Dr. Leuf replied that, in the first place, a metallic catheter of average size was readily passed through the urethra and withdrawn through the vesical orifice, thus proving the absence of any stricture likely to cause retention. In the second place, he did not believe that the cedema of the prepuce, though very great, could prevent the escape of urine, as there was no phi- mosis. In the third place, the prostatic angle of the urethra in this case was a Costo De Levitra 20 Mg very decided one. It was obtuse, of course, but measured not more than 100" or 110°, and that might prove an effectual impediment to the How of urine during life. In the fourtli place, the inter-ureteric bar was present in this case and appeared as a round ridge running from one ureteric orifice to the other, and had Costo De Levitra 20 Mg a diameter of about 5 mm. Aneurysm of the Arch of the Aorta. — Dr. C N. D. Jones presented a specimen with the following history, a portion of which was furnished by Dr. Morrel, of the Brooklyn Hospital : Alexander D., aged thirty-two, single, colored, a native of the United States, came under his observation February 4th. The patient's family history was negative. He was one of the ".Ju- bilee " singers. He stated that about one year ago, after an evening's performance, he had noticed a dull pain in the left chest. Three months ago he had first noticed a tumor in his left infra-clavicular region, which had been slowly but steadily enlarging. The patient suffered with pain, dyspnoea, cough, dysphagia, and aphonia. Examination showed the chest-wall bulged forward by a large pidsating tumor. On auscultation, there was a double murmur, with the unmistakable aneurysmal thrill. The patient was sent to the Brooklyn Hospital, where he remained until he died, February 25th. The treatment con- sisted of the use of iodide of potassium and opium. Large doses of the latter were required to ease his pain. At the au- topsy the heart was found to be but slightly enlarged, the valves were competent, and the muscular tissue was of normal consist- ence. The whole arch of the aorta was markedly atheromatous and somewhat dilated. Just beyond the origin of the left Costo De Levitra 20 Mg sub- clavian artery it was dilated into an aneurysmal sac of the size of a large orange. At the inner portion of the large sac a sec- ondary sac was given off, extending inward and to the right, where it pressed upon and had become firmly adherent to the trachea. The smaller sac, together with the adherent portion of the tracheal wall, was firmly calcified — apparently an effort of Nature to protect herself against the encroachments of the enlarging tumor. The other organs presented no lesions wor- thy of note. The case was intei-esting because of the rapidity of the growth of the tumor and the absence of symptoms until within a short period before death. Bfports on tbf progress of Hlcbtr'mf. OBSTETRICS. By ANDREW P. CtJRRIER. M. D. How shall we manage Abortion % — Hartwig (" Buffalo Med. and Surg. Jour.," Jan., 1886) ooincities with the views expressed in the recent publications of Schwarz and Kleinwachter upon this subject. He considers that the Costo De Levitra 20 Mg subject should be treated under the heads of pro- phylaxis and theriipy. If the prophylaxis is not begun until lalior pains have commenced, the prospects of preventing abortion are not favorable. The use of morphine and antipyretics, if fever is present, is suggested as offering some hope in favorable cases. If svphilis is present, anti- syphilitic treatment early in the history of the pregnancy will give good results. When abortion is threatened on account of a displaced uterus, reposition of the organ and the wearing of a suitable pessary are indi- cated. Reposition is, of course, not to be thought Costo De Levitra 20 Mg of in the presence of strong adhesions, which would demand an unnecessary display of violence. Pregnancy is not necessarily a bar to the removal of teeth which require extraction, and even operations of the magnitude Costo De Levitra 20 Mg of ova- riotomy have been done without damage to the fatiis in utero. If the OS uteri is eroded and nitrate of silver to be used in its treatment, it is recommended that a very weak solution (10 per cent.) be used. When expulsive pains have fairly set in, Hoenig's method of compressing the uterus through the abdomen by one baud which grasps the fundus will sometimes assist in expelling the foetus and membranes entii-e. Ergot at such a time is not recommended by the author, as the os internum might be closed as a result. If post-partum ha-morrhage is troublesome or dan- gerous, a tamponade of absorbent cotton dipped in a 5-per-cent. solution of carbolized glycerin is advised ; or the tampon may be made from a 5- per-cent. salicyl, iodoform, or borated cotton. After six hours this may be removed and the vagina . syringed thoroughly with a very hot weak antiseptic solution. If the entire contents of the uterus have not been expelled, its cavity should also be thoroughly injecteil. The method of Boeters of scraping out portions of placenta or membranes which may have been retained Costo De Levitra 20 Mg with a Costo De Levitra 20 Mg sharp curette, this being followed by a cau- terizing and disinfecting application to the mucous membrane, is com- mended as a rational and eminently useful measure. In doubtful cases the author thinks that the patient should receive the benefit of the doubt and of the operation. Cases and authorities are quoted in which this operation for cleansing the uterus is advocated and approved, not only in septic or haimorrhagic conditions which follow abortions, but in simi- lar conditions which follow delivery at full term. The Temperature of Mother and Child at the Uoment of Child- birth. — Bonual (" Ann. cic grace," Dec, ISsol. in a paper read before the Afniltiiiii i!is sciiunx, says tiiat there is no direct relation between elevation of temperature, the duration of labor, and the energy of the July 17, 1886.J N£W INVENTIONS. 83 pains. Neither does pi-imiparity or multiparity have any special bear- ing in the matter. The same is true if the presentation is of the breech or face, if also there is no marked disproportion between the volume of the child and the dimensions of the genital canal. After normal aecouchements the temperature of the mother is usually 99'5-° F., but it may reach 100-4°. In abnormal aecouchements it may reach ]09-2° F. The temperature of the child immediately after birth and be- fore the division of the cord in normal labors generally oscillates between 99'6'-f and 100'9°-t- ; exceptionally it falls below 99'5°. In abnormal labors it may reach 109-1°, rarely going beyond that figure. There is usually a difference of 0'2° to 0'T° between the temperature of the mother and that of her child immediately after birth, in favor of the mother. As has been frequently observed, the child's temperature be- comes quickly lowered if it Costo De Levitra 20 Mg is not suitably covered immediately after birth. It may fall below 96'8° within thirty or thirty-five minutes. Hence the necessity that the child receive attention immediately after liirth. Continuous Irrigation in the Treatment of Puerperal Infection. — Pinard and Varnier (Ibid.) remark that the antiseptic method as applied to the treatment of wounds of the uterus, vagina, and vulva consecu- tive to parturitiou has yielded remarkable results, although there are still occasional deaths from septicaemia. A physician in charge of an Costo De Levitra 20 Mg obstetrical Costo De Levitra 20 Mg service, especially if it is large and public, Costo De Levitra 20 Mg is called upon to Costo De Levitra 20 Mg treat three classes of parturient women : 1. Those who have been sur. rounded by antiseptic precautions before, during, and after accouchement.