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moved and the uterus left. 7. It may be indicated in aggravated sharp retroflexion, but he had seen no case of the kind which could not be relieved by the Alex- ander operation. 8. Ventral fixation is indicated under certain conditions in uterus unicornus. Indications for Vaginal Fixation. Dr. Hiram N. Vineberg felt that his paper had been largely an- ticipated by the two previous readers. Nevertheless he took a different view of vaginal fixation. Like every new operation, vaginal fixation had at first been carried to the extreme and applied to cases to which it ought not to be applied. On the other hand, the reaction was going to the opposite extreme, which was also but a repetition female viagra in london of common experience. The percentage of disturbances at labor had not been greater than in ventral fixation, nine in fifty-two cases against eleven in fifty-four. Personally he had not met with disturb- ances of pregnancy or labor. In his first cases he did not open the peritoneum, but during the past six months he had entered the peritoneum through an an- terior longitudinal vaginal incision, broken up adhe- sions, lifted the retroverted uterus, and fixed it by suture to the vagina. Out of twenty-nine cases operated upon in this manner there had been failure in none. He recognized but one contraindication, congenital retro- version with adhesion, in which it was doubtful if any operation would give good results. In fifty-two cases of labor following vaginal fixation there had been difficulty in nine one Porro, one Cae- sarean section, two cervical incisions, five versions. The difficulties arose chiefly from the circumstance that the fundus of the uterus was too firmly and exten- sively attached to the vaginal wall at the expense of the posterior uterine wall what one might expect from Diihrssen's method, or transverse incision in the anterior vaginal wall and firm fixation of the uterus viagra results photos by- several sutures, the method which was practised in all but one of the nine cases. Dr. Vineberg's own expe- rience and that of. others had female viagra in london taught him that when certain points were observed in technique vaginal fix- ation would cause no disturbance during gestation or labor. It was indicated in all backward displacements of the uterus with female viagra in london or without adhesions, and with or without disease of the adnexa and in which surgical interference viagra results photos was demanded. It was particularly indi- cated when backward displacement was complicated by moderate prolapse of the uterus and vagina, and it found an undisputed field in women with very fat ab- dominal walls, and also, in opposition to ventral fixa- tion, in women whose abdominal walls were very yielding. It could be done in nullipara? and even in virgins. The only contraindication was congenital retroversion with adhesions, and in such cases no method was successful. Dr. Charles P. Noble, female viagra in london of Philadelphia, said he had been anticipated by Dr. Edebohls. Two cases of his own of disturbance during parturition following ventral fixation female viagra in london had led him to ask for the experience of others. He was not yet ready to draw conclusions. In one of his cases the woman was confined by Dr. Norris, who found female viagra in london that the adhesion and thickening of the anterior wall of the uterus constituted a tumor ob- structing the brim of the pelvis. The female viagra in london woman was de- livered with great difficulty. A similar condition ex- isted in the other case, to which Dr. Noble was called in consultation. They waited for labor pains, only with the result that the woman viagra results photos became septic. Deliv- ery was impossible and he did Porro's operation, but the woman died. In his opinion shortening the round ligaments was the proper operation if the uterus was at all movable. He had had best results from hysterorrhaphy in proci- dentia, supplemented female viagra in london by plastic operations. Most of these' women had passed the child-bearing period. If he sacrificed the appendages he also removed the uterus. He did female viagra in london not feel disposed to try vaginal fixation. Dr. H. J. Boldt thought no operation was compar- able with shortening the round ligaments in posterior displacement with mobility. If we attempted to break up adhesions without incision we might be deceived, and then on doing the Alexander operation find it to fail. For posterior adherent displacement he would perform ventral fixation after breaking up the ad- hesions. Vaginal fixation might find a place in some cases of vaginal work. Its origin had been attributed to-night to Makenrodt, but Dr. Boldt held that Schuck- ing first performed it and that recent work was but a revival. viagra results photos Has Abandoned Alexander and Vaginal Fixation. Dr. Ill, of Newark, thought the indications for operation were very plain. It should be done in all cases of retroflexion or retroversion when the uterus could not be kept in place by other means, or when the patient lived at a viagra results photos distance and could not be looked after while wearing a pessary. He had employed the three methods but had given up two of them Alex- ander's operation and vaginal fixation. He had per- formed ventr.al fixation ninety times with good results. He could report three cases of pregnancy. They had terminated all right. Nothing had been said to-night of hernia following the Alexander operation. Dr. Coley had told him that he had operated on fifteen cases of hernia of this origin during a very brief period last winter. Dr. Ill had seen female viagra in london one case of hernia after ventral fixation. 360 MEDICAL RECORD. [March 7, 1896 Dr. J. R. viagra results photos Goffe had had experience with the three methods, and had welcomed vaginal fixation because it did away with the scars left by Alexander's method. His anatomical cures had been satisfactory, but he had had no experience with pregnancy following vaginal