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the vagina during hemorrhage if the os were undilated, but the author feared hemorrhage would go on within the womb. When the uterus was empty it might be packed. Kocher, he said, recommended a method which was at least novel : invert the uterus, put a rubber band around the neck, remove the band after six hours, and replace the organ. If the circular artery were injured, it should be ligated. Plugging of the vagina was good treatment in hemorrhage from the cervix, the seat of carcinoma. Trans- fusion was useful as a palliative. Dr. Barker, of Philadelphia, had learned from motrin discontinued an ex- perience with one case that ice, hot water, and ergot were entirely inefficient in severe post-partum hemor- rhage, and their use led to waste of precious time. He would recommend the tampon. In slight hemorrhage the measures first named would effect control. He thought the number of cases seen by 800 milligram motrin one was in inverse ratio to his experience in midwifery. The youthful doc- tor was apt to be meddlesome through over-anxiety. Dr. E. p. Davis said it was very difficult for a serious hemorrhage from the uterus to continue while one kept one hand in the uterus and compressed from without with the other. In England they were again discussing com- pression of the abdominal aorta. Dr. Morehead, of Wisconsin, had saved a case, twenty years ago, by compressing the abdominal aorta with the hand in the uterus, re-enforced part of the time by the other hand pressing upon the uterus from without. .\n- other case was seen by him later, and treated successfully in the same manner. Dr. MoNrciOMERV, of Philadelphia, had found strych- nia excellent in persons showing tendency to hemor- rhage, and also in a case of hemorrhage until shock had passed. He doubted the practical value of compression of the abdominal aorta, especially with the hand in the uterus, as part of the blood-supply came from the ovarian arteries, which arose higher on the aorta. The benefit experienced in Dr. Morehead's cases was probably due to the presence of the hand in the uterus, just as it was in other cases to gauze. Second Day, Wednesday, June 7TH. The Routine Practice of Administering Ergot motrin products after the Third Stage of Labor.— Dr. T. Ridgwav Barker, of Philadelphia, read a paper in extra strength motrin which he advocated the routine practice of administering ergot after the third stage of labor in order to avoid hemorrhage and its ac- companying dangers. It had been objected that it caused more frequent contractions and suffering. While, the first two hours, the discomfort was somewhat increased, this was more than offset by the advantages. Its use in- sured the woman against possible uterine relaxation. It reduced the size of the uterus and contracted the blood- vessels in the walls. It closed the uterine sinuses. It reduced the area of the placental site and diminished the danger of infection. It shortened the duration of the after-pains. It hastened the physiological process of in- volution. The author preferred the administration ot ergotine in tablet form, one-fourth of a grain. He had never known its use to be productive of harm. Dr. Joseph Eastman, of Indianapolis, objected to the routine use of ergot, because it substituted tonic ( unnat- ural) for clonic (natural) uterine contractions. He was confident he had seen subinvolution of the uterus pro- duced by the routine use of ergot. Strychnia permitted of more nearly the physiological action of the uterus. Dr. T- Murphy, of motrin 100 mg Wilkesbarre, had found mistletoe stop hemorrhage where ergot had failed. Dr. Duff, the Chairman, had read a paper on the same subject at the last meeting, taking the opposite view and opposing the routine use of ergot. It caused abnormal to take the place of physiological uterine contraction in ordinary cases in which no interference was indicated. Nature should not be forced when she was doing her work normally. The obstetrician could usually tell when hemorrhage or trouble was threatened, and strychnia would often be found preferable to ergot. Dr. C. S. Bacon, of Chicago, had ceased the routine administration of ergot, because it had tended to dry up the milk secretion. Another objection was the uncer- motrin 18 tainty of its preparation. Eepeated Extra-uterine Pregnancy, with Report of a Case.— Dr. Geor<.e J. McKelway, of Philadelphia, read the paper. He advocated the removal of the ap- pendages on both .sides in all cases of tubal pregnancy on one side, because of the likelihood in such cases for sub- sequent pregnancy to be also extra-uterine, subjecting the patient to the attendant dangers and the necessity for submitting to a second operation. The case related was of this nature, and many others similar found in literature were cited. In at least one there was evidence of double pregnancy in the same tube on different occasions. Law- son Tait and Bland Sutton claimed that many cases, heretofore regarded as hsmato-salpinx and pelvic haeina- tocele, were motrin gel caps really the result of tubal pregnancy. This fact, and the well proven ones of repeated extra-uterine pregnancy, showed the likelihood of disease on the oppo- site side, and pointed to the propriety of removing both tubes and ovaries. Dr. H. J. Boldt, of New York, related a case, to im- press the view which he held in opposition to the author, that where the opposite tube and ovary were healthy, they should be allowed to remain. Where, however, they were diseased, they should be removed in the class July I, 1893] MEDICAL RECORD. 25 of cases under discussion, just as during an operation for pyosalpinx or other condition. Dr., of Indianapolis, objected to operating on healthy appendages, because on one side there might be tubal pregnancy, and said the danger of having to submit to a second operation was more than offset by the enhanced danger of the double procedure at the same sit- ting. Dk. H. T. H.-^nks, Howard A. Kell\ , C. R. Reed. C. P. NoBi.E, Carsten, and McClaren favored removal of the appendages motrin gel on the opposite side when they were diseased, but objected to the procedure when there was no evidence of disease. Dr. Kelly thought especial attention should be given the pathological condition. The studies of his assistant, Dr. Williams, pointed to crypts or diverticula in the tube, sometimes observable only under the microscope, as the cause of tubal pregnancy, the ovum becoming lodged in one and unable to pass to the uterus. But we could not say that this condition existed, making tubal preg- nancy probable, in a tube which appeared to be normal, simply because tubal pregnancy had occurred on the other side. Dr. O. B. Will, of Peoria, referred to the potency of the tubes as bearing on the etiology. Porro vs. Csesarean Section. — Dr. J. H. Carsten, of Detroit, had reported a successful Porro-Caesarean section, in the Ainericaii Journal of Obstetrics, last year, and it was peculiar that he should be able to report another within six cvs motrin months. 'Ihe second motrin commercial patient was of German parentage, and in 1891 Dr. Carsten had helped to per- form craniotomy upon a dead child. She was told of the danger of a second pregnancy, but kept it secret un- til two weeks before term. She was taken to the hospi- tal, and at the commencement of labor prepared for oper- ation. The bag of waters was first ruptured, and then the usual incision was made. The motrin eq uterus was rolled out a la Mailer, an elastic ligature was applied, then the uterus was quickly opened, and a child weighing eight pounds was removed. It was yet undecided to do Porro operation ; but as all the physicians present were in favor of it, he applied the clamp and removed the uterus and ovaries. The after-treatment was like in any other celi- otomy, and the reco\ery was smooth. The only question in his motrin 500 mind was whether he should have done the Porro or have left the uterus. AA'as it right to deprive the woman of the possibility of becoming pregnant again, since she desired a child, and the one might possibly die ? Should she be subjected to the dangers of repeated Cesa- rean section ? Was it right to propagate the hereditary tendency to deformity ? Dr. Carsten was inclined to do Porro for three rea- sons : I, It could be quickly performed ; 2, it was less dangerous; 3, the woman's future was free from any such dangerous operation. A Successful Case of Caesarean Section. — Dr. Giles S. Mitchell, of Cincinnati, read the history of the case. The paper stated that the operation was demanded be- cause of a hard tumor filling the sacral curve, narrowing the conjugate at the brim to one and one-half inch. The nature of the tumor was not named. The patient refused to go to a hospital, and the operation had to be performed in tenement surroundings. He did not motrin 500 mg wait to try forceps, but operated soon after commencement of labor. Thirty minutes were consumed. It was usual to make the abdominal incision so that only one-third ex- tended above the umbilicus ; in his case two-thirds lay above the umbilicus. He also varied from the custom, and used but one line of sutures in the uterus, that through the peritoneal cover- ing — continuous, instead of interrupted. The quickness of the o[)eration, due to the manner of operating, and not interfering with the appendages, contributed to the re- covery, as did also the fact that there had been no injury to the soft parts by vain attempts at delivery with forceps. He thought motrin pm coupon that at present craniotomy on the living child was never justified. motrin b Dr. Noi'.le, of Philadelphia, had done Cesarean section twice successfully ; had been connected with two other cases, also successful. He had done one symphyseotomy successfully ; had witnessed another case, which was also successful ; and he believed symphyseotomy should sup- plant Csesarean and Porro where the diameter was not under two and three-quarter inches. There was no reason why a rachitic woman motrin printable coupon should be subjected to Porro because of hereditary propagation. She could bear healthy children like any other woman. Dr. Joseph Price thought the indications were differ- ent in Porro and in Caesarean section. He had done Porro six times, always in tumor. All the patients motrin 1000mg recov- ered. Methods of Removing the Uterus for Fibroids, with Cases. — Dr. J. N. Martin, of Ann Arbor, read a paper on this subject. Of thirteen cases of hysterectomy oper- ated upon by him for fibroids, two patients died- — one, because of the size of the tumor and seriousness of the operation ; in the other, because of supervention of cere- bral trouble with hemiplegia. In six cases the stump was treated intra-peritoneally, four called for total extirpation. As to methods, the author claimed no originality. The method must be adapted to the motrin ad case, and a combina- tion might be best. He approved of that method, if con- ditions permitted, which left the cervix with its stump, treated intra-peritoneally, for the following reasons: i, it left a stronger floor for the pelvis without a cicatricial mass, and left the vagina in better condition than when the cervix, too, whats in motrin was removed ; 2, it was better than fix- ing the stump in the abdominal wound, as it permitted free dilatation of the bladder, and there was no contrac- tion. Recovery was more rapid, as there was no slough- ing mass left to suppurate or interfere with union. The vagina was left in better condition than after By- ford's method, as in the latter he believed the cervix and

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