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cerned, did not cause more disturbance than Is 40mg Of Levitra Too Much silk. The CuAiRMAN asked how the ligature was passed under the peritonsBum. Dr. Lange replied: "Imagine both broad ligaments being Is 40mg Of Levitra Too Much tied, there exists on either side of the uterus close to the edge an opening through which the most median ligature of the broad ligament has been passed. Between these two openings the elastic ligature is passed, underneath the peritoneal cover- ing, first on the anterior, then on the posterior side of the uterus, and tied at the point of introduction." He had formerly used a thin leaden ring for securing the elastic ligature, which was tightly squeezed together; lately he had used a coarse silk ligature for the same purpose. In one of his cases the Is 40mg Of Levitra Too Much elastic ligature with lead ring had passed through the cervix, as men- tioned before. Dr. Gerster remarked that he w-ould like to bring up a prac- tical question which the general surgeon had frequently to meet, and that was in reference to the length of the incision into tlie abdominal cavity. He did not consider that the length of the incision materially increased the danger of the operation, but did not desire to enter into a discussion upon the subject, as his ex- perience had been comparatively small, but still he could speak from experience of the bad consequences of Is 40mg Of Levitra Too Much too small an incision. He had witnessed a number of ovariotomies in which enormous veins had been torn across during the efforts of extracting a large tumor through a small incision, the resulting hismorrhage being very severe, and the difficulty of finding the bleeding ves- sel being much increased, owing to the smallness of the primary incision, which ultimately had to be enlarged after all. He also cited one instance in which he had witnessed an extensive and fatal laceration of the intestines owing to forcible attempts at the extraction of a large tumor through a small incision. The case was in other respects a simple one and uncomplicated. Had a larger Is 40mg Of Levitra Too Much incision been made in Is 40mg Of Levitra Too Much the first place, he thought, the whole cf the tumor, together with the adherent gut, could have been taken out of the abdomen Is 40mg Of Levitra Too Much without the use of force, and the adhesions removed with ease; but, owing to the accidental rup- ture of the intestines and consequent shock, the patient died as the result of the operation. Did time permit he could recite several more similar cases. Dr. 0. K. Briddon thought that the statistics of the English ovariotomist. Sir Spencer Wells, relating to the mortality fol- lowing the long and short abdominal incisions, had exerted an unfavorable influence on the practice of American surgeons. The long incision had really nothing to do with any increase in the mortality, except that it was required in a more formidable class of operations, either as regarded the size of the tumor or the presence of adhesions. There were many and serious disad- vantages in using the short incision. Dr. Gerster thought that it was only a general surgical principle that he adhered to in this respect. Cancer of the Tongue. — Dr. Sands presented a specimen of a portion of the tongue removed from a man forty-seven years of age, on account of cancerous disease which had begun about a year ago. It extended from the tip of the tongue back- ward about two inches, involving mainly the right side, but, on removal, it was found to have extended deeper into the left side than Is 40mg Of Levitra Too Much was at first imagined. The' specimen was removed that day by Whitehead's method, the arteries being tied, however, instead of twisted. The speaker thought that the idea of ex- tensive haemorrhage in removal of the tongue was only a bug- bear. During the last three operations of this kind that he had performed the loss of blood had not exceeded two or three ounces. Dr. Gerster wished to put on record a case in which he had had serious difliculty on account of blood getting into the larynx. It was an operation involving the tongue and the floor of the right side of the mouth. The lingual arteries were tied and Whitehead's speculum was introduced into the mouth, and he then proceeded to operate in the usual manner. Hsem- orrhago was slight, but a serious difficulty occurred to the respi- ration by a clot of blood being drawn into the glottis. Alarm- ing asphyxia occurred and tracheotomy had to be performed rapidly ; this at once relieved the patient, and respiration was again established. The patient, however, died of acute exhaus- tion, due to mania, at a time when the wound was nearly healed. In another case, occurring shortly after the one first mentioned, he had performed preliminary tracheotomy, using the tampon cannula; and the facility with which the operation was carried on without any danger of asphyxia was very marked. Dr. Sands thought th.-it in these operations about the mouth partial anesthesia was better, as the patient then had the power and will to eject anything from the larynx should there be danger of asphyxia. The Chairman asked if cocaine was used by Dr. Sands, and how. Dr. Sands replied that he injected it along the gustatory nerve, the an»sthesia produced being very great, fifty minims of a four-per-cent. solution Is 40mg Of Levitra Too Much being used. Dr. Lange asked how many injections were made. Dr. Sands stated that six injections were made altogether. He thought the use of cocaine in these cases was of signal benefit. Dr. Briddon stated that he had nearly lost one patient of this class during the operation, and thought that Nussbaum's method of anesthetizing the patients was very good in these cases. 24 PROCEEDINGS OF SOCIETIES. [N. Y. Mkd. JofK., Wire Suture in Ununited Fracture of the Clavicle.— Dr. Mahkok presented a patient in whom lie hail iiseJ tlie wire sutures for an ununited fracture of the clavicle. The fracture had been of some months' standing, and in March last it came under Dr. Markoe's observation, when it was found the young man was suffering from an ununited fracture of the clavicle, being unable to raise the arm up to more than in line with the shoulder. The power of lifting with the injured arm was very greatly impaired'. On March 17th he was operated on, the fractured ends of the bone being sawn otf so as to present a fresh surface and clean section; these were then wired together with silver wire and dressed antiseptically, the result being an excellent union of the bones and perfect restoration of the func-