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firmatory of this view. In insanity the psychical phe- nomena were generally so striking as to overshadow bodily anomalies, and thus these had failed to be noticed. Among the _most recent authorities Dr. Bevan Lewis regarded the exhaustion and sequelse of labor, and de- fective uterine involution, as important etiological fac- tors, especially in the earlier cases of lactational insanity. Seven and four-tenths per cent, of all the women cheap rogaine online ad- mitted to the Maryland Hospital the past two years de veloped their insanity during the beginning of the nurs- ing period. They were thus classified : Melancholia, 2 ; mania, i ; confusional insanity, 2. Of the latter two one died and the other went on to profound dementia. The case of mania was discharged, recovered, after six months. One of melancholia recovered after repairing a badly lacerated cervix. The other case had improved. The average proportion of puerperal insanity in its widest sense to all insanities in women was about ten per cent. Among these the number of cases of lactational insanity number on an average thirty-five per cent. The practical question of prognosis was hard to settle by the statistics. The treatment of lactational insanity resolved itself simply into the exercise of the principles of general thera- peutics : remove sources of irritation, correct aberrant functions, restore wasted strength. These principles, if consistently carried out, would usually lead to success. The Abuse of Emmet's Operation for Laceration of the Cervix. — Dr. E. C. Dudley, of Chicago, read the paper. Emmet first operated for laceration of the cervix in 1862, and published his statement in 1869. He pub- lished elaborate papers in 1874 and 1877. Notwithstand- ing the clearness with which the indications and contra- indications, and the technique, were defined, the operation was still often so badly executed as to be followed by most disappointing, and sometimes by injurious, results. He passed by with mere mention the abuse of applying the operation to cases unsuited to it, including those in which the laceration was slight and not associated with uterine catarrh, cervical rogaine 5 costa rica cystic degeneration, cervical ero- sion, and cervical eversion. The most common faults in the execution of trachelor- rhaphy, so that the operation might fail or do rogaine generic versions harm, were : i , disregard by the operator of the presence ot granular endometritis; 2, closure of the os externum so tightly as to obstruct the free outflow of secretions; 3, failure to remove cicatricial plug in the angle of the wound ; 4, rolling the diseased cervical glands into the cervical canal, where they found expression either in cervical catarrh or retention cysts. Granular endometritis furnished a positive indication for forcible dilatation and curettement, uterine irrigation, and the application of strong carbolic acid and iodine, all of which should immediately precede closure of the cervix except in aggravated cases, when the curettement should kirkland minoxidil 5 for men (generic rogaine) 3 months supply be followed by thorough and repeated uterine tamponade of gauze after the method popularized by Polk. In practice he now found most cases requiring curette- ment for catarrh, and his results had been much better since adopting the custom of exploring in nearly all cases for this condition. Effectual treatment of the diseased Nabothian glands pouring out large quantities of white-of-egg secretion re- quired their removal by excision, cauterization or free use of the sharp curette was not sufficient. Fourth Day, Friday, June qth. After-treatment in Coeliotomy. — Dr. Fle.m.ming, ot Denver, read a paper on this subject. He did not hesi- tate to say emphatically that opium should not be given to control pain unless the patient had been addicted to the use of the drug. He believed opium had killed more patients than coeliotomy. It checked peristalsis, natural secretions, caused thirst, restlessness, etc. As to laxa- tiveness, they gave small doses of calomel, or if this caused nausea they gave salines. Where drainage was employed it was either by glass tube or iodoform gauze. To prevent pain of tympanites they avoided opiates, kept up peristalsis by hot- water injections and the use of laxatives'. The long rectal tube had been of little use in the majority of their cases. More benefit had come from hot-water injections. They gave ten grains of sulphate (luinine twice, if necessary, in twenty-four hours. Reopening the abdomen was practised under three conditions — hemorrhage, sepsis, and peritonitis — although their experience in this line had been limited. Regarding diet, the less one put into the patient's 56 MEDICAL RECORD. [July 8, 1893 stomach the first forty eight hours the better. Then give fluid food, and if there were nausea give predigested food. After a few days almost any food desired could be given with exercise of due care. Dr. Mitchell, of Cincinnati, regarded the subject matter of this paper as most important in gynecological practice. The success of ccfiliotomy depended upon the after-treatment. No food should be given in twenty- four or forty eight hours. The drainage tube also acted in controlling hemorrhage. Dr. J. H. \y. Chestnut, of Philadelphia, queried as to the theory of the drainage-tube controlling hemor- rhage. The clinical fact was well recognized. Like the author, he believed opium had done much mischief, but he thought that with care it could be used with benefit in some cases not addicted to the opium habit. Dr. Newman, of Chicago, said that in a hospital with which he was connected they used iodoform wicking in drainage instead of iodoform much does rogaine cost per month gauze. It did not become can you get prescription rogaine thready like gauze, and drained even better. They also applied the Esmarch bandage around the abdomen over the dressing, and had found it gave the patient comfort by its elastic support to the relaxed wall, and also by its warmth and soothing influence. Memorials were presented for publication in the vol- ume of the Section's Transactions of the late Dr. A. Reeves Jackson and Dr. F. do you need a prescription for rogaine M. Johnson. A vote of thanks was tendered the Chairman, Dr. Duff. SECTION ON SURGERY. First Day, Tuesday, June 6th. Antiquity of Syphilis. — Dr. J.T. Jelks, ofHot Springs, buy rogaine foam uk Ark., purchase rogaine women canada President of the Section, delivered the annual ad- dress, taking as his subject a consideration of the antiquity of syphilis. He congratulated the profession upon the advance of surgical methods in the past buy rogaine pills fifty years, espe- rogaine farmacias costa rica cially do you need a prescription for rogaine in australia through the introduction of anesthetics, antisepsis, and modern bacteriology, which as yet is in its infancy. Some indeed affect to slur at the good work done in the days of our fathers as viewed by the light of modern re- search ; but this spirit should receive no sympathy. Referring to the subject of his paper, he said that Dr. Buret had proved that syphilis was known many centuries before the Christian era. In 1921 B.C., Abraham intro- duced his wife Sarah as his sister to the court of the Egyptian Pharaoh, who took her to wife, and as a conse- quence infected himself and all his other wives, so that the infection spread generic brand rogaine women through the court and a plague of sterility followed. In the book of Psalms, King David graphically describes his sufferings due to his own trans- gression, and his description is a perfect representation of tertiary syphilis with iritis and gummata. Moses speaks of a severe epidemic among his men following upon their intimate relations with Moabitish women. To check it he ordered the massacre of twenty-four thousand tainted men, and later all the women who had known men carnally. The worship in the temples of Baal was simple prostitution, and the epidemic of Baal was un- doubtedly syphilis, although possibly in a rather more acute form than it presents to-day, as the human race may now be partially inured to it through the sufferings of former generations. Acute Intestinal Obstruction Treated by Laparoto- my. — Dr. a. J. OcHSNER, of Chicago, reported three cases of this nature. He regretted that he could not re- port a larger number, but offered them, knowing the value of individualization in such cases. Case I. — A child, after a fall, had slight recurring pains in the abdomen. The pain increased gradually with the formation of a sausage-shaped tumor to the right of the umbilicus. Laparotomy in the middle line below the umbilicus showed an intussusception of the ileum into the cecum which required considerable force to reduce. The appendix was removed, for it was very long and formed a complete loop around the ileum, and evidently was the cause of the trouble. The recovery was rapid and uneventful. The force necessary for the reduction of the intussusception proved that injections of water would have been useless in this case. Case II. — A laborer, cheap rogaine canada thirty-two years of age, com- plained of pain in the left inguinal region following a fall. Three days later the symptoms were nausea, tym- panites, and obstipation, with an indistinct tumor in the left buy rogaine foam inguinal region. A diagnosis of volvulus was made. Laparotomy disclosed a volvulus of the sigmoid flexure. The twist was easily unturned outside of the buy rogaine foam online canada abdomen, but the inflated intestine could only be returned after the withdrawal of gas through a large anal tube. Case III. — A man, eighty-one years of age, had in- creasing umbilical pain, with shock and stercoraceous vomiting on the third day. A diagnosis of obstruction of the small intestine, cause unknown, was made. Lapa- rotomy revealed a loop of intestine, one foot long, which had sliijped under Meckel's diverticulum. It had evi- dently been there for years, but strangulation had occurred recently. Death followed from shock in thirteen hours. The author wished to call attention to the great value of washing out the stomach with a stomach-tube before oper- ating upon cases of intestinal obstruction from any cause, especially if stercoraceous vomiting is present. It will lessen the vomiting during and after the do need prescription rogaine canada oi^eration, and so reduce shock as well as the inhalation of vomitus. Unnecessary Restrictions in Surgery was the title of a paper read by Dr. J. D. Roberts, of Philadelphia. He pointed out the danger of too blindly following the dogmatic statements of many of the teachers of to day, and so of limiting the amount of good which comes from individual experience. He believed that the immobili- zation of fractures of a limb after operations, or in joint diseases, is often carried on too long simply from theo- retical reasons. Water is can you buy rogaine foam ireland denied to laparotomy patients too frequently, simply from the dictum of old teachings, certainly not from the result of individual experience. The restrictions in the after-treatment of operations upon the eye are too frequently severer than are necessary. While the speaker did not advocate a reckless cutting loose from the old-established customs which govern all difference between rogaine generic minoxidil the details of the management of stated cases, still he wished to make a plea against the blind following of all the rules from memory, and not from the knowledge of their why and wherefore, and to protest against the old routine treatment without regard to the individuality of the cases. Report of Cases in Evidence of the Surgical Impu- nity of the Peritoneal Viscera. — Dr. J. E. Link, of Terre Haute, Ind., presented a communication with this title. The author had recently made numerous intestinal sutures for artificial wounds and gut resections in dogs, without the slightest attempts at antisepsis or even clean-

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