hemorrhage, and then only when it is excessive. He limits drainage to the septic cases or those in which the intestine has been wounded. He advocates gauze drainage because it covers a large area any quantity can be used, and because it can be used in curved and angular spaces, and because a constant capillary ac- tion is kept up. The disadvantages are that the drain- age is apt to stop after a while unless watched, and the pain of removal. It is his plan to remove the gauze very soon if it has been used for hemorrhage ; if for sepsis, to leave it in viagra online net for five or six days. Dr. Noble, of Philadelphia, said that in the be- ginning he drained a larger percentage of cases than Dr. Kelly, but the longer he operates the less he drains. In his early cases he thought the recoveries were due to the tube, but he has since seen his mistake. According to his experience gauze ceases to drain af- ter a few hours. The serum collects in the gauze and is retained. He, therefore, is in the habit of insert- ing a glass tube in the middle of the gauze. In his opinion the chief function of the gauze is to pack off the infected area. He has viagra 50mg pakistan never found it necessary to use drainage for hemorrhage, and thinks that with the patient in Trendelenburg's position viagra online net it can always be controlled. In a case viagra online net in which it is necessary to employ drainage for this purpose he would prefer a glass tube for twenty-four hours. Dr. H. O. Marcv, of Boston, said that for many years he stood alone on this question of drainage, and he was glad to see others coming to his views. He has laid down two rules for his own guidance. If the case is aseptic, no drainage; if septic, drainage. The reason, he thought, gauze sometimes ceases to drain is because the operator tries to drain up hill. The prop- er place to drain is not through the abdominal wound, but through the vagina, and a large opening should be employed. Dr. Newman, of Chicago, said he has lately em- ployed iodoform wicking instead of gauze and has found it more satisfactory. The capillary action is better viagra 50mg pakistan and it viagra online net is easier to introduce and remove. Degenerative Changes that Occur in Uterine Fi- bro-Myomatous Growths. Dr. Augustus P. Clarke, of Cambridge, Mass., began his paper with the state- ment that the belief that fibroid tumors are always benign, and that if a patient viagra 50mg pakistan suffering from these growths once passed the menopause she would have no further trouble; is erroneous. The same is true of the statement that degeneration of a fibroid is viagra 50mg pakistan favorable. Later investigations have shown that these growths frequently become harder, and may press upon the ureters and cause renal com- plications. In addition to the dangers from hemor- rhage and pressure, suppurative changes may take place, endangering the life of the patient from septic poisoning. lie has seen several cases of this charac- ter. He doubts if a fibroid tumor ever wholly disap- peared spontaneously. It may remain stationary for a long time, but there is constant danger of viagra online net degeneration and the development of malignancy. viagra online net These changes are not rare, and they may occur at any time, even after the menopause. This change is usually insid- ious in onset, and the early signs and constitutional symptoms of primary cancer attacking the cervix are not present. The patient may appear viagra 50mg pakistan in perfect health until the growth has become very extensive and in- volves the lower portion of the uterus. Fatty degen- eration is another degenerative change which may take place in fibroid tumors. It may occur under the influence of pregnancy. It is more likely to take place when the growth is myomatous. The liquefied portions may become absorbed and cavities formed, which give it the appearance of a fibro-cystic tumor, but it is not, as the cavities are not lined with epithe- lium. The other degenerative changes liable to occur in fibroid tumors are inflammation leading to oblitera- tion of the vessels and consequent sloughing viagra 50mg pakistan and gan- grene, colloid degeneration, melanotic growths, calci- fication, contraction, and atrophy. In consequence viagra 50mg pakistan of these various changes, many of them fraught with so much danger, he advises the re- moval of all fibroid tumors as soon as they are dis- covered. Drainage versus Radical Operation in Cases of Large Pelvic Abscesses. Dr. Charles P. Noble, of Philadelphia, said that the object of his paper was to call attention to drainage in large pelvic abscess and to contrast the results with those of abdominal section. He wished to state at the outset that the method is applicable only to a specific class of cases, viz., those in which there is a large collection of pus in the pelvis and the patient has become very viagra 50mg pakistan weak and ill from a long-continued septic process. Previous to July, 1895, he always performed ab- dominal section in these cases, and while he had ob- tained some excellent results, yet the mortality was somewhat high, being at least twenty-five per cent. This would be fairly satisfactory in this class of cases if there were nothing better, but simple drainage has