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Adolph Ripp, M.D. 406 West Thirty-Fourth Street, February 23, 1S96. Medical Men to Avoid. The one who has acute exacerbations of insanity when exposed to any new fad. The one who is always successful with all his difficult operations. The one who alwavs sees hun- viagra kaufen per nachnahme dreds of cases of a rare disease. The one who can always match your case and improve on your treat- ment. The one who always finds you have omitted something in the examination of your case. The one who thinks he can talk well and is always ready to discuss any paper of the evening. The one who is always the first to do the new operation. The one who is in a chronic fear of being anticipated in his important discoveries. The one who in consultation feels it his conscientious duty to explain to the pa- tient why he differs with the attending physician. Society Reports, MEDICAL SOCIETY OF THE COUNTY OF NEW YORK. Stated Meeting, February 24, i8q6. Edward D. Fisher, M.D., President, in the Chair. Conservative Surgery viagra kaufen per nachnahme upon the Uterus and Adnexa by the Vaginal Route red viagra c200 Dr. H. N. Vineberg read a paper on this subject. Mention was made of the advance of our knowledge of pelvic diseases and of their treatment during the past ten years or more, and the later custom of removing the uterus where both tubes and ovaries had to be sacrificed. While this had resulted in relief in a greater number of red viagra c200 cases than before, it must be admitted that even so radical a measure did not always free the patient from pelvic pain and other symptoms. This was due to the fact that some pelvic tissues must always remain, however radical the operation, and the disease process may ha\ e extended beyond the uterus and adnexa to them. Conservative surgery, therefore, was indicated, if by it the uterus and the whole or a part of the adnexa could be saved and the patient be relieved of her symptoms. He made a distinction between palliative and conser- vative pelvic surgery. The former implied letting out of pus through red viagra c200 an opening in the vagina, a secondary operation being necessary sooner or later; it was a procedure, however, which was not to be despised, as it had saved many lives which would have been sacri- ficed had a more severe operation been performed in the first instance. Conservative pelvic surgery im- plied removal of diseased tissue short of complete sacrifice of adnexa and uterus. Opening through the abdomen was always attended by immediate danger and also by the remote danger of stitch abscess and ventral hernia. These facts had prevented operation in the past until the disease had made considerable advance, viagra kaufen per nachnahme usually preventing con- servative work. Conservative pelvic surgery had re- ceived a strong impetus since the introduction of the vaginal method, which rendered it but little more dan- gerous than curettage of the uterus. It might justly be called prophylactic pelvic surgery. Dr. Vineberg then read the histories of some cases viagra kaufen per nachnahme illustrative of different types from a total number of about forty. The first was in red viagra c200 a woman who had borne a child thirteen months before and was suffering from pelvic pain, etc., found to be due to gonorrhoea! en- dometritis and urethritis. The latter was relieved, the endometritis was not. After some months of pallia- tive treatment which did not effect a viagra kaufen per nachnahme cure, and a pelvic tumor being felt, he made vaginal section, drew down the left ovary, and punctured some small cysts; he then returned it, drew down the other ovary and tube, and removed them because the ovary was disorganized and pus was present. The -woman red viagra c200 red viagra c200 then made an un- eventful recovery. Had he waited longer the other ovary would have become disorganized and might have demanded removal. Another case was that of a work- ing-girl aged twenty-two, disabled from work by pelvic trouble; the uterus was displaced backward and the ovaries were prolapsed ; pessary and non-operative treatment had failed. He made a longitudinal incision in the anterior vaginal wall, drew down the ovaries and tubes, punctured small cysts in the ovaries, and excised one of the larger cysts: he then returned the appendages, and made vaginal fixation of the back- wardly displaced uterus, thus holding it forward. The patient was completely relieved. It was safe to predict that had red viagra c200 she been allowed viagra kaufen per nachnahme to go on a year or two longer both appendages would have become so March 7, 1896] MEDICAL red viagra c200 RECORD. 557 disorganized that a conservative operation would have been impossible. In another case a small subserous uterine fibroid was removed through vaginal incision. The work of A. Martin and other authors was quoted to show the value of conservative vaginal surgery. Dr. Vineberg had found that the appendages could be easily drawn down through a longitudinal vaginal incision unless there were adhesions. In the latter case one should be prepared to make an abdominal opening if it became necessary after doing vaginal exploratory operation. The longitudinal incision was preferable to the transverse one because of freedom from endangering the ureters in front or the rectum