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.\nother class of cases met with after labor at full term have as their most prominent feature a large purulent collection in one or other side of the pel- vis, a condition frequently described as cellulitis and abscess. To this term the writer takes excep- tion, for he is convinced that these cases 'originate from sepsis carried through the Falloppian tubes into the pelvis, where the inflammatory exudate breaks down and forms an abscess circumscribed by an adventitious membrane so closely resembling peritonaum that operators Alesse Cost pronounce it such, and record the case as one of abscess of the broad liga- ment. I have studied these cases very carefully and from an anatomical standpoint I have never been able to make them out other than cases of circum- scribed peritonitis, and not Alesse Generics suppurating cellulitis. Cases of this class frequently occasion a Alesse Acne bulging of the rectouterine cul de sac so far Alesse Vs Yaz as to make it feasible to evacuate it through an incision in the vault of the vagina. That they can be so evacuated does not disprove their true nature. In septic metritis, which always means involve- ment of the annexa and probably of the peritoneum, radical surgery is unfortunately called for. Total hysterectomy, with the removal of the entire area of infection, tubes, ovaries, broad ligaments and uterus, should be performed. It is better, I think, in most cases at least, to perform this operation by the vag- inal route, packing the entire true pelvis with Buy Alesse Online iodo- form gauze. In closing. I cannot do better than quote from a paper written by Dr. Oliver Wendell Holmes, in 1843. Dr. Holmes says : "I have no wish to ex- press any harsh feeling with regard to the painful subject that has Alesse Price come before Aviane Vs Alesse us. If there are any so far excited by the story Alesse Discontinued of these dreadful events, that they ask for some word of indignant remon- strance, *to show that science does not turn the hearts of its followers into ice or stone, let me remind them that such words have been uttered by those who speak with an authority I cannot claim. It is as a lesson rather than as a reproach that I call up the memory of these irreparable errors and wrongs. No heart can tell the heart-breaking calam- ity they have caused ; they have closed the eyes just opened upon a new world of love and happiness; they have bowed the strength of manhood into the dust ; they have cast the helplessness of infancy into the stranger's arms, or bequeathed it with less cruelty the death of its dying parent. There is no tone deep enough for regret, and no voice loud enough for warning. The woman about to Buy Alesse become a mother, or with her new-born infant upon her bosom, should be the object of trembling care and sympathy wherever she bears her tender burden or stretches her aching limbs. The very outcast of the streets has pity upon her sister in degradation when the seal of promised maternity is impressed upon her. Alesse 21 The remorseless vengeance of the law, brought down upon its victim by a machinery as sure as destiny, is arrested in its fall at Alesse Ocp a word which Alesse And Acne re- veals her transient claim for mercy. The solemn Alesse For Acne prayer of the liturgy singles out her sorrows from the multiplied trials of life, to plead for her in the hour of peril. God forbid that any Alesse Mg member of the profession to which she trusts her life, doubly pre- cious at that eventful period, should hazard it neg- ligently, unadvisedly, or selfishly." June 20, 1903.] MacGOWAN: SURGERY OF THE PROSTATE. 1113 THE SURGERY OF THE PROSTATE FROM THE STANDPOINT OF PERSONAL EXPERIENCE. BEING THE ORATION IN SURGERY.* By GRANVILLE MacGOWAN, M. D., LOS ANGELES, CALIFORNIA. Purchase Alesse (Continued from p. 1062.) I have operated on forty-nine individuals ranging in ages from forty-nine to eighty years, for en- larged prostate with retention and catheter life, by what is known as total prostatectomy — which, of course, does not mean the removal of the organ — for this is not possible, except it be thoroughly ripe, when it can be stripped off the urethra like a bead ofif its string, as in the cases reported by Gib- son and Paul Thorndyke. Prostatectomy means rather the removal of such tumors as can be shelled out, or if it be necessary, cut out, in order to clear the channel for the free passage of the urine. Twenty-eight of these were perineal operations. Twenty-one were suprapubic. Of those operated on through the perinasum there were four Order Alesse Online who died. Two of these, the youngest, were aged forty-seven and forty-nine years respectively, and had carcinoma of the prostate. One of these had also an impassable stricture, requiring Yaz Vs Alesse perineal section without a guide. The prostate was known to be enlarged but was not believed to be obstructive until an attempt was made to enter the bladder with the finger through the membranous urethra ; the hard nodules, Alesse Generic Brand four in numijcr, felt fibroid and were removed. The in- dividual died from secondary hemorrhage on the fourteenth day. He was an alcoholic, and had had Alesse Vs Aviane total retention for three days when he came into my hands. The man of forty-nine years was a poor farmer who had led a catheter lifefor three years. There was increasing difficulty in the pas- sage of the instrument, until its introduction be-

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