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is thought necessary to lift the uterus. The com- plications named do not apply to the Alexander oper- ation at all, or do so in very slight degree, and this is the method which ought to be viagra online order adopted for uncompli- cated retro-displacement of the uterus. Vaginal fixation has given the worst results of all the methods in its bearing upon pregnancy and labor. Third DayMay 28th. The session was opened with a discussion upon Dr. Nol lie's paper on suspensio order viagra pro uteri with reference to its influence upon pregnancy and labor. Dr. Thomas \ - Em m 1 1 said he has found suspension of the uterus bj any of the methods named, including Alexander's, unnecessary, as tin- condition could be corrected in a more natural way by plastic operations on viagra online order the vagina. The discussion was continued by DRS. EdEBOHLS, Kelly, Ashton, Fry, Lapthorn Smith, and the author. Some Aspects of Ureteritis Dr. Edward I'. Reynold , ol Boston, gave as the full title of order viagra pro his pa- per, " Some Aspects ol 1 reteritis, with Especial Refer- ence to Diagnosis of tin- Disease as Hearing on Mis- lakes Between I reteritis and More Serious Pelvic Diseases, ami Some Reference to the Treatment as Determined by its Etiology." The majority of cases which he has viagra online order seen seemed to have been inaugurated by order viagra pro altered condition of the urine due to renal inefficiency. Anion- the symptoms were frequency of micturition, not wholly relieved by recumbent posture; bearing-down pain, increased by standing, usually completely relieved by a few hours' rest in bed; pain and tenderness on pressure on ureter with the finger introduced into the vagina. Cysto- scopic examination is likely to reveal reddening and erosion at the mouth of the ureter, with eversion of mucous membrane of the outlet. Treatment is palliative and curative. Applica- tion of solid nitrate of silver at the inflamed area men- tioned will give more or less temporary relief. Cur- ative treatment is hygienic and medicinal, but chiefly the former. The diet should be regulated by giving largely albuminate food, bland fluid, three pints or more daily of water, supplemented by alkaline diu- retics. The condition is probably less due to func- tional vice of the kidneys than to imperfect metabolism in the body as a whole. So-called alteratives may- prove of benefit, and he has given iodide of potassium and mercury a limited trial. In acute cases there are symptoms not present in the chronic, relating to pain on pressure, referable at successive stages to the region of the pelvis of the kidney, then to the so-called McBurney point of ap- pendicitis (on the right side), then to a spot about Poupart's ligament. He at first mistook two cases for appendicitis. The paper was discussed by Drs. Mann and Lap- thorn Smith, who recognized constitutional treatment as especially important. Dr. Mann said his attention has not hitherto been directed to the tender points men- tioned. He will hereafter look for them. Implantation of the Ureter into the Bladder, by Abdominal Section, for the Cure of Uretero- Vaginal Fistula. Dr. H. J. Boldt, of New York. Among the causes leading to the production of uretero- vaginal order viagra pro fistula', the most frequent at the present time is probably vaginal extirpation of the uterus. For- merly difficult parturition was the most prolific source in the etiology of this malady. It is the author's belief that injuries of the ureter from the performance of vaginal hysterectomy are of more frequent occur- rence than is known, many cases not being reported. It is liable to occur relatively viagra online order oftener in the hands of experienced operators than in those of less experi- ence, because the former are apt to undertake more difficult order viagra pro cases, especially when operating for cancer, if the broad ligaments are thickened, and viagra online order the oper- ator works far away from the viagra online order cervix while endeavor- ing to remove all viagra online order particles of malignant infiltration. The ligature or clamp may prevent dribbling until necrosis has taken place. If a fistula is absent, the diagnosis is more difficult. In relating the his- tory of a case, the author said the patient at times passed urine from the fistula, and on such occasions had more pain in viagra online order the renal region radiating down the course of the ureter; after a short time a copious flush of urine would make its appearance with subsequent relief of pain. He believed the attacks of partial suppression of urine from the affected kidney are readily accounted for by the existence of this fistula, which at times probably becomes occluded: hence the severe pains in the renal region, which are relieved on the free escape of urine. The patient made a good recovery after removal of the kidney on the affected side, although for a time there were signs of acute nephritis in the remaining kidney. This case taught that all uretero-vaginal fis- tula' should be operated upon as soon as possible aftei the diagnosis has been made, on account of the great liability of the kidney to become infected. If complete anuria viagra online order is present there is reason to suspect that both ureters have viagra online order been tied, especially when |iain and sensitiveness to touch are present in the renal regions, with nausea and vomiting. Under such circumstances a cystOSCOpic examination should be made without delay. When injury has been shown to exist the question of treatment arises. A sponta- neous cure van only come about if the ureter has been injured in its long axis. Such cases are more June 6, 1896J