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patient had a hernia of the diaphragm and an opera- tion was viagra patent trial agreed buy viagra website upon for the next morning. Upon entering the abdomen, an opening was found in the diaphragm with buy viagra website a band of adhesive tissue extending up to the exact point where the stab wound was. It was evident that the buy viagra website man would die, and the opening in the diaphragm was enlarged until the hand could be inserted into the left thoracic cavity. A viagra patent trial small por- tion of intestine was found in the pleural cavity buy viagra website and the adhesions were very dense. The lung was com- pressed and the condition of the bowel was one of beginning gangrene. The patient came out of the an- a-sthesia and died shortly afterward. One of the most interesting points about viagra patent trial the case was that the man who did the stabbing was declared not guilty. Dr. Maclean closed the discussion by saying that the result of his paper and the discussions seemed to be that a surgeon should have the courage of his con- viction and advocate an early exploratory incision. Although some patients get well without operation, buy viagra website ninety-nine in every hundred do not. Some Mechanical Causes of Interference with the Action of the Stomach and Their Surgical Re- lief. Dr. \Y. J. Mayo, of Rochester, Minn., presented a communication with this title. The author divided his subject into two classes: first, those which act from within the cavity of the stomach or its immediate connections, such as a tumor, cicatrix, or a foreign body which may obstruct its inlet or outlet or prevent its normal muscular action ; and second, those which buy viagra website act from without the stomach and interfere either by pressure or adhesion, obstructing its inlet or outlet or fixing some portion of its viagra patent trial wall, thus preventing its functions. The history of the case, the physical examination, the distention with air, and the test meal constitute the main diag- nostic resources. The diminution or absence of free hydrochloric acid, when taken into consideration with the physical examination and the history, is buy viagra website of some service. The treatment of forms of obstruction due to stenosis as a result of scar tissue is exceedingly trying, but some of the less resistant cases, when seen early, can be dilated by means of bougies used through the mouth. If it is impossible to pass a bougie, retro- grade dilatation by means of gastrotomy is a rational procedure, and the olive-tipped whalebone bougies are of most value. Gastrotomy for the purpose of retro- grade dilatation is perhaps best done by Fenger's oblique left lateral incision through the abdominal walls, which brings this opening more directly in line with the cardiac orifice. Gastrotomy for the removal of foreign bodies is an operation of great efficiency, while gastrostomy for the purpose of feeding is sub- ject to great annoyance in the way of leakage. For temporary purposes the Witzel method is of the great- est benefit, as immediately after removing the tube the fistulous tract closes, while for permanent feeding Frank's spout method is undoubtedly the best. Ob- structions at the outlet of the stomach are exceedingly common, and many cases, especially those of pyloric stenosis secondary to buy viagra website ulcer, are too often pronounced malignant without proper examination. For the relief of non-malignant stricture at the pylorus the Hoenke- Mikulicz pyloro-plastic operation is the one of buy viagra website choice and is wonderfully well adapted to the average case. The author briefly cited a case in which this opera- tion had been done and viagra patent trial in which the recovery was prompt and the gain in weight remarkable. For in- operable obstruction, such as advanced malignant dis- ease, gastroenterostomy is the operation of choice. As a result of three of these operations, in which the Murphy button was used by the author, there were two successes and one death. Of the two patients who recovered, one has gained forty pounds up to the pres- ent time, which is one and a half years after the opera- tion. The buy viagra website frightful mortality of pylorectomy in malig- nant disease without reported permanent cures is not encouraging, and the reason for this great mortality- lies in the debilitated and starved condition of the patient at the time the operation is resorted to. Among the external causes of interference with the stomach, adhesions of the pylorus or duodenum to the gall bladder due to the inflammation excited by gall stones is not infrequent. The most common cause of external interference with the action of the stomach is adherent omentum. Irreducible onii ntal hernia? of any variety are almost always accompanied by gastric distress which disappears after the radical cure of the hernia. The author mentioned a case of a man fifty- four years of age who had suffered for seventeen years from gastric pain and chronic indigestion, and in whom upon dilatation of the stomach an old irreduc- ible omental hernia was found. Radical operation on the hernia with liberation of the omentum promptly re- lieved the symptoms. Third Day Thursday, May Jth. Surgery of the Stomach. Dr. Alex. Hugh Fer- guson, of Chicago, in discussing Dr. Mayo's paper read at the previous session, said that he approved of Dr. Mayo's methods of treating non-malignant and malig- 742 MEDICAL RECORD. [May 23, 1896 nant stricture of the oesophageal end of the stomach and also the palliative treatment that he recommends for malignant disease of this region, discarding curet- tage and adopting Frank's operation as superior to Witzel's and Fenger's, since this operation, although onlv palliative, will give buy viagra website the patient considerable trouble. He also agreed with him in advising forcible