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them with silver-wire sutures ; also closed the perinieum. From the time the ether headache passed off there has been no return of the old constant misery, except an occasional attack of head- ache which could be readily accounted for. Within the next few months she gained fully thirty pounds in flesh and became rosy and strong. That the restoration of the perinaaura did little in accomplisliing this result is demonstrated, I think, by the fact that after the operation she was obliged to wear a pessary to overcome the slight amount of prolapsus before mentioned. Case IV. — ^Mrs. W., aged forty-one, first How Much Does Levitra Cost At Walgreens came under my care March 26, 1885. She has been married twenty-three years and has had four children, but no abortions. The last labor oc- curred eleven years ago. The first labor was hard and tedious; the others were normal. She has had slight leucorrhrea follow- ing the menstrual flow, frequent micturition with burning at times, and some bearing down. Locomotion causes pains in the pelvis, which pains seem to extend up the spine to her head. Her general health is very poor, she is excessively anremic, her bowels are constipated, and her appetite is poor. For years she has had to depend upon specially prepared foods, on account of inability to digest ordinary food. She can walk but very little. She has suffered from almost constant severe pain begiiming in the top of her head and extending down to the base of the skull and upper portion of the spine. She is very nervous, but not hysterical. She has been, in short, a complete invalid for the past fifteen years, but dates her sickness from her confine- ment, twenty-one years ago. She has been attended by two physicians, being cauterized freely for so-called " ulceration " of the cervix. Examination showed the uterus in position, except for a slight anteflexion of the fundus, and of normal depth. There was no very marked tenderness or hardness How Much Does Levitra Cost At Walgreens in the cellular tissue about the uterus or in the broad ligaments. There was an old, deep, double laceration of the cervix, which contained a number of enlarged Nabothian follicles and was generally hard and un- yielding to the How Much Does Levitra Cost At Walgreens touch. There was no tenderness on pressure in the cervix, except deep in the angles of the laceration, where slight pressure caused great suffering. The perinseum was slightly lacerated, but there was no rectocele. The patient was placed upon hot douches twice daily. The follicles in the cervix were punctured, and applications of iodine and glycerin pads followed up for one month, when I removed a very large amount of dense tissue from both angles and closed them with silver-wire sutures. The excavating process was carried to such an extent that one of the gentlemen assisting me remarked that it was a revelation to him that such a cavity could be made without serious haemorrhage. From the time of her getting up the improvement in Mrs. W.'s general condition was very marked. The headaches became less severe and less frequent. Her appetite and digestion improved steadily, and in a comparatively short time she was able to walk twelve city squares without great fatigue, and now doubles that distance. And all this improvement took place in spite of the greatest drawbacks, her husband becoming insane and dying in an asy- lum subsequent to the operation — circumstances calculated to test a nervous systefti to the utmost. Here, again, we have a woman whose surroundings were of the best, who had the most tender care, but whose local treatment was calculated to increase the deleterious effects of the original laceration, and who for fifteen years had steadily lost ground. Examination failed to show any factor which could account for the marked aniemia and apparently reflex neuroses, except this same " cicatricial plug," upon the removal of which the improvement was prompt and rapid. As there was still some tenderness in the angles in this case, a year after the first operation, I repeated it a few days ago, removing some bits of hard tissue that I had before left ; but it is too early to give the result of my second operation. My records would furnish How Much Does Levitra Cost At Walgreens me with many more How Much Does Levitra Cost At Walgreens cases in which there were present hard, iibrous masses in the angles of old lacerations and in which their removal was marked by relief of the same set of symptoms as in these cases Cited, yet, although I am personally thoroughly convinced of the part the cicatricial tissue played as an active irritant, there were, accompanying this one factor, too many other patho- logical conditions to allow one to demonstrate just what role the hard tissue filled. Still we have four cases in which the principal symptoms were decided irritation of the nerv- ous system, the so-called reflex neuroses, and anamiia. Thor- ough examination failed to reveal any abnormal local con- dition other than the mass of cicatricial tissue which, to 100 AGNEW AND WEBSTER: PAINFUL OLAUCOMA ABSOLUTUM. [N. Y. Mki>. Jouk., my mind, would serve to explain the symptoms. In every case the operation was done with great thoroughness, the removal of all the hard tissue in the angles being the first object (and this was How Much Does Levitra Cost At Walgreens accomplished in all except the case of Mrs. W., her whole cervix being hard and fibrous). In every case the relief to symptoms was prompt and marked, dating from the day of operation. My attention was first specially called to this subject while in the Woman's Hospital by a case in which Dr. Emmet operated for the third time for the relief of persist- ent nervous symptoms, and up to the time of my leaving the hospital the last operation appeared to be a success. Dur- ing the past four years I have studied this class of cases as closely as possible, and only to be each year more thor- oughly convinced of the important role which this hard- ened tissue plays when found in the angles of a lacerated cervix. I am not prepared to advance any new theory as to its mode of action, or, as the result of any personal investiga- tions, to corroborate any old theories, but I have tried, sim- ply by a system of exclusion, to demonstrate that, in some cases at least, certain conditions result from the presence of this tissue, and that relief follows its thoroiujh eradica- tion. If Dr. Emmet is correct in his estimate of the baneful influence How Much Does Levitra Cost At Walgreens of this cicatricial tissue, and at this writing I am fully convinced he is, we can not do better for our How Much Does Levitra Cost At Walgreens patients, for ourselves, and for gyn;ecology, than to follow his instruc- tions to the letter and remove all the cicatricial tissue from the angles before closing a lacerated cervix. A CASE OF PAINFUL (:^LAUCOMA ABSOLUTUM OF TRAUMATIC ORIGIN.