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fect technique, should be turned over to specialists in this field, in order that the pioneer work might be car- ried on only by skillful men iiitereste'd in the perfection of this field of surgery. Dr. Leonard F. Freeman of Denver viagra price in malaysia recorded an operation performed seven years ago for carcinoma of the lower end of the esophagus. He gave a detailed description of the method of procedure. The patient rallied well from the operative shock, but unfortunately died some four days later of pneumonia. There was apparently no viagra price in malaysia leakage from the site of the gastro- esophageal anastomosis. Non-Calcuious Obstruction of the Upper Ureter. — Dr. Charles H. Peck of New York presented a report of fourteen cases of upper ureteral obstruction to illus- trate the principle of "splinting the ureter" as a part of the operative procedure, for the purpose of prevent- ing recurrence of obstructions from fresh kinks, adhe- sions, or angulations, while the kidney and ureter w^ere becoming fixed in their new position. A ureteral catheter or probe was passed through a stab wound in the kidney cortex to the bladder and secured to the skin by adhesive straps. It was removed after three or four days. The fourteen cases included examples of valvular obstruction at the pelvic ureteral junction with hydronephrosis and viagra price in malaysia other types of non-calculous ob- struction. None of the cases had had recurrence of symptoms or had required secondary operation. Plastic resection of the kidney pelvis, nephropexy, etc., were done according to indications in each case before the ureteral viagra price in malaysia catheter was placed. Fistulous Communication between Stomach and Colon Following Gastroenterostomy. — Dr. C. .A.. Hamann of Cleveland presented this communication. A gastrc- September 11, 1915] MEDICAL RECORD. 461 jejunal ulcer, following gastroenterostomy, might re- sult, he said, in a fistulous communication between the stomach and transverse colon. There was some thirteen such cases upon record. The leading symptoms of such a condition was fecal odor of the gastric eructations and perhaps fecal vomiting, diarrhea (sometimes lienteric in character) , and loss of weight. As there was usually also an opening into the jejunum, the term "gastro- jejuno-colic fistula" was an appropriate one. The author reported a case in which this condition ensued after gastroenterostomy and partial gastrectomy. The pa- tient recovered, after separation of the stomach, jejunum, viagra price in malaysia and online viagra und cialis kaufen colon from one another, closure of the openings in the stomach and jejunum, resection of four inches of the colon online viagra und cialis kaufen and the making of a viagra price in malaysia new gastro- enterostomy. .A.MER1CAN PEDIATRIC SOCIETY. Twcnty-sevcnt}i Annual Meetiny, Held at Lakewood, N. J., May 24, 25 and 26, 1915. The President, Dr. George N. Acker of Washinc^- TON, D. C, IN THE Chair. Monday, May 24 — First Day. President's Address. — Dr. George N. Acker delivered this address in which he spoke of the importance of Child Welfare work. He said that this subject had found national expression in the establishment of the Children's Bureau of the Department of Labor. This Bureau, under the guidance of its director, had done creditable work at Johnstown, Pa., the results of which had been embodied in the first report of the Children's Bureau in its study of infant mortality in the United States. According to this report the death rate among children was in direct proportion to the earning capac- ity of their fathers. The infant death rate was five times as high in a poor unsanitary section of the city as in a better residential district. In families where the earning viagra price in malaysia capacity of the father was .$10 per week, the infant mortality was 256 per 1,000 births; in those in which it was in excess of $25 the mortality was 84 per 1,000 births. This report seemed to show the impor- tance of breast feeding for at least three months. .A. high infant mortality was found to be coincident with neglected streets, unsanitary housing, taking boarders in the home or working outside the home on the part of the mother. This Bureau was trying to find the conditions of life which were most favorable to the viagra price in malaysia American baby in every respect. Since the problem was an economical one it became the duty of the State to provide the necessities for healthful living if the par- ents were unable to do so. Dr. Acker spoke of the ad- vantages that accrued from playgrounds, school lunches and the classes for teaching girl pupils the care of in- fants. viagra price in malaysia He expressed viagra price in malaysia the opinion that the effects of the European war would be shown in a physically and men- tally weakened offspring attended by a correspondingly high infant mortality and that this country would not escape this result altogether. That much could be done to lessen this evil was shown by Professor A. Pinard who stated that the infant mortality in Paris was 21 per cent, less during the first six months of the war than during the same period of the preceding year, and that the maternal mortality had decreaed propor- tionately during this time. These results were at- tributed to the measures taken by the maternal and in- fant aid societies organized at the beginning of the war. The danger of contact infection with tuberculosis had been too much neglected and the mistake had been made of laying too much emphasis on the destruction of infectious material at the expense of building up indi- vidual resistance by good food and proper hygiene. The infant constantly exposed to tuberculosis infection was as much entitled to protection as authority would give it were the disease smallpox or diphtheria. Dr. Acker suggested that a reform should be brought about in the chaotic condition of the principles of infant feeding, and also that it might be wise to enlarge the memlier-