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lie believed that the cotton pessary would hold better. Dr. Levitra Purchase Uk Emery said Levitra Purchase Uk that the pessary in practice did its work well. It certainly acted well according to his experience. The President asked if Dr. Emery could tell why it re- mained in place? Dr. Emery rejilied that in large flabby vaginai it might not July 17, lSb6. PROCEEDINGS OF SOCIETIES. retain its place; but in a vagina not large or flabby there was no danger that the pessary would not be retained. The firra tissues of the parts would keep it in its place. It was so light that it did not sink down by its own weight. The ovaries rested upon the arms of the pessary very readily, and by its use the patient was given perfect relief almost instantly Levitra Purchase Uk after it was put in place. Dr. C. N. Dixox -Jones said that Dr. Chase had gone over the subject of his paper very fully, but it seemed to him that he had not given Levitra Purchase Uk sutHeient importance to the different forms of circum- uterine inflammation complicating displacements. He had almost come to believe that displacement of the uterus, out of the so-called normal position, rarely gave rise to any trouble if there was not inflammation of some form, either around the uterus itself, the Fallopian tube, or the ovary. The great influ- ence of disease of the Fallopian Levitra Purchase Uk tube in the production of uter- ine displacements should not be forgotten. The peritonitis in many of these cases originated in a salpingitis. In the treat- ment of these complicated cases he could testify to the value of the use of the cotton tampon. He thought it improved the pelvic circulation, relieved engorgement, and softened out in- duration whether due to cellulitic or peritonitic inflammation. In connection with glycerin, he had used Levitra Purchase Uk boro-glyceride instead of carbolic acid, as the latter was objectionable to some Levitra Purchase Uk patients on account of the odor. In a certain proportion of cases, how- ever, the uterine displacement was due to disease and fixation Levitra Purchase Uk of the Levitra Purchase Uk tube and ovary, the uterus being drawn out of position by the contraction of bands of adhesions, the tubes often forming strong fibrous cords adherent to the broad ligament and serving to fix the uterus in its abnormal position. In these cases, not only replacement, but even palliation of the symp- toms, without an operation, was impossible. The uterus was ■often enlarged and tender, pessaries were either unbearable or useless, and all local Levitra Purchase Uk measures after prolonged treatment proved frnitless. In such cases removal of Levitra Purchase Uk the uterine appendages, thereby causing atrophy of the uterus, afibrded the only hope of a cure. He related the history of a case, in which he had recently operated, illustrating this condition. For a period of three years the Levitra Purchase Uk patient had wandered from one doctor to an- other without obtaining relief. Examination showed signs of extensive pelvic peritonitis, and the uterus was retroflexed and retroverted and held by hands of adhesions. The tube on each side could be made out as enlarged and adherent. As her con- dition was rapidly becoming worse, she readily consented to an operation. The principal adhesions were found to surround the tubes an*l ovaries, after the removal of which the uterus be- came quite free. Dr. Chase said that the point made by Dr. Jones was im- portant. In fact, he thought that there could be no question whatever that pelvic cellulitis and pelvic peritomitis were the conditions which had given more work to the physician than any other single condition of the female pelvic cavity, if cer- vical metritis was excepted. He believed that it was only dur- ing the last few years that the significance of these conditions had been fully recognized. Dr. Emmet in his late Levitra Purchase Uk work had •dwelt particularly on the close relation which Levitra Purchase Uk pelvic cellulitis bore to the Levitra Purchase Uk various forms of uterine disease. If the methods of exploration were adopted which he (Dr. Chase) had recom- mended in his paper, especially in cases where displacements were backward, where the utero-sacral and broad ligaments were involved, errors Levitra Purchase Uk both in diagnosis and in treatment would be less frequent. The same might Levitra Purchase Uk also be said concerning procidentia. The subject of the relations of pelvic cellulitis and peritonitis to various forms of pelvic disease was a broad one, and could not be exhausted in the brief discussion of an evening. Meeting of May 18, 1SS6. The President, Dr. George R. Fowlek, in the Chair ; Dr. C. E. De La Vergne, Secretary. Wiring of the Patella, and Incision of the ftuadriceps Extensor after Macewen's Method. — Tlie President read the following account of a case : On September 24th I was requested by Dr. Quinn to visit John Quinn, aged seventeen, with him concerning a fracture of the patella which he bad sufl:ered the day previously. The fracture was of the ordinary transverse variety, the lower frag- ment being somewhat smaller than the upper, and was probably due to muscular action. A space of about two inches separated the fragments. The case was treated with the plaster-of-Paris splint, with a large fenestra at the site of the anterior region of the knee joint. The upper fragment was held in position, after coaptation, by means of a compress held in position with ad- hesive plaster. At the end of seven weeks the splint was re- moved. Ligamentous union was found to have taken place with a space of about half an inch between the fragments. Several weeks afterward the patient accidentally fell and stretched the ligamentous connection between the fragments to a length of about two inches and a half. Almost total loss of the power of locomotion followed this Levitra Purchase Uk accident. Attempts to approximate the fragments by means of an elastic bandage were made, and the latter was worn continuously for several mouths, but with no improvement. Walking was accomplished by a peculiar "sidliug" gait, in which the leg was kept extended. If fiesion occurred, the limb could not he brought into an ex- tended position except by rotating it and allowing the weight of the leg to assist in bringing it into line with the tliigh. In view of the young man's station in life and the necessity for greater usefulness of the limb in earning his living than was likely to result from the employment of any of the usual methods Levitra Purchase Uk of treatment at this stage of the case, I advised wir- ing of the fragments, and he entered the hospital for that pur- pose. On May -i, 1885, nearly eight months after the accident, the following operation was done, all antiseptic precautions being observed : A transverse incision was made over the an- terior aspect of the knee joint, and the ligamentous band of union dissected from between the fragments. By means of a fine saw, thin slices were removed from the opposing surfaces of the line of fracture. Levitra Purchase Uk A hole was drilled through the middle of each fragment, commencing about three fourths of an inch from the edge of the freshened surface and upon the anterior surface of the bone, and terminating at the point where its oartilage-covered, or posterior, surface joined the line of frac-