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[July 8, 1893 tion preceding curetting. The quantity at one sitting varied from three-quarters to two grains. Discussion on the four preceding papers was then taken up. Dr. Carsten thought if one was going to use strych- nia he should use sttychnia, not nux vomica. The latter was of varying strength. Dr. Mitchell, of Cincinnati, had used cocaine in mi- mor gynecological operations, but found it unsatisfactory, producing alarming symptoms. Dr. C. p. Reed was also afraid of cocaine. Dr. Mordier, of Kansas City, thought Dr. Martin's operation would be useful, but only in a limited class of cases. He said the circulation was only in part to blame for symptoms in fibroids, the nerves should be consid- ered. Dr. Martin replied to this criticism that his liga- ture included nerves as well as arteries. robaxin euphoria Dr. Griggs, of Buffalo, had reduced fibroids by hypo- dermic injection of ergot, but he would now try Martin's method. Dr. K. W. Hoff had, in one case of uterine fibroid as large as a pitcher, injected daily two to three grains of ergotine over the region of the broad ligaments, and in seventy-five days the tumor, also a nasvus of the size of the hand, had quite disappeared. robaxin brand name Dr. Humistox thought pelvic hernia due to subinvo- lution of the uterus following laceration of the cervi.x, the perineum being only of secondary importance robaxin 500 mg muscle relaxer in sup- porting the uterus. Ectopic Pregnancy : Its Comparative Symptomatolo- gy robaxin canada and Treatment. — Dr. Joseph Hoffman, of Phila- delphia, read on this subject. Those who had most widely argued the possibility of exact diagnosis had had the least abdominal experience. They believed that it was possible to say positively that this or that swelling was the result of an ectopic gestation, because they did not understand the various train of pathological conditions that had their manifestation in pelvic fulness, tenderness, throbbing, and the like. In a given case we could say that here we have a dis- ease in which the probability of the presence of an extra- foetal pregnancy could often be safely affirmed after cer- tain periods. First, after rupture ; second, after the fcetus had become viable ; third, the presence of dis- charging foetal remains, either through the bladder, rec- tum, or umbilicus. But it was most ridiculous to con- sider the last condition under the head of diagnosis. As to the diagnosis previous to rupture, it need hardly be considered, for our attention was called to the case only by the symptoms of rupture. The diagnosis must be after the conclusion that a pregnancy existed. We could then judge by the conditions whether the case was one of ectopic gestation. Winchel's assertion that ectopic gestation was more readily diagnosticated than the normal condition, was one which was safely left with himself It was hardly worth while to dispute it. His abdominal experience had not been sufficient to justify his sweeping statements in robaxin 550 mg diagnosis. The treatment was only by cceiiotomy. Extra-uterine Pregnancy. — Dr. A. H. Cordier, of Kansas City, read only that portion of his paper relating the history of a case of extra-uterine pregnancy, the specimen being presented. A few years ago extra-uterine pregnancy was considered very rare. During his brief experience he had seen an unusual number. The past two years he had operated or assisted in sixteen cases. The duration of pregnancy had been between six weeks and two years. In all cases the pregnancy was at first tubal, and rupture must always take place into some part at some time unless there was arrest of growth. Intra-peritoneal was to extra-peritoneal rupture in the proportion of three to one. Where rupture was intra- ligamentous the fcetus could live. The specimen presented was from a woman, aged twenty-four, operated upon .\pril 15, 1893. The preg- nancy dated from August, 1891, sjTnptoms of rupture in October. She had felt fcetal movements up to April, 1892, or nine months after conception. False labor pains came on. She began again to menstruate, Decem- ber, 1892, and was regular until March, 1S93. The diagnosis before operation was uncertain, but ec- topic gestation was the one most acceptable. When the incision was made down to the tumor, it was noticed that the knife cut down upon the growth at the lower angle of the vascular membrane ; this was tied in sections. This tying and cutting process had to be tied around the middle of the tumor. On the upper and posterior as- purchase robaxin pect of the growth an intestine was found attached nine inches. This had been brought about by the mass, or it had ascended out of the pelvis, stripping the peritoneum from the posterior wall of this cavity and separating the layers of the mesentery up to the gut by the same grad- ual process that early in the pregnancy had pulled apart the two layers of the broad ligament. .Vfter making a complete circuit of the growth (amnionj the tumor robaxin high was easily lifted from the bottom of the pelvis. This locality did not require a single ligature. At the left side robaxin 750 mg of the uterus, near the tubo-uterine junction, the peritoneum was so firmly attached to the uterus that the organ was cut into and gave rise to considerable hemorrhage. This was controlled by a stitch or two, and the membrane was divided robaxin 500mg tablets at a greater distance from the uterus. The tu- mor being taken out, the peritoneum was lifted up from the bottom of the pelvis on that side, hemorrhage being controlled by water. Irrigation and drainage were used. She did well. The robaxin 500 mass contained a full-formed eight- pound child. The sac was filled with the foetus and placenta. The placental site was at the top of the sac. The rupture had evidently, he said, been into the broad ligament where the fcetus went on to develop. Dr. Howard A. Kelly had had three cases of extra- uterine pregnancy which had gone to term ; the child had died, and in about robaxin 75 mg six months afterward he saw the woman, and operated by the only method which he thought was satisfactory — complete extirpation of the foetus, with sac, membranes, and placenta. The vessels having shrivelled, there was less danger from hemorrhage than when the fcetus was li\ing. Dr. Kelly formerly disbelieved in intra-ligamentous pregnancy, but had seen one undoubted case, shown to be so by the pathologist. Dr. Boldt had seen three cases of undoubted intra- ligamentous fcetation. Dr. Davis, of Birmingham. Ala., thought the child could not have been taken out in the sac as it was had it not been in the broad ligament, and asked Dr. Joseph Price's opinion on this subject ; and Dr. Price said he did not think there was any robaxin generic evidence of the case being one of rupture into the broad ligament and development there. He had never seen such a case, and believed tubal preg- nancy always ruptured into the peritoneal cavity, not into the broad ligament. Accouchement Forc6 in Certain Obstetrical Compli- cations. — Dr. Lewellyx Elliot, of Washington, D. C, read this paper. He defined accouchement force as labor actively begun and terminated by artificial aid, either with dilators, tampons, Barnes's bags, or the fingers. He urged as his opinion the superiority of the fingers over all the mechanical devices in use. as well as the most harmless. This mode of practice was indicated in cases of uraemic convulsions, either threatening or in existence, rigid os, placenta prrevia, uterine inertia, and other conditions recjuiring artificial aid. He deplored the fact that books and journal articles were silent upon this old method, and quoted Charpentier, Winchel, and Lusk as being opposed to it. He denied that the method would be attended by untoward effects — post-partum hemorrhage, laceration of the cervix, uterine inertia — robaxin 750 more frequently than generic robaxin by other means. He recited the histories of four cases robaxin mg where the method had been em- ployed by him — two of uraemic poisoning, one of placenta praevia, and one of rigid os — all of which terminated favorably. This paper was discussed by Drs. Mitchell, of Cincin- nati ; H. A. Kelly, Earle, of Chicago ; Barker, of Phila- July 8, 1893] MEDICAL RECORD. 55 delphia, who condemned accouchement force except in certain rare cases, and thought it had cost many hves. Much was said about meddlesome midwifery, danger of sepsis from use of the finger, etc. Suspensio Uteri. — Dr. Howard A. Kfxlv, of Balti- more, made some remarks based upon the principal points contained in a paper upon this subject. The board, drawings, and photographs were used in illustra- tion. He claimed to be the originator in suspending the uterus by attaching it to the abdominal walls. He wrote a paper ten years ago upon the correction of retro-dis- placement of the uterus by stitching the organ to the an- terior abdominal wall. It had since come to be one of the tested gynecological procedures. He and others had designated this method of keeping the uterus forward by several terms (hysterorrhaphy, ventral fixation, etc.), which he regarded as inappropriate, and he had come to call it suspensio uteri. The suspension of the uterus could be effected satisfactorily by two methods, and by only two. In the one, the abdomen being opened, sutures were passed through at the horns on both sides and fastened to the walls of the abdominal incision. In the other meth- od the sutures passed entirely through the uterus at its base. He used silk and left it in. One would find that after several months the uterus could be moved freely, but could not be thrown backward. He had done other op- erations, among them shortening the round ligaments within the abdomen, but the uterus soon fell back. It was not to be supposed that suspensio uteri should be practised in all cases of retro-displacement. At the dispensary of the Johns Hopkins their attending physician had sent up to robaxin generic name him only eighty cases out of several hundred in which he thought this procedure was called for, or me- chanical robaxin 500 mg measures had failed. Dr. Kelly had operated on only 44 of the 80. The result, however, had been en- tirely satisfactory in all the 44. The women were of two classes, the unmarried, and robaxin 1000 mg the married who had all borne more than three children apiece. Of the 44 there had been 18 single, 23 married. Among other symptoms which had disappeared in many, were those of a hyster- ical or nervous nature. Dr. H. J. BoLDT, of New York, thought Dr. Kelly should not object to the term ventral fixation since he left in the silk ligature, for that would certainly keep the uterus fi.xed unless it cut through the walls. It was ob- jectionable too, for it would interfere with the advance of pregnancy. Dr. Boldt claimed to have first denominated the operation suspension of the uterus. He would do the operation only where a pessary failed to keep the uterus up, or the patient was anxious to get rid of the pessary, or the abdomen were opened for some other condition. To open the abdomen for this operation when the uterus was quite movable, was unjustifiable. Alexander's opera- tion was then indicated. Lactational Insanity. — Dr. George H. Rohe, Super- intendent of the Maryland Asylum for the Insane, read this paper. generic for robaxin He said prolonged or excessive lactation had been given as the chief cause of insanity occurring during the nursing period. In most cases this was probably true, yet there were some in which the disease must be attributed to other etiological factors. Recent careful study of insanity during the lying-in period had shown its frequent dependence upon septic puerperal processes. Certain of his own observations, presented at the last meeting, might be regarded as con-

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