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and West Indian ancestry, married. Her family history includ- ed cases of leprosy in the West Indian ancestors, and a case of epithelioma of the tongue in a brother, who was operated upon by me at the age of seventeen, and one third of his tongue removed. I had also removed an adenoma Generic Levitra Online Uk of the breast from the patient herself a few months prior to her marriage. She had likewise been treated by me for synovitis of the hip joint, wearing a splint for a number of months with satisfactory results. On August 21, 1885. I was called to treat Mrs. M. for gen- eral weakness, loss of appetite, and inability to sleep. I found her in bed, with a feeble, somewhat irregular pulse, slightly coated tongue, and nervous to a degree that every sudden sound made her start and flush. The patient informed me that she was pregnant, and imputed her symjjtoms to that condition. She had menstruated regu- larly on May 21st, and during the ensuing month she had suf- fered from constant nausea. For one week, beginning June 20th, she had suti't-red from a continuous and somew hat copious flow, not attended with the pain usually accompanying her menses. She dated her pregnancy from May because of nau- sea, and attributed the "flow" in June, and succeeding slighter loss of blood on July 16tb and July 21st, to threatened miscar- riage. Examination of the abdomen showed no enlargement of the uterus. The breasts were somewhat large Generic Levitra Online Uk and tender, but sliowed no areola. By combined vaginal and abdominal ma- nipulation the uterus was shown to be larger than normal, but not corresponding in size to that of a three-months pregnancy. A probe passed with ease into the cavity of the uterus, and seemed to encounter nothing in the interior of the organ. I disappointed Mrs. M. by assuring her that there was no pregnancy, but a peculiar condition of the pelvic organs which was the probable cause of her ill-health. I could at this time discover nothing extraordinary in the region of the Generic Levitra Online Uk ovaries, and 1 concluded it to be possible that the products of a conception had passed away with a metrorrhagia, and that a state of sub- involution of the uterus existed. On August 23d a sharp hfemorrhage occurred. I was able to check it with the application of cold, but it had continued with some activity for four hours in all. August S6th. — Slight bsemorrhages daily. The patient is kept in a recumbent ]iosition, and given fluid extract of vibur- num prunifolium to allay uterine excitement. 29tfi. — More considerable Ijaamorrhage. September Sd, 4(h, and 7th, I saw the patient. There was noticeable increase in the size of the abdomen during last week, perhaps made apparent by the patient's loss of flesh generally. Examinations that would excite hfemorrhage have been avoided since the first thorough investigation. The patient's desire to be pregnant led her to use the abdominal muscles to stimulate the increase in the size of the abdomen. There was some mam- mary secretion. 14t7i. — A sharp hfemorrhage occurred, which was again checked by cold applications. An examination now showed tenderness to the left of and in line with the umbilicus. The uterus had increased in size. The loss of blood had affected the patient so much that the propriety of producing an abortion, if a pregnancy now existed, was considered. She begged for de- lay, and, as baamorrbage was cbefked, she was Generic Levitra Online Uk kept in the re- cumbent posture, and her Generic Levitra Online Uk request for delay complied with. Up to Generic Levitra Online Uk September 22d a slight show was found daily, but from this time to October 13th no blood was seen, the patient in the mean time maintaining her horizontal position. On the evening of October 13th the patient suffered for some hours from sharp, slight pains in the abdomen, and about 8.30 p. M. she was seized by intense intermittent pains. She was drawn up during the paroxysms with her knees to her chin and beat her head on the pillows. Each paroxysm lasted about sixty seconds, and was followed by an intermis-ion Generic Levitra Online Uk of half the duration. Twenty minims of Magendie's solution of morphine were administered hypodermically, followed by thirty grains of chloral hydrate, and, as the pains continued, though somewhat modified in degree, the Generic Levitra Online Uk opiate Generic Levitra Online Uk was repeated in half an hour. In fifteen minutes after the second hypodermic the pains Generic Levitra Online Uk had ceased, and, after watching the patient for an hour, I left, with directions to the attendant to repeat the morphine every second hour if the pains returned, and the chloral on the alternate Generic Levitra Online Uk hours. I was summcmed again at 4 a. m., October 14th, the message being that the pains were as bad as before. I arrived at the house to find the patient sleeping, she having had in my absence two ten-minim doses of the morphine solution and one fifteen-grain dose of chloral hydrate. During this day and night sufilcient chloral was given to induce light sleep. On October 18tb the soreness of the abdomen from the mus- cular contractions had so far abated as to admit of a thorough examination. The fundus of the uterus was now found as high as the um- bilicus, and to the left, on the same line, was found an oblong tumor somewhat larger than the unimpregnated uterus. This was very tender, and continued pressure on it produced pain running up the back. Through the vagina the tumor was felt as if it might be the fundus of a flexed uterus. Through the rectum a tumor could be felt in the line of the left Fallopian Generic Levitra Online Uk tube and connected with the uterus, but the con- nection was a neck of less diameter than the tumor itself. This tumor gave great pain on pressure. The patient was seen on October 23d by Dr. Charles McBur- ney, who made out the conditions as described and verified the FAHSHAM: WHEN TO OPERATE IN THE NASAL PASSAGES. [N. Y. Mel. Jouk.^ diagnosis of extra-iiterine fetation ; and, on October 25tl), Dr. J. B. Hunter, iu consultation, agreed in the location and rela- tions of the tumor. With Dr. Hunter's indorsement, I applied, on October 26th, a current of faradaic electricity. The application of the elec- tricity was made to the tumor by the negative pole in the rectum, and the positive pole applied externally to the abdomen over the tumor. The current was regulated by the patient's sen.iation, and continued for ten minutes as strong as could be borne without positive pain. The battery was used again on the 27th, 28tli, and 29th. On the 30th the application was Generic Levitra Online Uk omitted on account of irritation of the anus from passing the electrode. On the 29th it was thought there was diminution in the size of the tumor, and on the 3l8t the diminution was in degree about Generic Levitra Online Uk one third of the