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should be removed. Suppuration will sometimes ef- fectually destroy all the invading bacilli; yet this is a slow and dangerous process subjecting the individ- ual to constant' risks. Infected glands should be re- moved if possible during the stage of induration. The removal of tuberculous glands from the neck is frequently a most serious operation, provided connec- tive infiltration is present and especially if the chain of glands has dipped deep beneath the cortical vessels and pink viagra cheap nerves or has extended below the clavicle. These deep glands can be safely removed only by following the line of cleavage between the gland and the protec- tion wall, w liich has been partially thrown about it, each gland being 1 autiously shelled out. The jugular wins, the branches of the carotid, and the pneumogastric and phrenic nerves should be care- fully avoided. When a vein is injured immediate pressure with subsequent ligation or lateral suturing should be performed. If the phrenic or pneumogastric are injured they should be at once sutured with fine silk. Great care should be exercised to prevent the dis- charge of pus and pink viagra cheap caseating material upon the fresh wound. If such accident occurs, the area should be thoroughly 1 li ai ied and disinfected. Temporary drainage is viagra patents generic advisable when infection has occurred from such discharge; but in healthy opera- tions with clean enucleation primary union without drainage can be secured. In infection in the axilla, the glands should be enucleated with the same care that is employed in the removal of the carcinomatous nodule. The same rule holds good in regard to glands situated in other portions oi the arm. In the groin many difficulties may be encountered, especially if the indurated glands extend deep about the femora! or saphenous veins. Secondary operations are advisable if necessary. In cases that absolutely ise operation, local and constitutional measures :.mst be employed, including tuberculin pink viagra cheap and orrho- iherapy. I'll \uthor has m< e 1 - in the local effects dine upon tuberculous granulations than in iodo- form. 1 1 ! ! ilso had beneficial results from, stimu- lation of cell growth by a mixture of viagra patents generic aristol with nuclein 01 protonuclein applied locally. His conclu- sions are 1 hat tuberculous infiltration glands should not he allowed to remain and contaminate the general system. md /I'v viagra patents generic May 27th. Castration in Hypertrophy of Prostate Gland Dr. 1 CABOT, of boston, dwelt at great length upon the operations of castration and prostatectomy, and gave many statistics from varii earing upon this subject. Alter considering the relative merit of each operation, he closed his paper with the following conclusions: 1st. In the matter of mortality the operation of pros- tatectomy has a slight advantagi n. It seems pink viagra cheap probable that with later statistics, reflecting the last improvements in the technique of prostatectomy, this advantage will be further increased. 2d. Prostatectomy has the further advantage that it allows of a thorough examination of the bladder and of the discovery viagra patents generic and correction of other conditions not before suspected. Stones are frequently removed in this way without adding to the viagra patents generic gravity of the opera- tion. In several reported cases of castration the ab- sence of improvement has led to the subsequent dis- covery of stones, which have required other operations for their removal. 3d. Prostatectomy has, on the other hand, the dis- advantages that it confines the patient for a longer time and that it is sometimes followed by a fistula. This occurred in one of the forty-two cases referred to in this paper. 4th. It is too early to determine whether any perma- nent loss viagra patents generic of vigor follows castration when done on old men. The nervous effects which sometimes immedi- ately follow the operation suggest a suspicion that with the testes the system may lose some tonic effect exerted by those organs. 5th. The functional results of the two operations seem at present to be as nearly equal as possible, and the tendency to relapse shows itself in about the same proportion of cases after either operation. pink viagra cheap 6th. The reduction in the size of prostate after castration pink viagra cheap is largely due to a diminution of conges- tion. Later a degeneration and absorption of consid- erable portions of the gland may occur. The glandu- lar viagra patents generic elements are particularly affected by this atrophy. 7th. Castration would seem to be especially effica- cious in cases of large tense viagra patents generic prostates when the ob- struction is due to pressure of the lateral lobes upon the urethra. 8th. Castration is of but little use in myomatous and fibrous prostates. gth. Prostatectomy has its especial field in the treat- ment of obstructing projections which act in a valvu- lar way to close the urethra. There is, however, no form of prostatic obstruction which a skilful operator may not correct by prostatectomy. 10th. Prostatectomy is, then, applicable to more cases than castration, and is especially to be selected when an inflamed condition of the bladder makes drain- age desirable. The Ambulatory Treatment of Fractures of the Lower Extremities. Dr. Louis S. Pilcher, of