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covery seems perfect, leave the body in a condition of great susceptibility to the motilium pharmacy action of further morbific agents. A classification was also made order motilium of the various morbid processes which are found associated with each other. In discussing this paper. Dr. Charles W. Dennison, of Denver, noted the common association of fibrosis with tuberculosis. He believes that those masses of new de- ])osit which we call •' tubercle " are in reality the " prison vault" of the bacilli. The latter always signifies or in- duces an increase of connective tissue and cell-prolifera- tion. Tuberculin has a contractile influence on these tuberculous masses, and not a softening influence unless July I, 1893] MEDICAL RECORD. 23 used in such large doses as to cause necrosis, a thing which he studiously avoided. Election of Officers. — The following officers of the Section were elected for the coming year : Chainiian, Dr. H. A. Hare, of Philadelphia; Secretary, Dr. W. H. Washburne, of Milwaukee ; Executive Com- mittee, Drs. I. E. Atkinson, of Philadelphia, N. S. Davis, Jr., of Chicago, and C. G. Stockton, of Buffalo. During the session the following papers were read by title : " Some Thoughts on the Differential Diagnosis of Chest Disease," by Dr. J. G. Truax, of New York City ; "The Treatment of Pyrexia," by Dr. Jas. Witherspoon, of Columbia, Tenn. ; "The New Chemistry of the Stomach as a Means of Diagnosis and a Guide to Thera- peutics, based upon the Results of One Thousand Analy- ses of Stomach Fluids," by Dr. J. H. Kellogg, of Battle Creek, Mich.; "The Value of Belladonna and Strych- nine purchase motilium in Conditions of Circulatory Depression," by Dr. H. A. Hare, of Philadelphia, Pa. ; " The Management of Hysteria by the General Practitioner," by Dr. W. F. Rochelle, of Jackson, Tenn. ; "Hematoma Auris," by Dr. H. A. Matzinger, of Buffalo, N. Y. ; " Aneurisms considered Medically rather than Surgically," by Dr. O. C. McNary, of Leavenworth, Kan. ; " Insanity of Physiological Epochs," by Dr. A. W. Hurd, of Buffalo, N. Y. ; " A Case of Cancer en Cuirafse, with Report of an Autopsy and Illustrations," by Dr. J. B. Marvin, of Louisville, Ky. ; " The Cancer Parasite from a Micro- technical Stand-point," by Dr. motilium generic A. P. Ohlmacher, of Chicago, 111.; "Studies in Immunity," by Dr. D. N. Kinsman, of Columbus, O. ; "A Preliminary Report on an Inquiry as to the Frequency of a Form of Kidney Degeneration in which Albuminuria may not be regarded as a Symptom," by Dr. D. D. Stewart, of Philadelphia, Pa.; "The Origin and Clinical Significance of Uric Acid," by Dr. Victor C. Vaughan, of Ann Arbor, Mich. ; " Experiments with Trional as a Hypnotic," by Dr. W. C. Krauss, of Buffalo, N. Y. ; "Typhoid I-'ever," by Dr. M. J. Crouch, of LTnion, Ky. ; "A Case of Fever of Un- determined Type," by Dr. Starling Loving, of Colum- bus, O. ; " The Treatment of Diabetes Mellitus by Jam- bul (Sygygium Jambolaneum)," by Dr. James Tyson, of Philadelphia, Pa. ; " Heat in the Treatment of Dis- ease," by Dr. Chas. H. Shephard, of Brooklyn, N. Y. SECTION ON OBSTETRICS domperidone motilium AND DISEASES OF WOMEN. First Day, Tuesday, June 6th. The Section limited the number of papers to be read to forty, which had compelled the Chairman to reject some from very able men. Some General cheap motilium References to Obstetrical and Gyneco- logical Advancement was the subject of the address by the Chairman, Dr. John Mh.ton Duff, of Pittsburg. He thought the Section should publish a volume of proceed- ings, more especially in order to put on permanent rec- ord the discussions. The specialist should be an evolu- tion from the general practitioner. Too many of our recruits had not had sufficient experience to be taken into the ranks of the Section. -Sufficient instruction was not given in obstetrics and diseases of women in teaching in- stitutions. He believed it was no e.xaggeration to say that fifty per cent, of graduates had never witnessed a labor nor introduced a speculum. We should demand of teaching institutions that they appoint professors for their broad ability to teach, and not because of their ability to purchase position. Many young men showed a willing- ness to do cceliotomy who were unable to repair a vesico- vaginal fistula or determine the diameters of the pelvis. The general and special medical journals were steadily improving in quality ; and Dr. Duff" said he hesitated, through fear of showing his inferiority, to make any criti- cism in this direction. He had heard, however, motilium uk an ex- pression of opinion on the part of some that there ought to be more leading articles from the editors. Hysterectomy, he thought, had been shown by statis-' ticsto be a justifiable procedure in cancer of the uterus. Fully ninety per cent, of cases coming to the gynecolo- gist were, however, inoperative ; and this suggested the responsibility of early diagnosis by the general practi- tioner. Referring to operations on the insane, Dr. Duff said it was absurd for editors or others to suggest that gynecol- ogists seriously considered removing the appendages for all cases of insanity. But insanity was not a panacea for pain, and insane women should not be denied the benefit of surgery for disease which was given her well sisters. It should motilium price be regarded as a crime against society at the pres- ent time for those mentally unsound to propagate the species. motilium 10 The copulative act should be performed only in the best physical and mental condition of both father and mother. The field opened up by the revival of motilium domperidone 10mg pubectomy was alluded to. The rate of mortality from puerperal sepsis was now lower in institutions than in private practice — a suggestive lesson to general practitioners and obste- tricians. Exploratory operations were not without dan- ger, and should be undertaken with precaution. The Causes of Diseases ofWomen. — Dk. Charles P. Noble, of Philadelphia, read a paper on this subject, treating of it in a systematic way, dividing the causes as follows : I, Imperfect development of the sexual organs ; 2, gonorrhcea ; 3, pelvic inflammation following child- birth ; 4, lacerations due to childbirth; 5, miscellaneous causes — such as constipation, erroneous methods of liv- ing, bad dress. Among the causes of imperfect develop- ment one could recognize forcing at school, want of bodily exercise, work motilium online in factories, etc. Absence of men- struation or .scanty flow was seen in some corpulent women ; but he was unable to say what was the relation- ship. This class of patients were apt to show imperfect de- velopment of the general system, to have chorea, etc. Exercise in the open air, iron, arsenic, tonics, were buy motilium online indi- cated. Dr. Howard A. Kelly, of Baltimore, had given this subject of preventive disease in women much thought, and believed a book could well be written upon it. In many instances the cause of imperfect development of the geni- tals and of the general system was to be traced back of the child to the poorly nourished and ill condition of the mother before and after conception. Gonorrhoea in children was not an uncommon first cause of disease in women. Tuberculosis had been found as the cause in one out of five of his operative cases of pelvic inflamma- tion. Dr. E. p. Davis, of Philadelphia, thought neuralgias during the pregnant state, especially of the sciatic type, were often avoidable by early attention to constipation and general habit. Dr. Joseph Price had found vaginitis in infancy not an uncommon cause. Gonorrhcea was now a frequent source of pelvic inflammation, while it was unusual before the wide development of the railroad system. Referring to the favorable statistics of some lying-in institutions, regarding the mortality from puerperal sepsis, he said they did include the mortality from other motilium imodium causes. In an insti- tution with which he was connected, not a child had been lost among 1,300 births. Dr. Reed, of Ohio, had found the motilium tablets usual cause of one daughter only in a family of several failing to menstruate at the usual time to be due to imperfect development. The doctor erred in telling the mother it would be all right after marriage ; for unless measures were taken for better development, the marriage would be sterile — the patient would suffer. Dr. Carstens, of Detroit, did not believe gonorrhoea so common a cause of pelvic inflammation. The more frequent cause was the vicious habit of women producing abortion with dirty darning-needles, etc. Dr. Hoff, of Ohio, had practised nearly half a motilium tablets 10mg century, and had not seen half a dozen cases of gonorrhoea in daughters. Perhaps it was not so common as it had been represented in Philadelphia. 24 MEDICAL RECORD. [July I, 1893 Dr. Hoffman, of Philadelphia, did not belie\e the vaginitis of children was often of gonorrhoeal type. He had often found tuberculosis in the pelvis, and motilium buy beliesed it frequently followed pus collections, if it was not caused thereby. Dr. Sell, motilium mg of New York, had observed gonorrhcea in children, and even in a minister's family from supposed moral country districts ; he would not mention the State. Dr. McMurtrv, of Louisville, thought some doctors were yet guilty of causing much disease among women by motilium canada using caustics to the cervix, etc. Puerperal Hemorrhage. — Dr. Tame* P. Kerr, of Pitts- burg, read the paper. The importance assumed by puer- peral hemorrhage among medical and surgical subjects was due to its frequency, and the fact that, unless it was met by speedy and efficient remedies, it would end fatally. Practitioners were too apt to consider all cases of labor as normal, and not to make any preparations for this acci- dent. One motilium cost should obtain all the information possible re- garding whether there was a family history of bleeders, of individual menstrual peculiarity, hemorrhage at previous confinements, etc. The author mentioned causes, which, naturally, were various, then related one personal experience, and passed to the general subject of treatment. His case was that of a woman, to whom he was called for the first time after the beginning of hemorrhage. She gave a good history, having had no trouble at previous confinements, but her feet were swollen and albuminuria was not improbable. Without warning, a sudden gush of blood took place, and when he arrived she was in collapse and died within an hour from the commencement of the hemorrhage. The treatment had been podalic version and delivery, general and uterine stimulants, and uterine manipulations. The uterus did not contract in spite of the use of ergot, hot water, ice, vinegar, etc. The exact cause of the hemor- rhage was not learned. Severe post-partum hemorrhage was generally a preventable accident by skilful manage- ment of the third stage of labor. Attention should be given to securing contraction of the uterus by carefully following the organ down with the hand when the child was expelled. If the uterus were soft and flabby, give a preparation of ergot. Misrachi claimed that caffeine acted more readily than ergotine, especially if the patient had lost blood. If the patients were known to be bleeders, J. M. Duff gave strychnine, Jj to 'i gr., three times daily for about two months before term. Bossi recom- mended hydrastis canadensis. Murray advocated plugging

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