2. Those who have been infected by hands or instruments during their confinement, and are brought into the hospital twelve or twenty-four hours afterward Levitra 20mg Bayer Vital — that is, before the appearance of septiesemia. This class of cases would include abortions with retained placenta, repeated and maladroit applications of the forceps, attempts at Levitra 20mg Bayer Vital version, etc. 3. Those cases in which septicemia is already present when the patients Levitra 20mg Bayer Vital are Levitra 20mg Bayer Vital received. In the first class the mortality can and ought to be zero ; in the other two it may be considerable, but is susceptible of some im- provement. The conditions for antiseptic treatment of the wounds which follow partiu'ition are very unfavorable. There are not only open wounds, but wounds and granulations which are infected with micro-organisms. In addition, a discharge which consists of decompos- ing or decomposed matter in the form of the lochia is flowing over them; hence antiseptic treatment can be only relative. Such treatment has heretofore consisted in the intermittent use of vaginal or uterine injections, of solutions of carbolic acid which may be as strong as one to twenty, or of biniodide of mercury of a strength not exceeding one to two thousand. Though these injections are in many cases extremely eflScient, their beneficial influence is less decided or does not exist at all in cases in which the system is already extensively invaded by micro- organisms, Levitra 20mg Bayer Vital the alleged reason being that their influence is only tem- porary. Too little of the carbolic acid or of the mercury in solution in the injections is absorbed to counteract the influence of the poisonous germs. The theory which the author propounds in such cases is as follows : Admitting that the kidneys and liver are in a fair condition of health, it appears that the difference in the gravity of puerperal disor- ders depends simply upon the greater or less quantity of poisonous ma- terial which is absorbed by the utero-vaginal wound, upon the degree of rapidity with which the doses which are absorbed succeed one another. Levitra 20mg Bayer Vital On this theory, if one acts energetically upon the traumatic Levitra 20mg Bayer Vital fever, which is the first Levitra 20mg Bayer Vital degree of infection, as soon as it makes its appearance, one will prevent septicjemia. If one acts sufficiently early and with sufll- cient energy upon the septic endometritis which ensues, one can prevent or arrest lymphangitis, peritonitis, and phlebitis. The important point in all cases is the amount, together with the more or less profound de- gree of penetration, of the septic agent. The conclusion from the fore- going propositions is that continuous irrigation of the utero-vaginal canal would accomplish a means of treatment which is both antiseptic and rational. This conclusion has been reached, notwithstanding the dis- credit into which this method fell after a brief trial, and the objections that it is impracticable, useless, and even dangerous. The published experience of Sneguireti', of Moscow, shows that the method is both practicable and safe. Complicated apparatus for carrying out the method is not necessary, and the author's experience warrants him in recommending it. leto Jnbtiitions, etc. AN EMERGENCY OPERATING BAG. By W. S. Tremaine, Levitra 20mg Bayer Vital M. D., SORGEON, n. S. AKMT. For some time it has seemed to me desirable that surgeons, who aie liable Levitra 20mg Bayer Vital to be suddenly called by day or night, should have an operating case, in convenient and portable form, supplied with all the iustrumeuts likely to be used in any operation of emergency, such Levitra 20mg Bayer Vital as amputation, kelotomy, tracheotomy, etc. ; and, moreover, in these days of antiseptic surgery, that the case in which the instruments are kept should have no absorbent material to become contaminated. Any ordinary traveling satchel can be fitted to contain the instru- ment case. The sample case, wliich was made by Messrs. George Tie- minu \ (. tNin Yoil i li \n m the accompan\mg cut. The in- struments are cout imed m a bo\ made of sprmg brass, nickel-plated or gilt, and fitted with metal racks. The box contams the following in- struments, some of which are new in pattern : One amputating knife, 1 Sands's periosteum knife, 1 metacarpal saw, 1 Levitra 20mg Bayer Vital finger knife, 1 Cooper's hernia knife, 1 probe-pointed bistoury, 1 aneu- rysm needle, 1 tenaculum, 1 large scalpel, 3 smaller scalpels, 1 curved bistoury, 1 sharp-pointed tenotoiin', 1 blunt tenotome, 1 eye spud, 6 haemostatic forceps, 1 bull-dog forceps, 1 Olds's scissors forceps, 2 Tre- maine's hare-lip clamps, 1 Tremaine's ratchet trephine, 1 small aspi- rator, 1 sequestrum forceps, 1 bone forceps, 1 needle forceps, 1 pair Tremaine's retractors, 1 Tremaine's saw (2 blades), 1 elevator, Levitra 20mg Bayer Vital 1 trache- otomy tube. 1 director, 3 silk or catgut spool cases (Tremame's), 1 needle case, 1 long uterine scissors, 2 probes. A still more compact and less expensive case can be made by leav- ing out some of the instruments which are duplicated in the pocket case. The spool cases of hard rubber will especially commend themselves, as also the hare-lip champs. The interior of the bag is fitted with metal-cased bottles to contain chloroform, antiseptic solutions, catgut ligature^ etc., at the pleasure and preference of the surgeon. It also gives plenty of room for addi- tional non-cutting instruments, with a package of antiseptic gauze, sponges, Esmareh's bandage, etc. 84 31ISGELLANT. fN. Y. Mkd. Jooe. After many years of experience of the needs of the surgeon in mili- tary, civil, and railroad practice, I believe this case will fill every need of the operating surgeon in any emergency. As such, I present it to the profession. Of course the instruments can be varied to suit the needs of the surgeon. To military surgeons accompanying detachments of recruits or scout- ing parties, to " railroad " surgeons called suddenly to an accident, the idea of having all needed instruments and dressings always ready in compact and portalile form will especially commend itself. To the operating surgeon, who knows beforehand what operation he is about to perform, the additional instruments, such as lithotomy staff, ovariotomy trocar, additional haimostatic forceps, etc., can easily be se- lected from his cases and put into the upper part of the bag. 449 Washington Street, Buffalo, N. Y. i s r « 1 1 a It D .