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amount of cocaine necessary ; and perfect primary union is more readily secured than when the parts are infiltrated, and rendered cedematous by the in- jection of a foreign solution. Still, when necessary, a local anesthetic can be used, but it is not my choice. From eighty to one hundred minims of a two per cent, solution of co- caine or eucaine are injected under the skin just back of the corona. A rubber band should first be applied at the root of the penis, to prevent the solu- tion froin entering the general circulation by ab- sorption through the lymphatics. Before oi)erating the skin should be marked with Cheap Generic Levitra India indelible pencil or ink a short distance in front of the ridge made by the corona glandis. This dis- tance, in adults should be from one third to one half an inch, depending upon the amount of phymo- sis, and oedema of the foreskin present, which draws the skin of the penis forward, thus displacing its normal relations. \\'ith the normal retraction of the skin, incision at this site will leave the cut edge just back of the corona. The Cheap Generic Levitra India parts should be cleaned and disinfected, care being taken not to use too strong antiseptics. Cau- terize such sores as do not contraindicate the op- eration. The operation should be conducted ac- cording to the principles of modern aseptic surgery. The penis should be surrounded by sterile towels, or drawn through a hole made in a sterile towel. The prepuce should be grasped on its sides by the thumb and fingers of the left hand, and drawn forward until the mark made upon the skin is just Cheap Generic Levitra India beyond the glans ; then it may be clamped or not, just as the operator desires. The use of a clamp insures a cleaner, evener line of incision. Then with a sharp knife, at the site of the mark, a clean, quick incision should be made oblicjuely from above downward and forward, removing the prepuce at Cheap Generic Levitra India one stroke, taking Cheap Generic Levitra India care that the glans penis is pos- terior to the line of incision. If a clamp is used the incision should be made on the proximal side of the clamp, thus removing all clamped tissue. The cut ?kin then recedes back of the corona glandis, leav- ing the glans still covered with Cheap Generic Levitra India a layer, raw on the outside and semimembranous on the other, next the glans. A director should be inserted between this layer and the glans, and with a sharp pointed scis- sors, it should be split, midline on its dorsal sur- face, right up to the sulcus back of the corona, thus avoiding the possibility of subsequent constriction. This layer should then be turned back with the fingers, any adhesions being broken down, Cheap Generic Levitra India com- pletely freeing it down to the coronal sulcus. Then with a sharp scissors this portion of the skin should be clipped off on a line, one third of an inch back of the corona. At this distance there is little chance of wounding the arteries of the frenum, and it is none too much for the convenient insertion of sutures. Ligature any bleeding vessels with fine catgut. Most of the bleeding will stop when the parts are suttu'ed. Wash freely with a boric acid or normal salt solution, and insert su- tures of horse hair, catgut, or silk. Catgut is best for children, as it does not need removal. The first suture should be at or near the frenum. taking care to use a round needle, and to secure perfect apposi- tion of the corresponding cut edges. Then a stitch on the dorsum Cheap Generic Levitra India and one on each side ; after which a sufficient number of others are inserted to secure ))erfect apposition of the cut surfaces, without their gaping between the sutures — in children about six. in adults ten or twelve, in all, are required. Avoid inversion of the skin and do not tie the sutures too tightly. Flush again with mild antiseptic, and dress with dry dusting powder, and apply an inch to an inch and a half roller gauze bandage around the ])enis, from the corona to the root of the penis, leav- ing the most of the glans bare, Cheap Generic Levitra India so that the patient can urinate without soiling Cheap Generic Levitra India the dressing. Dress as often as indicated by the soiling of the dressing, previous condition of the parts, or for necessary observation. If silk or horse Cheap Generic Levitra India hair are used, remove the stitches according to conditions, firmness of union, absence of oedema or tension, tendency to priapism, etc. Some of the sutures can be left in longer than others as a matter of precau- tion. If gonorrhoea is present, give urinary antiseptics as hexamethylene tetramine, methylene blue, oil of santal, etc. If there be priapisiii give bromides, camphor, or heroine hvclrochloride. OIR READERS- DISCUSSIOXS. '.29 Dr. C. E. Montgomery, of [Valla Walla, Cheap Generic Levitra India Wash., zcrites: While no one method meets all the conditions re- quiring circumcision, it is best to adhere as closely as possible to one method and to modify it to meet the few unusual conditions in the organ, and to adapt it to the age of the patient. Children can often be relieved by gradual dilata- tion of the foreskin by retracting it. at a very early age, or if retraction is not possible, it may be gently stretched with Cheap Generic Levitra India forceps and then retracted. This is advisable to prevent adhesions forming between the glans and the mucous membrane of the foreskin. But if this procedure has been neglected until con- siderable growth has taken place circumcision is preferable to nuich manipulation. Children should be anaesthetized for this opera- tion, which should be done as follows : Cleanse the penis very thoroughly with soap and water and boric solution. Grasp the edge of the foreskin on the dorsum with a forceps on each side of the median line, and with another forceps catch the skin at the frenum. Satisfy yourself that the scissors are not in the meatus, and then slowly split the foreskin of the dorsum between the two forceps, back to the