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ating as soon as immunity had occurred was so much greater than the raw surfaces which remained after operating, if the adhesions had viagra south africa price become somewhat or- ganized so as to make the advantage in favor of the later operation. The number of adhesions encountered in operating at an earlier period were undoubtedly greater, many of them being absorbed more readily than they were during a later period. Dr. DoUGAL BissELL of New York generic viagra scam City said he was in perfect accord with generic viagra scam everything contained in this paper, and his conclusions regarding the subject dated back several years, the result of an unhappy experience in the Woman's Hospital viagra south africa price when he was an intern. The mortalitv from persistent operations upon cases of acute pyosalpinx and pelvic inflammations was very high, and with increased generic viagra scam experience he refused to op- erate on these cases, and in following that practice his mortality had been very low ever since. Dr. J. Wesley Bovee of Washington, D. C, said as soon as Dr. Simpson told him of his method of treat- ment, he adopted generic viagra scam it, and in conjunction with the leu- cocyte count, he generic viagra scam had followed it very thoroughly with the exception of two classes of cases. In the tubercular cases he would operate at once. In these one could hardly expect nature to bring about a successful cure. In the other class he had markedly gone afield, and that was in the acute gonorrheal cases. He was not yet ready to report on his work in this regard. He had not seen the abdominal conditions after this pro- cedure, but he had sterilized the vagina and vulva with iodin and the interior of the uterus by injecting it, the vagina and the Fallopian tubes, opening the abdomen, separating adhesions, painting all raw surfaces thor- oughly, but not normal peritoneum, with viagra south africa price iodm, putting in drains down to the cul-de-sac before he opened the abdomen, and then draining through the cul-de-sac of Douglas, and he had been pleased with the results. He had done viagra south africa price this in the acute cases with a temperature of 103.6°. For the cases that were more subacute and with lower temperature he did not think the plan was feasible. , , Dr. H. S. Crossen of St. Louis said one had more or less difliculty to determine when to operate upon a mass that had passed the acute stage and was in the sub- acute or chronic stage. It might be two months or two years since the acute infection took place, and it was a question whether to do an abdominal operation or not. We could often determine a gonorrheal infection, and it was safe to operate within three months afterward or two months after sterilization. If it was a strepto- coccus infection, it was never safe. Streptococcic masses were in many instances found self-sterilized. On the other hand, there had been other cases reported in which the infection had lasted as long as six or even twelve years. Some Points in the Diagnosis of Ectopic Gestation. — Dr. George Tucker Harrison of Charlottesville, Va., said the diagnosis of ectopic gestation often presented few difliculties, but at other times, as all gynecologists must admit, there was no problem in the whole range of gynecological diagnosis so difficult as the establish- ment of this pathological condition. One error of diag- nosis must be carefully guarded against, and that was to assume that viagra south africa price the case was one of hematocele, when in point of fact it was a tubal pregnancy, located in Douglas' cul-de-sac. Such a case he reported some years ago. The deep situation of the fetal sac in Doug- las' cul-de-sac and the rough uneven surface above stim- ulated the characteristic phenomena of an accumulation of blood in the posterior pelvic cavity. Before he saw the woman she had suffered a chill, followed by fever. When she generic viagra scam came under his observation the temperature was 105°. His diagnosis was hematocele which had become infected. A posterior colpotomy was performed and to his surprise, on entering the cavity with the finger a fetus viagra south africa price of four months was discovered. Fearing a fatal hemorrhage the placenta was not removed, but treated by continuous irrigation. The patient ulti- mately made a good recovery. To mistake uterine preg- nancy, the uterus being in a position of lateral flexion, for a tubal pregnancy Would seem to be utterly unjus- tifiable, and yet such mistakes had been made by some competent men. Dr. Arthur H. Curtis of Chicago said in the diagno- sis of tubal viagra south africa price pregnancy, also in certain instances of uterine pregnancy, in which it was difficult to ascertain the exact condition of affairs, he wanted viagra south africa price to mention possible enlargement of one ovary. This was due to the presence of a corpus luteum. The enlargement of the ovary due to the presence of a corpus luteum in the case of tubal pregnancy was no greater oftentimes than was viagra south africa price that in association with normal menstruation, but it was great enough so that the ovary was noticeably 420 MEDICAL RECORD. [September 4, 1915 enlarged and felt about the size of double that of the normal. Dr. Philander A. Harris of Paterson, N. J., said one should not place too much reliance on the physical examination of the pelvis in any stage of pelvic conges- tion, because he did not know of any pathological state in which one would find a greater variety of conditions existing, owing to the fact that when we had ectopic gestation to deal with it was likely to present varied conditions and symptoms in different patients. He had come to think therefore that the important thing we must do was to get at generic viagra scam the primary history. We needed this, as well as the initial symptoms of ectopic gesta- tion, to make a diagnosis of the condition. Dr. Herman J. Boldt of New York City said the