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the shape of inflammatory exudate, and in this way opening up avenues of infection, thus doing more harm than good with the aldactone order instruments. In those cases where there is decomposed material in the uterus and already commencing pelvic peritonitis, it is advisable not only to empty the uterus, but to open the cul de sac by buy aldactone online an incision through the pos- terior wall of the vagina and introduce drainage. I am sure that cases which would otherwise end in general pelvic peritonitis can often be aborted aldactone 25 mg by this method of treatment. In fact, if this operation is done under strictly antiseptic conditions, little if any harm can accrue, granting that nothing abnor- mal is found. What usually takes place upon in- cision of the posterior vaginal vault is the escape of a serosanguineous, serofibrinous, or purulent fluid, depending upon the degree of peritonitis. The preparation of the field of operation is as essential here as elsewhere. The vulva and pubic region are to be shaved, and the vagina thoroughly cleansed. During the operation the external parts are bathed constantly by the bichloride purchase aldactone online and carbolic solution, which is allowed to flow from an irrigator. An antiseptic pad is adjusted upon completion of the operation. .A.fter each urination aldactone price the parts are to be washed with bichloride, etc. I think it safer to allow the patient to pass her urine than to use the catheter: First, because I believe it bad prac- tice to suspend the function of the bladder; and secondly, the use of the catheter is too often fol- lowed by cystitis, a condition I have seen quite aldactone buy as troublesome to correct as the one order aldactone online for which the operation was done. If a catheter is used it should be a glass or a metal instrument, for these are the only instruments that can be sterilized. It is fitting to say a word here relative to lysol as an antiseptic wash. Personally, I regard it as of little use com- pared with bichloride and carbolic acid. In short, to use lysol I consider much like sending a boy on a man's errand. If treatment is delayed, the temperature rises to 103° or 104°, the pulse becomes weak and rapid, the tongue coated and the breath foul aldactone 50 mg : buy cheap aldactone thirst, nausea, anorexia and a gradually progressing weakness and circulatory embarrassment presage the development of a general sepsis. Locally, the mucous surface becomes ulcerated or covered with a false membrane, and involution of the uterus is arrested. But such is the progressive nature of these infections that an endometritis, per se, is rare, and a salpingitis, metritis, or pelvic peritonitis are coincident. This brings up the question of abdominal section for puerperal sepsis, a most difficult problem, in- volving as it does the assumption that the attending physician has an exact knowledge of the lesion pres- ent. For instance, the disease manifests itself in some cases as a phlebitis of the uterine sinuses and of the veins of the broad ligament. The consti- tutional symptoms are pronounced ; rapid pulse, aldactone online high temperature, irritable stomach, with, in some cases, aldactone cost a disposition to diarrhoea ; associated with this condition of the vessels there is endometritis, giving rise to an offensive purulent discharge, often blood stained. Local examination shows a hot vag- 1112 DEAFER: POSTPUERPERAL buy spironolactone online SEPSIS. X. Y. Med. Jour, and Phil*. Med. Journal. ina, an enlarged, painful and movable uterus, which offers more or less resistance to aldactone mg touch, suggestive of infiltration; fulness and increased resistance in either vaginal vault indicative of a like condition of the broad ligaments; cheap aldactone and the absence of fulness in either the retrouterine or vesicouterine pouch. In this condition operation promises nothing; on the contrary, it may do much harm by breaking down septic purchase aldactone buy cheap spironolactone thrombi, often favoring foci of inflammation, to say nothing about the risk of cerebral or ptomaine emboli. Curetting is especially harmful. The treatment which promises most under these circumstances is supporting ; stimulants, large doses of tincture of iron, thirty drops every three hours, quinine, ten grains in twenty-four hours, plenty of milk and concentrated nourishment; locally, vaginal and intrauterine douching with bichloride and carbolic solution, antiseptic pads, etc., and ice bags constantly applied to the lower quadrant of the abdomen. The bowels are to be opened two or three times daily with salines. Convalescence is usually prolonged. In a percentage of these cases convalescence is interrupted by the development of foci of suppura- tion which, in my experience, has usually occurred in generic aldactone the broad ligaments, one more often than both being affected. This manifests itself aldactone tablets as a unilateral swelling, which can be detected by vaginal, rectal, and abdominal examination, and to the sense of touch presents a boggy feeling, a sense of resiliency or perhaps fluctuation. The general condition of buy spironolactone the patient usually bespeaks the presence of pus. We find a hectic temperature and moist skin ; the tongue is usually red, but not always so; chilly sensations are complained of or a decided chill may occur. At this stage of the disease operation is indicated, and the selection of the best avenue to evacuate the collection will depend on the point at which it is most accessible ; this may be through the vagina or immediately above Poupart's ligament. It is my experience that in these cases recovery usually occurs. I have seen spontaneous evacua- tion above Poupart's ligament, followed by recovery, take place in a number of cases.

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