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stances as these that an effort be made to save the life of the child, viagra online medicine and as a means of accomplishing this three plans have been suggested. They are: (1) To wait for the mother's death and then immediately to extract the child: (2) to do Caesarean section while the mother is yet alive; (3) to employ means to ex- pedite labor and to extract the child by the natural passages as speedily as possible. Remy then pro- ceeds to discuss the relative advantages of these differ- ent modes of action. Prunshuber's statistics show that when the mother is allowed to die before the child is extracted by abdominal section, only about five per cent, of the children survive. Puech's statistics are somewhat more favorable; but there can be no doubt that the chance of obtaining a living child under these circumstances is very small. The performance of Cae- sarean section upon a dying woman who is unable to give her consent to the operation is undoubtedly open to sentimental objections. Gusserow viagra online medicine and Manasse consider that the operation is justifiable under the fol- lowing conditions: (1) When it is clearly proved that the mother is about to die, and (2) that the child is alive. Remy favors the plan of rapid dilatation of the cervical canal and extraction of the child per va- ginam. Violent measures should be avoided, viagra online medicine and the dilatation should be proceeded with as viagra order usa slowly as the condition of the mother will permit. The cervix may be dilated by means of Champetier de Ribes' bag or by the hand alone. If traction is made upon the bag, dilatation may be produced in less than half an hour. Practitioner. June 27, 1896] MEDICAL RECORD. 9 2 5 Medical Record: A Weekly Journal of Medicine and Surgery. GEORGE F. SHRADY, A.M., M.D., Editor. Publishers WM. WOOD &. CO , 43, 45, & 47 East Tenth Street. New York, June 27, 1896. THE PAINS OF HEART DISEASE. Pain associated with diseases of the heart is one of the most alarming and distressing of symptoms. Nothing frightens even the bravest more than a feeling of pain in this region, with the sinking and feeling of help- lessness that often accompany it. The viagra online medicine prevalent idea that people who have heart disease are liable to die at any moment and the frequent reports of death from heart failure make symptoms of this kind particularly terrorizing. Dr. James McKenzie, of Edinburgh, has published an article upon pains and other sensory symptoms that are associated with heart failure. Dr. McKenzie's ar- ticle is devoted to the presentation of evidence show- ing the special kinds of pain, hyperesthesia, and ner- vous disturbances that are produced by heart disease and heart weakness. He shows, also, the distribution and character of these pains and other sensations. He finds that the common seat of pain, in cases of heart weakness and in attacks of heart failure, is that which is familiar to all, namely, the region of the left breast and the left arm, especially the inner and ulnar side of it. He reports several cases of patients who had attacks of pain in this region, and in whom careful and repeated physical examination showed no heart disease. These patients all died suddenly, however, from acute heart failure. Dr. McKenzie finds that in persons who are liable to these attacks there is a cuta- neous hyperesthesia over the area where the pain is felt a hyperesthesia that is easily mapped out by slightly pinching the skin or pressing it with a pin- head. In most cases, he says, the pain starts in the chest and radiates into the arm. In rare cases the pain starts in the arm and radiates to the chest a fact which has been noted by Walsh. There is sometimes, he finds, irregularity in the distribution of the pain; just as viagra online medicine there are persons whose spinal nerves are dis- tributed in a peculiar way. Thus, he gives an account of a man, fifty-two years old, whose chief complaint was pain induced by exertion. This pain began in the left chest, extending to the armpit, down the inside of the arm, thence across the palm to the thumb, viagra order usa causing great aching in the thumb. This man had no detecta- ble heart viagra online medicine disease, but he died rather suddenly, and the cardiac muscle was found to be fatty and degenerated. Other cases are cited in which the pain was con- fined to the left chest under the nipple, and other cases in which it is limited to the ulnar border of the left arm. These pains were generally brought on by some exertion, associated with some cardiac distress. At viagra online medicine times the pain extends viagra order usa over to the right side and right arm, and one case is given in which the patient, with a very damaged heart, used to suffer from great pain over the right scapula viagra order usa and viagra order usa viagra order usa the inner part of the right elbow-joint. The bilateral distribution of the pain in heart disease viagra online medicine is not equal, it being more marked upon the left side than upon the right. Besides the hyperesthesia and pain, which are de- scribed as occurring in the left chest and arm and sometimes the right chest and arm, Dr. McKenzie finds viagra order usa at times an abnormal sensitiveness over the neck,