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explored, and enables him to avoid pushing the in- strument against ulcerated surfaces. The metal plug instruments have been pushed through deeply ulcerated portions of the bowel, as it is impossible for the operator to see each portion of the bowel before the instrument reaches it. These instruments possess every advantage of other proctoscopes and sigmoidscopcs. are Aygestin Price inexpen- sive, and can be safely used by the most inexperi- enced physician. The patient should have all constriction removed from the waist and be in the knee-chest position. The operator should constantly Buy Aygestin bear in mind the normal direction of the bowel : through the distal two inches the instrument should be made to pass as though the umbilicus were the objective point. then it should be turned abruptly backward, or rather upward, in the Aygestin 5mg proctoscopic posture, into the hollow of the sacrum, the concavity of which is closely followed for the succeeding Generic Aygestin four inches. The instrument readily enters the sigmoid after pass- ing the rectosigmoid valve. 1 148 MISCELLANY. N. Y. Med. Jour, stto Phila. Med. Journal. gp;isalkng. Surgery of the Heart. By Benjamin Merrill Rickctts, I'll. B., AI. D. {Continued from p. 964). ANEURYSM. 1843-I903. Aneurysm may involve any portion or the whole of the cardiac wall. The left ventricle and upper portion of the intraventricular sa^ptum are the most frequently involved. Heart strain and syphilis are the most frequent causes. There is no group of symptoms that will definitely determine their presence. The rupture in the direction of least resistance, which may be in the pericardial or pleural cavity. There have Aygestin Online been one hundred and twenty-five contributions to this subject. C.VRDIORRHAPHY. There Aygestin Cost have been tifty-three cases Aygestin Tablets in which gun shot and stab wounds of the heart have been sut- ured ; in eighteen of which recovery took place. Penetrating or non-penetrating Buy Norethindrone Acetate wounds of the \\-alls of the four chambers of the heart have been sutured with more or less success, the ages varying from childhood to old age in both man and woman. Some have been done with and some without the use of chloroform or ether. Some have been sut- ured with silk and some with catgut. The time of operation after injury has varied from immediately to twenty hours. Accident to the coronary artery during operation h^s occurred in one Aygestin 5 Mg case. There have been twenty-six contributions to this subject. CARDKlI.ITHS .WD CO.NTRETIONS. are quite common, and originate from the blood, polypoid growths, clots or microorganisms. They may form in any part of the myocardium and rup- ture into the pericardial cavity or into any of the cardiac chambers, and may afterwards pass into other chambers Norethindrone Acetate Tablets of the heart, or pass out beyond the tricuspid valves. There are many such cases re- ported, beginning with that of Goodwin (1700). There have been sixty contriliutions to this sub- ject. FOREIGN BODIES. 1814-1903. Foreign bodies in the hearts of bipeds are usually found in the floor of one Buy Aygestin Online of the ventricles. The heart of the quadruped is in a different posi- tion from that of the biped ; it falls backward when man is upon his back ; in the animal forward when he walks about or lies down. Foreign bodies Buy Cheap Aygestin in the heart are of two types, those that form within the heart itself, and those that had been made to enter the heart from without. The latter consist of metals of various kinds and shapes, wood, glass, etc. l-'erris (1882) reports a case of a man who lived twenty days with a screw traversing his heart. There have been twenty-five contributions to this subject. OSSIFICATIOX AND CALCIFICATION. 1832-1903. A deposit of calcium carbonate or phosphate asso- ciated with some of the salts of magnesium is some- times found in the heart. It may be deposited in the endothelium and the intermuscular fibres. It is usually preceded by fibrosis and is due to weak cir-

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