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bidden; a proper water supply should be available for drinking purposes; and prompt recognition and treat- ment of all cases should be encouraged. OBSTETRICS. In extrauterine pregnancy, there will be signs of early pregnancy, hypogastric or inguinal pains, prob- able history of a previous sterility, probable expulsion of decidual membrane or shreds, softening of the cer- vix, enlargement viagra tablets side effects of the uterus, presence of a distended tube, contractions of the wall of the gestation sac; if rupture occurs, there will be sudden, excruciating pains over the lower abdomen and on the affected side, shock, collapse, and symptoms of internal hemorrhage. The treatment after rupture is — laparotomy. "After thorough cleansing and sterilization of the abdomen and pubes, as well as of the instruments and hands of the operator and cheap single viagra pills assistants, the bladder is emptied and the patient anesthetized. An incision 3 inches long is then made in the median line above the pubes down to the peritoneum, any viagra tablets side effects bleeding vessels being twisted viagra tablets side effects before opening the peritoneal cavity. The peritoneum is then incised; the intestine kept back by pads of cot- ton or gauze wrung out of sterilized water; the opera- tor's fingers bring out the distended tube and ovary at the incision after having freed them from any exist- ing adhesions; the pedicle is then transfixed by a double ligature of sterilized silk, and each half of it tied securely according to surgical rule. The pedicle is cut, and the entire mass — the Fallopian tube, with the cyst, fetus, ovary, and eflfused blood, removed, extra care being taken, in .the ruptured cases, to quickly secure the bleeding vessels of the ruptured tube from further hemorrhage. The pads are then withdrawn and the abdominal incision closed and dressed in the usual manner. In case of threatened collapse from hemorrhage during the operation, the peritoneal cavity may be flooded with a 1 per cent, sterilized solution of common salt at a temperature of 100° F., a quart of this solution having been previously prepared. It is rapidly absorbed by the peritoneum, "and acts as a restorative — like transfusion." — (King's Obstetrics.) 2. Mastitis. Etiology: Infection, viagra tablets side effects generally due to handling; cracked or sore nipples and overacti\aty of the gland with retained secretion are predisposing causes. Treatment: This consists in resting the part; supporting it, applying a hot boraeic acid fermenta- tion; nursing from the affected breast should be stopped at once. Prophylactic measures consist in not touching the breasts (by doctor or nurse or patient) without thoroughly clean hands; by washing and drying the nipple before and after nursing, and by proper atten- tion to hygienic conditions before labor, and the nipple and breasts being preserved from pressure. 3. Placenta pnevia is the condition in which the viagra tablets side effects pla- centa is attacned in the lower uterine segment, and may be near or over (partially or completely) the in- ternal OS. Varieties: (1) Central, viagra tablets side effects when the placenta completely covers the os. (2) Partial, when the pla- centa overlaps the os. (3) Marginal or lateral, when the placenta reaches the margin of the os but does not overlap it. Symptoms : Sudden hemorrhage, accom- panied by syncope, vertigo, restlessness, and feeble pulse. Dangers: Hemorrhage, sepsis, death of the mother, death of the fetus. Treatment: stop the hemorrhage by a tampon ; this must be tight and thorough. Accouchement force is indicated; this con- sists of dilatation of cervix, version, and immediate extraction of the child. 4. Liquor AMNII. Functions: (a) During preg- nancy: (1) As a protection to the fetus against pres- sure and shocks from without. (2) As a protection to the uterus from excessive fetal movements. (3) It distends cheap single viagra pills the uterus and thus allows for the growth and movements of the fetus. (4) It receives the excre- tions of the fetus. (5) It surrounds the cheap single viagra pills fetus with a medium of equable temperature, and serves to prevent loss of heat. (6) It prevents the formation of adhe- sions between the fetus and the walls of the amniotic sac. (7) It has been supposed, by some, to afford some slight nutrition to the fetus. (6) During labor: It acts as a fluid wedge, and dilates the os uteri and the cervix; it also slightly lubricates the parts. 5. "In tnento-posterior positions, endeavor to secure anterior rotation of the chin when it fails to take place spontaneously. The several methods of attempting this are: 1. Press the forehead backward and upward dur- ing a pain, so as to make extension more complete, and thus cause the chin to dip lower down and touch the anterior inclined plane upon which it may glide for- ward. 2. Put a finger in the mouth, or on the outside of the lower jaw, and draw the chin forward during a pain. 3. Apply the straight forceps and twist the chin to the pubes. 4. Apply the vectis, or one blade of the forceps, under the most posterior cheek, and over the anterior inclined plane, thus, as it were, thickening the latter, so as to make it reach the malar bone and con- stitute a point d'apjjui which the chin can touch and so glide forward. Should these attempts to secure anterior rotation fail, an effort may be made with the hand, vectis, or fillet, to bring down the occiput and convert the face into a head presentation. In order to succeed in this maneuver the membranes should be unbroken, the os uteri dilated, the face not so deeply engaged that it cannot be lifted to or above cheap single viagra pills the pelvic brim, and an anesthetic administered. Again, failing in this way to produce anterior rotation, the head, if it be not too deeply engaged in the pelvis, and have not passed through the os uteri, may be pushed back, and the child be delivered by podalic version. Should none of these methods be practicable and the head become impacted in the pelvis with the chin toward the sacrum, the only resort is craniotomy. Attempts have been made in these cases to deliver by forceps after lateral incision of the perineum, but they can only succeed when either the child is small or the pelvis over-large. Usually the child's life has been so far imperiled cheap single viagra pills viagra tablets side effects by delay and cheap single viagra pills its consequences that craniotomy may be done without compunction. Possibly symphyseotomy may prove use- ful in these cases in future. In all cases of face pres- entation special care is necessary to avoid rupture of the perineum" (King's Manual of Obstetrics) .