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[New York Medical Journal. to believe that multiple abscesses could subside with this conservative treatment. Incomplete surgical work was also responsible for an immense amount of suffering. It would be unnecessary to discuss the technical details Order Generic Levitra of this condition, because each case was a law unto itself and the surgeon Order Generic Levitra must work out the individual problem. The question of drain- age was highly important. The intestants were lifted out of the cul-de-sac and a gauze roll inserted, the end being brought out through a thin rubber tube. Conclusions were that many cases might recover without operation ; ninety-eight per cent, tended to become quiescent. Operative work should not be undertaken when in the acute stage ; but, when undertaken, should be radical Order Generic Levitra in the ex- Order Generic Levitra tieme. Rectal Surgery for Pelvic Abscess. — Dr. Harry P. Ritchie, of St. f'aul, Minn., made this presen- tation. In certain cases of peritonitis where vag- inal section was unsuitable, this operative route was very efficient. Often after pelvic abscess a sec- ondary operation became imperative in order to es- tablish drainage, and, in these cases, so disturbing to the patient and to the surgeon, it was often far easier to drain by the rectal route than to do an- other abdominal operation. The mass was often clearly felt on the posterior wall, and puncture only obtained a very small amount of pus. If the pres- sure could be removed by this simple route, the pa- tient could be Order Generic Levitra very much improved. This method was by no means a last resort operation ; it hlled a very useful role as a secondary operation in com- plicated cases. In the female there was no partic- ular advantage over vaginal section, so that this operation was advocated for male patients. If puncture of the bladder occurred, it should be im- mediately repaired. The points of operation were dilatation of the sphincter, incision, and the in- sertion of the rubber tube. Repeated observations were necessary, as changes might occur in a few hours. In certain specially indicated cases this operation would solve the problem. Treatment of Incisional Ventral Hernia by the Transplantation of Fascia Lata. — Dr. Willard Bartlett, of St. Louis, said : These lesions with the ring and sac were due to stretching and atony of the muscular Order Generic Levitra coats of the abdomen, due to nerve section at previous laparotomies. Ninety-one cases were analyzed, in twenty-four of which were his own. There was known cure in sixty-one cases and six failures, two of the latter being due to im- plant of wire filigree, and four to overlapping. This procedure was only indicated where the Order Generic Levitra tissue was not too thin to hold in place. Among Order Generic Levitra etiological factors were : post operative vomiting in seventy- five per cent. ; meteorism in seventy-three ; drainage in eighty-six per cent. ; wound suppuration in sev- enty-five per cent. ; constipation in sixty-six per cent. ; dysuria in twenty-five per cent. ; gain in weight in eighty-six per cent. ; muscle strain in thirty-five per cent. ; pregnancy in eight per cent. ; herniotomy in thirty per cent. A post operative gain in weight, an important factor, meant increased intrabdominal pressure and vifeakening of the wall. Order Generic Levitra This combination of factors resulted in hernia. Hernial tendency also seemed to play a strong role in producing this lesion. Repair to the damage in the wall, as well as treatment for increase of pres- sure must be instituted. Attention was directed to cardiac and respiratory conditions ; to weight re- duction ; to constipation and urinary retention ; to pievention of vomiting and meteorism. Tight closure of the abdomen often caused a rise in blood pressure and this was to be avoided. No one opera- tion was indicated, but in the majority a trans- plantation of the fascial flapwould be valuable, either by itself, or superimposed on some other method. A technic was illustrated by which this was done Order Generic Levitra by the one operator, at one operation. Methods of treatment were by reconstruction of Order Generic Levitra the wall ; by flap inversion ; by filigree wire work only in emer- gency cases ; finally by free fascia transplantation. The Use of the Rubber Band in Abdominal Surgery. — Dr. John Order Generic Levitra W. Keefe, of Providence, R. 1., presented his second communication on this subject as he felt that the advantages of this method justified emphasis. These included: less adhesions, less shock, less hemorrhage, and less danger of leav- ing a foreign body in the wound, the wound itself healing more easily and the after symptoms of dis- comfort markedly decreased. Any device which made the operation safer and more comfortable for the patient should be welcomed. The leaving of gauze drains and sponges in a wound by the sur- geon seemed unpardonable to the layman. The multitude of devices by surgeons for preventing such accidents, showed that none were entirely suc- cessful. According to the work of Yandall Flen- derson, carbondioxid loss was productive of acapnea. The use of the rubber Order Generic Levitra roll eliminated this feature. Sterilizing by boiling was easy. Impermeability to air and moisture was effected. The prevention of shock and adhesions should make this appliance worth the consideration of the profession. Dr. Goldspohn, of Chicago, said that he could speak very favorably about its use. For the past two years he had used this device with great success, and it had made a great diliference in the comfort of the Order Generic Levitra patients by the avoidance of gas, tympanites and shock. Pituitrin had also been used during the same period, so that it was hard to say which of the two measures had the greater effect. Paravertebral Anesthesia : Report of One Hun- dred Cases. — Dr. N. R. Mason and Dr. F. C. W. KoNKAD, of Boston, considered the form of an- esthesia, combined with scopolamine-morphine semi- narcosis, the Order Generic Levitra ideal one when reduction of surgical shock Order Generic Levitra was of paramount importance in those cases classed as poor surgical risks, or those so handi- capped as to be practically Order Generic Levitra inoperable. Twenty-six such cases were analyzed. They included carcinoma of the cervix during pregnancy; malnutrition, ar- teriosclerosis and senility in an extreme postopera- tive ventral hernia ; toxemia of pregnancy Order Generic Levitra with termination of the pregnancy after the pulse had risen above 140 per minute ; failing cardiac com- pensation in pregnancy ; blood pressure of 240 milli- meters with fibroids of the uterus ; diabetes ; ether