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fection is confined to the Falloppian tubes, one or both, there may result a tuboovarian abscess, usually a favorable condition for operation. It will can you buy albendazole over counter be seen, therefore, that if the pelvic cellular tissue becomes involved, it is only secondary to a pelvic peritonitis. If abscess formation occurs as a result of the latter, while from the location of the collec- tion it is necessarily a pelvic abscess, it does mebendazole albendazole over counter not mean that it is the result of pelvic cellulitis alone, but of a pelvic peritonitis as well ; the latter being the primary lesion of the floor of the pelvis. These abscesses become extraperitoneal through Nature's effort to protect the general peritoneal cavity. They can be opened extraperitoneally by an incision through the vault of the vagina or above the outer half of Poupart's ligament, depending upon the site of the most prominent part of swelling. Where the inflammation is not confined, but excites a pelvic peritonitis that is not disposed to become limited by generalizing itself, the case is serious. I do not believe that pelvic cellulitis cheap albenza as a primary condition occurs, except by infection introduced by way of a wound through the peritonaeum, tears in the vagina or cervix which take place during childbirth, or by extension of pus from the upper to the lower retroperitoneal space. I question the wisdom of the practice advocated by some surgeons of repairing a recently torn peritonaeum or cervix by doing the ideal albenza 200 mg operation. The tear having oc- curred, cleanliness and drainage are to my mind the surest road to recovery. I would particularly advise purchase albenza online those of you who are not generic albenza doing surgery daily to follow the latter practice. The expert operator is at times justified in doing that which he could not order albenza online conscientiously advise the occasional operator to do. The uterine wall may be directly attacked, as a albendazole albenza result of septic endometritis, order albenza with ulceration, necro- sis, or localized collections of pus within the uterine muscle. The buy albenza online uterus is frequently boggy, oedematous, and friable throughout, or else the inner layers of the nuiscle may alone be involved, with sloughing off of masses of tissue (dissecting metritis). In most cases of metritis a septic lymphangeitis and thrombophlebitis is present, frequently followed by pyaemia. The symptoms of the various forms of puerperal sepsis depend upon the virulence of the infection, the nature of the tissues attacked, and the resistance of the organism to absorption of septic products. albenza price The most common type is a simple sapraemia from the absorption of the toxines produced by the putre- faction of shreds of decidua, blood clots, etc. Upon the second or third day after labor the temperature rises and the lochia may have a foul odor ; albenza 400mg the appetite is impaired and there may be slight nausea and chilly sensations. The pulse is usually a little faster than normal. In these cases early recogni- June 20, 1903.] DEAVER: POSTPUERPERAL SEPSIS. iiii tion will confine the operative treatment to the vagina and uterus and simply necessitate thorough cleansing of both cavities and the establishment of drainage with iodoform gauze. All symptoms will usually disappear thirty-six hours after operation. Septic endometritis, from infection by strepto- cocci and occasionally staphylococci or pyogenic bacilli, buy albenza may assume serious proportions and give rise to a general and fatal sepsis. Such infections have their starting point in a torn or abraded surface in or near the vaginal can i get albendazole over the counter outlet, with an extension of infection upward or else pri- marily in the uterus itself. Ihe symptoms at first are purely local and at this time most buy cheap albenza amenable to treatment. If allowed to pass this stage in its development we may meet with any or all of the complications and extremelv dangerous conditions of a full fledged puerperal sepsis. The lochia becomes foul, the mucous mem- brane of the genital tract reddened, the temperature elevated, and the pulse increased, with perhaps some chilliness. It is at this time that prompt, vigorous disinfection of the genital tract is indicated, with active stimulation. It is Always better to err on the safe side and purchase albenza disinfect the parturient tract albenza online of every patient who has a rise of temperature with disturbance of the lochia, than to allow one woman to progress to general infection. To defer curetting, cleansing, etc., until the pa- tient is constitutionally infected with perhaps a sep- tic peritonitis is virtually locking the stable after the horse is stolen. Early recognition of the danger and the immediate institution of proper treatment is the sine qua non to a successful issue in the majority of cases. Conservative treatment' is the early institu- tion of radical measures, which results in saving life; not the waiting until the "eleventh hour' in hope that Nature, by establishing albenza cost a leucocytosis or what not, will by chance accomplish a cure. The best possible curette is the finger, but the use of the dull currctte is warrantable. I would ad- vise against the use of the sharp curette, and with either instrument, dull or sharp, always against too nuich curetting : it is simply necessary to empty the uterus of decomposing matter. Too much activity with the curette exposes albenza tablets the patient to infection from the breaking down of Nature's barriers, in

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