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revolutionized things. Since July, 1895, he had operated in eight cases viagra price london of this nature without a single death. Seven of these patients were very septic, and he thought at least six of them would not have survived the shock of an ab- dominal section. A detailed report of the cases fol- lowed. Dr. Noble then added that his experience was too limited to predict the number of cures by this opera- tion, and that probably some of his cases would re- quire a second operation. What he claimed was that in desperate cases it was a life-saving operation ; that it permitted the patient to recover strength and get into a condition which would permit a radical opera- tion if necessary. He viagra price london also thought that in a certain percentage of cases the operation would bring www viagra usa about a permanent cure without further interference. Some Suggestions on the Prophylaxis and Man- agement of Puerperal Eclampsia. Dr. H. D. Thomason, of Albion, Mich., stated that the pathology and etiology of puerperal eclampsia are still unde- termined and unsettled and that it is necessary there- fore to fall back upon our clinical experience. The various causes which have been given viagra price london are: 1, al- buminuria; 2, www viagra usa renal insufficiency; 3, cerebral irri- tation ; 4, obstruction to the portal circulation due to cirrhosis; 5, peripheral nerve irritation; 6, pres- sure on the renal vessels; 7, viagra price london pressure on the ureters. Probably no one cause can be assigned for every case. He has been accustomed, therefore, to make for clin- ical purposes viagra price london three groups: 1. Toxaemia from some cause. 2. Peripheral nerve irritation. 3. Hysteria. Whatever may be the cause of eclampsia, the im- portant thing to bear in mind is to keep a close viagra price london watch on the patient. Rarely are convulsions un- heralded. In the vast majority of cases there were prodromal symptoms. Frequent urinary analyses, both qualitative and quantitative, should be made, and if albumin is found or the amount of the solids greatly diminished, suspicion should be aroused. Any abnormal symptoms, such as headache, disturbances of vision, or eedema, should put us on our guard. When May 23, 1896] MEDICAL RECORD. 749 such symptoms appear the patient must be put on a milk diet with large quantities viagra price london of sterilized water; hot baths should be employed, and the bowels kept active by catharsis and saline enemas. If there seems to be pressure on the ureters, the method of catheterization advocated by Dr. Kelly may be used. In the ma- jority of cases this treatment will viagra price london remove the unpleas- ant symptoms, but if there is no improvement then the induction of premature labor must be considered. The continuance of these symptoms threatens the life of the child by toxaemia, and, therefore, if the child is viable, labor should be brought on both for its sake and for that of the mother. If a convulsion does occur and the child is viable, labor should be at once in- duced. If the child is not viable, then there may be delay unless the mother's life becomes endangered. In post-partum eclampsia the treatment varies with the subject. If the patient is plethoric and vigorous, venesection is the best remedy: if anaemic and weak. veratrum accompanied by the transfusion of the salt solution is indicated. Third Day Thursday, May jt/i. Vaginal versus Abdominal Section for Small Tumors and Pus in the Pelvis. Dr. R. S. Sutton, of Pittsburg, who opened the appointed discussion on this subject, said that the whole www viagra usa question hinges upon the disposition of the uterus in cases of bilateral puru- lent infection of the appendages. If viagra price london the uterus is to be removed, the vaginal route should be selected, and if the uterus has become a pathological organ it should be removed in all cases. He accepts the statement of Jacobs, that seventy-five per cent, of all cases of pus in the tubes were due to gonorrhoea; he thought tuberculosis accounted viagra price london for ten per cent., and cancer and other causes for fifteen per cent. Gonorrhoea first affects the vagina, viagra price london then extends along the uterine canal and into the tubes. The tubercle bacillus will produce pus if lodged in the tubes. We may also have a pelvic cellulitis and abscess in the broad ligaments due to infection, starting in abrasions and travelling along the lymphatic system. If, therefore, the uterus is thus infected, we should remove it. When both ovaries are taken out the uterus has no further func- tion, and it is liable to cause further trouble from www viagra usa hemorrhage, discharges, chronic poisoning, and its susceptibility tc malignant disease. The question has been asked, Does it add to the danger of the opera- tion? Judging from his own experience and that of his colleague, his opinion was that it does not. There- fore the vaginal route is to be chosen, because it gives absolute and perfect drainage, shortens the convales- cence from a period of from twenty-one to twenty- eight days to seven or eight clays, and settles the ques- tion of future trouble both as to infection and uterine disease. In the case of small fibroids Diihrssen's op- eration of anterior colpotomy should be employed and only the tumor removed, saving the uterus and appen- dages. When the tumor is too large for this method then morcellement may be employed. This operation is better than abdominal section, for it leaves no ex- ternal marks and the convalescence is shortened.