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behind. Then the anterior incision permitted of vagi- nal fixation of the uterus at the same sitting, for there was commonly posterior displacement of that organ. He preferred to open the abdomen in extrauterine pregnancy because the uterus in these cases was fria- ble and easily injured in vaginal work. He laid spe- cial stress upon the necessity of keeping the patient abed, say, three weeks. Ten days was too soon to al- low her up. Dr. W. R. Pryor thought the discussion turned on the choice between the abdominal and the vaginal op- erations. viagra tablet in sri lanka He could see no reason for changing his views of some years ago. As a viagra tablet in sri lanka basis for judgment the cases could be divided into those of disease of the pelvic organs with abdominal associations and those with only pelvic associations. In the former cotli- otomy was indicated, in the latter usually vaginal inci- sion. If, for instance, there were tubal disease asso- ciated viagra pour homme prix with appendicitis, the abdominal operation was assuredly indicated. For exploratory purposes he would choose the vaginal route. In all localized sup- purative pelvic troubles and in pyosalpinx without ab- dominal complications one should operate through the vagina. There were, however, cases of disease of the uterus and appendages in which an abdominal opening was indicated, as he had already suggested. In doing vaginal work he made the opening in the posterior cul-de-sac. Dr. H. J. Boldt, who had not heard the entire paper, said he understood by conservative pelvic sur- gery plastic work on the pelvic organs for the pur- pose of restoring their utility. He believed that this could be done on the ovaries and tubes through the abdomen better than through the vagina. If, on the other hand, one meant removal of pelvic disease, such as pyosalpinx or ectopic gestation, he held that it could be done as easily through the vagina and with- out certain risks attending viagra pour homme prix abdominal section. All knew that if there were unilateral disease high up it was better to operate through the abdomen, and large fibromata could be removed better through an ab- dominal opening. In nulliparae the viagra tablet in sri lanka vaginal route would be attended by more bruising because of the small size of the vagina. It was not always nec- essary in suppurative disease to remove all of the dis- eased structure, yet the patient would recover sooner than if the viagra pour homme prix abdominal route had been chosen. The uterus should be removed whenever it became neces- sary to remove the appendages of both sides. Dr. Egbert H. Grandin said all were agreed that conservatism in surgery is a desideratum. There was no doubt that for exploratory purposes the va- ginal route should be selected whenever possible ; if necessary the abdomen could be opened afterward; vaginal operation was always indicated for disease within the pelvis. If the disease was above the pelvic brim, aside from doing whatever was possible through the vagina the operation must be completed from above. If there were pus tubes, we should operate through the vagina. If adhesions existed above, or there were appendicitis, etc., we should make a sup- plementary abdominal incision. It need not be a large one. It was simply a question of the locality of the disease, whether high or low. The primary shock, the pain, the length of convalescence, espe- cially if forceps were used, were about as great in the vaginal as in the abdominal operation. The duration of the operation and the risk were a little less in the former when the disease was low in the pelvis. Dr. E. B. Cragin thought that in a society like this doctors should be able to find a common ground of agreement, and on the present occasion all would probably admit that masses lying high should be at- tacked from above, masses lying low might be attacked from below or from above. The mode of operating could be called conservative under two conditions: 1, When chosen in preference to other modes of operat- ing in order to conserve the patient's strength; 2, when chosen as a means of saving the pelvic organs. An example of the first was seen in puerperal infec- tion, when it was better to open a collection of pus through the vagina and postpone a more radical oper- ation, should it become necessary at all, because of the patient's present low state viagra pour homme prix and one's inability to judge of the extent of the disease. In his opinion plastic work on the appendages, to save the child- bearing function, could better be done from viagra tablet in sri lanka above than from below, although he had had experience with both routes. In vaginal work he preferred posterior incision in most cases. Each case had to be decided on its own merits. Dr. Vineberg did not think one was capable of judging of vaginal plastic work on the appendages who had operated only through the posterior cul-de- sac. Non-Nocere in Obstetrics. Dr. Julius Rosenberg opened his paper with the statement that one of the most noted viagra tablet in sri lanka papers read at the International Medical Congress at Rome was by Dr. A. Jacobi, entitled " Non-Nocere." In it he showed that not infrequently our desire to aid resulted in harm to our patients. This seemed to Dr. Rosenberg especially true in ob- stetrics. Labor was a physiological process, and ninety-five per cent, of all labors terminated normally when permitted to take their course. But not infre- quently in our desire to do something we brought about a pathological condition. Puerperal fever stood foremost among viagra tablet in sri lanka diseases of childbirth artificially pro- duced. While the mortality from this cause had been much decreased, it was far from nil. The author then quoted several authorities to show that the vaginal secretions and the bacteria normally present there were destructive to pathological bacteria, and practical experience had shown that puerperal sepsis developed more frequently when labor had been preceded by the vaginal douche than when this had been omitted. All that was required was disinfection of the external gen- itals and of the hands of the accoucheur. In his own practice he had had no cases of puerperal sepsis, but had seen a number in women attended by other physi- cians. Time permitted him to touch upon but one other