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qua non to successful treatment, but an indispensable pre- requisite to the safety of the patient. The importance of a correct diagnosis in this connec- tion can not be overestimated, and it generally admits of an easy solution. The patient being on her back, on placing the index finger under the cervix and lifting it upward, or on attempting to move the uterus laterally or from before backward, or vice versa, a pretty correct estimate is made of the degree of fixation or the limit of mobility without the use of the sound. At the same lime a careful explora- tion of the Buy Cheap Generic Levitra roof and walls of the pelvis by touch, accom- panied by bimanual palpation, will determine the presence of pelvic peritonitis or cellulitis. Examination by the rec- tum is often Buy Cheap Generic Levitra essential in confirming the diagnosis. If the peritoneal structure is found thickened and resist- ing, or the cellular tissues are a?dematous and slightly fluctu- 12 GHAtiE: MECHASICAL SUPPORT IN UTERINE DISPLACEMENTS. [N. Y. Med. Jodk., ating, particularly the latter symptom, at the utero-vaginal junction, associated with tenderness — conditions with which you are all familiar — Buy Cheap Generic Levitra you will decide that, whatever the form or degree of displacement, Buy Cheap Generic Levitra no use of the sound or ropositor will be admissible for overcoming the displacement. The imminent risk and almost certain disappointment which will follow such efforts will settle at once the im- propriety of their use ; and it is probable that the evil con- sequences which occasionally follow the introduction of the sound generally occur in patients suffering from unrecog- nized chronic or subacute pelvic peritonitis or circum-uterine cellulitis, which might have been avoided had careful search for its presence been instituted. If any intiammation, sub- acute or Buy Cheap Generic Levitra chronic, of these structures is found to be present, it Buy Cheap Generic Levitra should first receive attention, and none but the gentlest measures should be adopted. With the patient either in the Sims position or, gen- erally better still, in the knee-chest position, let tincture of iodine be applied over the points of inflammation twice a week, and the patient kept quiet; if she is in pain, perfect rest in bed should be enjoined. This may be succeeded or alternated with small tampons of cotton saturated with pure glycerin, glycero-tannin, or glycerin and alum, having in the solution a small percentage of carbolic Buy Cheap Generic Levitra acid, applied at intervals of two or three days. Here, too, the use of coun- ter-irritation is often of great value in (he shape of external application of tincture of iodine, and sometimes blisters, over the hypogastrium. Some cases Buy Cheap Generic Levitra of pelvic peritonitis are so prone to recur on exercise, on exposure, or at the menstrual period, that pro- longed rest in bed of a few days or a few weeks in connec- tion with treatn)ent is needful for perfect relief, particularly if there is coincident uterine or ovarian inflammation. Un- der these circumstances, should evidence of acute inflam- mation appear, perfect rest in bed should be followed and all pain controlled by the free use of opium or morphine. Where uterine displacement is associated with cervical laceration, with eversion and abrasion of the cervix, and with cervical and corporeal hyperplasia, it is a question in some cases which should receive attention first — the correc- tion of the displacement, or the repair of the cervix. It is a matter of common observation that prolapsus, due to congestion and hyperplasia attendant and depending upon laceration, recovers promptly after the union by opera- tion of the lacerated cervix, or, if any artificial support is required, it is only for a brief period. According to my own experience, there are cases of this kind in which temporary support, either by tampons or ring pessary, is indispensable to the preparatory treatment re- quired in healing the abraded surfaces and relieving the congested cervical tissues, as well as preventing friction by their resting upon the floor of the pelvis before the repair of the cervix can be undertaken with reasonable prospect of success. Experience proves beyond all qnestion the con- servative influence of the repair of a lacerated and hyper- trophied cervix, and demonstrates that under these circum- stances any but radically curative measures will be fallacious ; and, while temporary improvement will follow the applica- tion of alteratives to the abraded and destenerated cervix. the patient is almost certain to relapse into her former con- dition, greatly to the disappointment of herself and the dis- comfiture of those who had supposed and pronounced her cured. It will remain for the surgeon to decide which shall first be undertaken, the cure of the laceration, or the correction of the displacement. Generally my rule has been to first repair the cervix, unless the displacement so complicated the condition that it could not be accomplished. Occa- sionally support will be first required. I recall a case I operated on several years ago, in which there was marked descent of the uterus accompanying extensive laceration Buy Cheap Generic Levitra of the cervix and considerable hypertrophy, with eversion and erosion, where a ring pessary, attached to a stem for exter- nal support, was worn for months to enable the parts to be successfully treated, so as to make the operation admissible. Laceration of the cervix Buy Cheap Generic Levitra is so frequently found as a fac- tor in uterine hyperaemia and hyperplasia that its presence and possible influence in cases of Buy Cheap Generic Levitra displacement should be carefully studied and rationally treated. Among the most embarrassing and furmidable of all the complicating circumstances attending uterine displacements is that of adhesions — the result of former inflammatory ac- tion. Taken as a whole, they are altogether uninviting. Some cases are amenable to treatment and yield results alike satisfactory to the patient and the attendant, but such efforts should never be undertaken in the presence of a peritoneal, cellular, or circum-uterine inflammation, Buy Cheap Generic Levitra nor un- der circumstances and conditions unfavorable to the patient, and, if entered upon, Buy Cheap Generic Levitra none but the gentlest measures, pa- tiently followed and limited by a wise conservatism, should be employed. Viewed in the light of modern surgery and the brilliant results attending abdominal section, it is safe to assert that any but the gentlest measures adopted to overcome uterine fixation from inflammatory adhesion would carry with it far greater risk to the patient than a laparotomy done for the sole purpose of severing the adhesion. Certain forms of displacement, particularly that of ante- version and procidentia dependent upon and resulting from