231 In children I apply a square of absorbent cottoi) over the whole penis and hold in place with a diaper the first twelve hours to prevent the child from disturbing the parts. In some diseased conditions of the glans or fore- skin it is advisable to do a preliminary operation which consists in slitting up Levitra Buying Online the prepuce over a grooved director, using cocaine as an an.Tsthetic. ^luch of the attendant pain of this operation is ob- viated bv keeping all the parts immersed in hot boric acid solution during its performance. This only exposes the parts for cleansing. When they arc healed, the flaps should be amputated by cutting of and suturing the edges as in the regular operation. The steps of the procedure then are: i. Cleanse. 2. Make a slight cut as a guide. 3. Draw forward and cut ofT. 4. Slit up the hood and trim off the flaps. 5. Insert the four sutures. 6. Tie in the gauze. In an uncomplicated case the whole opera- tion can easily be done in three minutes time. (To be conchtdrd.) Carrcs|)oiilifiice. LETTER FROM LOXDO.X. Opcialioyis for Cancer of the Rectum. — Lead in Soda Water. LoxDOX, January 17, Levitra Buying Online i<)ii. At a recent meeting of the Surgical Section of the Royal Societj' of Medicine, a discussion was held on cancer of the rectum. Mr. F. Swinford Evans entered a protest against the performance of an unnecessarily severe operation attended with a heavy mortality for cases of cancer attended with but little risk to life and which, Levitra Buying Online moreover, entailed no crippling of the patient. .Ml forms of treatment other than operative, whether Levitra Buying Online by radium, x Levitra Buying Online rays, high frequency currents, or trypsin and other digestive ferments, had proved unavailing. Now- adays the position of the growth — namely, its dis- tance from the anus — was no bar to extirpation. The only real bar to a successful operation was the fact that the growth was no longer confined to the bowel, but had become adherent to neighboring parts, while the lymphatics were infected, .-\nother condition which quite barred any attempt at re- moval was metastasis in the liver, often not dis- covered until the Levitra Buying Online abdomen had been opened either for exploration of the growth or for the i)urpose of forming an Levitra Buying Online artificial anus. In considering the best method to employ for removing the disease, due regard must be paid to the immediate mortality of any given operation, the risk of recurrence, and the amount of cripjiling, if any, likely to follow the operation. Mr. Ernest Miles had advocated a very extensive proceeding, which he called the radical abdominoperineal operation, for all malignant growths of the rectum Levitra Buying Online and colon. That operation consisted in the formation of an Levitra Buying Online iliac anus with the entire removal of the rest of the sigmoifl colon, the rectum with the soft parts adjacent thereto, and the anus. .After fifty-eight operations of this na- ture there had been fifty-four recurrences. For the last ten or twelve years Mr. Edwards had aban- doned the old perineal operation except for cases of epithelioma of the anus, and in the majority of cases had performed the extirpation by the sacral or coccygeal route. He had performed this opera- tion eighty-one times with four deaths. There was recurrence in twenty-two cases. Cases of cancer of the sigmoid colon were very Levitra Buying Online favorable ones for op- Levitra Buying Online eration by the abdominal route with end to end union imless obstruction was present, when a tem- porar}- colotomy should be Levitra Buying Online the rule. In the Levitra Buying Online face of his own results he could not agree with those surgeons who advocated a combined operation for all cases of rectal carcinoma any more than he agreed with those who for a Levitra Buying Online small and limited can- cer of the breast would remove all but the ribs and thus cripple the patient for life. Mr. W. Harrison Cripps said he agreed with Mr. Edwards. The class of cases that he considered suitable for removal of the cancer was one in which the growth was still confined to the rectum and had not extended beyond ; to discover if the growth was confined in that manner it was necessary to find Levitra Buying Online out by feeling whether it was fixed or not. If it was not fixed, the disease could be removed with ad- vantage to the patient. Mr. Cripps said it took him some time to learn when a growth was reinovable or not. He emphasized the importance of making an examination for rectal cancer under an anes- thetic. As regarded recurrence, in most of his cases, the cancer, when it recurred, was found in the tissue surrounding the part from which the growth had been removed. Concerning Levitra Buying Online the method of operation, he thought it was impossible to lay down precise rules. Turning to the question of the value of the operation, his view Levitra Buying Online was that if there was any doubt as to whether a growth should be removed or not the benefit of the doubt should be given for the removal of the tuinor. He believed a very large number of these patients with cancer of the rectum were curable if operated upon early, and appealed to practitioners to spend more time in studying the symptoms of the disease. Sir Frederick S. Eve said that, judged by the best clinical observation and by the percentage of permanent cure, there was no doubt in his mind that Kraske's operation had not been sufficiently thor- ough. In regard to cure, every surgeon was aware that a three year limit was far too small. There were plenty of cases of cancer in which recurrence occurred after ten years. He had seen a melanotic cancer recur after twenty years. It was clear that Kraske"s or the perineal method of operation could not be trusted to obtain a permanent cure, and he had come to the conclusion that the operation which filled the most important position at a low mortality risk was the abdominoperineal operation combined with a permanent colostomy.