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localized through the assistance of ureteral catheteriza- tion. (3) Persistent pyuria in the absence of a gross bladder lesion is almost invariably due to kidney dis- ease. (4) In those frequent cases of viagra natural para hombres bladder irritabil- ity which yield clear, bacteria-free urine, cultures from the traumatized ureteral canal, or from the introduc- tion of a probe into Skene's ducts, may demonstrate the cause of infection. When bacteria are widely scat- tered or grow with difficulty, a mixture of the urinary sediment with blood followed by making a large num- ber of ascites-blood agar tubes, of high dilution, result in conditions favorable for the development and isola- tion of the bacteria present. (5) tempe viagra Experience teaches that the chief lesions in urinary tuberculosis are usually renal. In obscure cases laboratory diagnosis is facili- tated by the use of potassium iodide, tuberculin, kid- ney massage, limitation of liquids, repeated examina- tions of fresh specimens after high power centrifuga- tion, Petroff's cultures, and the injection of a series of medium sized guinea pigs. (6) There is seemingly a tendency to put undue stress on functional urinary tests at the expense of careful routine examination. The Advantage of Kelly's Method of Cystoscopy in Women. — Dr. Hiram N. Vineberg of New York City said Kelly's method of cystoscopy was so easily learned and so free from errors in interpretation, that it formed the method par excellence for the gynecologist, who had neither the time nor the vast experience necessary to become an expert in the use of the prism cystoscope. Further, in addition to being an easy method of diag- nosis, it formed at the same time a ready means of making topical applications directly to the diseased areas and for the removal of foreign bodies and small growths. The Use of the Galvano-Cautery Knife for Excision of Mammary Tumors for Microscopic Diagnosis. — Dr. J. Wesley Bovee of Washington, D. C, said shortly after viagra natural para hombres installing the Downe's electrothermic angiotribe in 1903, he began experimenting with it in the treatment of the uterus and of the breast. For galvanocauteriza- tion of the advancing cervical cancer, he devised a cooling vaginal speculum that had proven very efficient and in breast tumors localized and only suspicious of malignancy he applied the galvanocautery for excision of the growths, or removal of portions of doubtful tu- mors for microscopical examination. In this work car- ried out in many cases he had found but one objection to it when properly used. This consisted of the slow- tempe viagra ness of the cautery knife when the breasts had been large. This led him to viagra natural para hombres change the technic somewhat. To economize in time he adopted the plan of cutting the tissues for a short distance with a sharp knife, and with the flat sides of the cautery knife, immediately sealing to a considerable depth the sides and tempe viagra bottom of the wound. The use of the knife was again resumed to be promptly followed by the cautery as before. This process had been continued until the tissue desired was entirely removed, leaving behind a crater with charred viagra natural para hombres boundaries. The hot oil that was fried from the tissues during this procedure was taken up promptly with small pledgets of cotton of gauze in the grasp of for- ceps and at once discarded. The wound was now cov- ered carefully and the report of the microscopical in- vestigation awaited. If the tissue was reported to be malignant a radical operation was at once performed. If it was reported to be benign the surgeon might yet decide, from a consideration of the clinical evidence, to perform a radical operation. If the operation was not to be extended, the wound margins were trimmed of all cooked tissue and the proximal portions of severed milk ducts and the wound closed completely with su- tures. The J. Collins Warren operation he had per- formed satisfactorily with the knife and cautery. The Treatment of Pyelonephritis in Pregnancy. — Dr. Raleigh R. Huggins of Pittsburgh said experiments led to the conclusion that ascending infection reached the kidney through the lymphatics more frequently than was formerly supposed. If this was correct, much might be learned from a careful search for the primary focus. This might be found in the bladder it- self. Owing to the intimate relationship between the lymph system of all abdominal viscera, and that of the kidney, the primary infection might lie in the Fallo- pian tubes, appendix or the gall-bladder. In severe cases the diagnosis was usually made without difficulty. The evidence of toxemia, high leucocytosis, pus in an acid urine, with the viagra natural para hombres presence of colon bacilli in pure culture were symptoms which were most suggestive. When pain was a prominent feature, pleurisy, infection of the gall-bladder, salpingitis, or stone in the ureter or kidney must be excluded. There was usually a pro- nounced rise in the temperature viagra natural para hombres and chills. If not contraindicated, cystoscopy with catheterization of the ureters had the same field of usefulness here as a diag- nostic measure that it had in the non-pregnant. The important factor in the recognition of this complica- tion viagra natural para hombres of pregnancy was to remember that in the presence of the above symptoms it was the condition most likely to be found. He had been impressed that the treat- ment in some instances required careful judgment. The mild cases were usually self-limited and responded to rest, proper diet, and urinary antiseptics. Irrigation of the pelvis of the kidney should be done if the infec- tion did not yield to simple measures. Severe pyelitis was always a danger for both mother and child, and if the clinical manifestations did not subside promptly under the above treatment, then one ought to con- sider nephrotomy or the interruption of pregnancy. When viagra natural para hombres surgical measures were not employed in some manner, death not infrequently occurred. 422 MEDICAL RECORD. [September 4, 1915 Postoperative Kenal Infection. — Dr. George Gray Ward of New York City said that in many instances tempe viagra