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lower limbs, in a sack or bag (a common small pillow-slip would serve) of charcoal finely pulverized, a fair excess of this to be used, order glucophage so as to shield and envelop the tissues, the charcoal to be either directly laid on the wound, or mediately, a fold of some dressing, gauze or book-muslin, or the like, being applied next the surface; this not to be removed for days at a time, except under pressing ne- cessity, and then preferably by a jet of water from some clean source ; the same form of dressing glucophage generic to be reapplied thereafter, if fitting. Although this, as I am ready to glucophage xr 500mg admit, would not have the ex- tremely neat surgical look of good bandaging scientifically applied, I am convinced that, in hospitals glucophage price of the kind to which reference is made, it would prove infinitely superior to the orthodox dressing by the infected hands and armamenta of the ignorant, dirty, or careless army nurse or aid. The charcoal dressing may, and perhaps should, be slightly dampened with some antiseptic or disinfectant fluid, according to the predilection of the surgeon, though this, in view of the properties of charcoal itself, would seem supererogatory. I am convinced that, in this way, and by carrying out the ra- tionale price of glucophage of this dressing, a certain, not to say large, amount of septic infection, and consequent suffering and death in field hospitals, might be avoided. The -proceeding is so egregiously simple, that I have hesitated many years to set it glucophage tablets on paper, but have thought glucophage cost on it so long and seriously that, at the risk, it may be, of ridicule, I can hold my peace no longer. The earth-dressing of Ilewson has long been known, and has its advocates, as has also the cotton-batting dressing. We know that the perfect carrying out of tablet glucophage Listerism is practically impossible in the field, generic for glucophage and I incline to the belief, which 24 370 GOFFE: A CASE OF LACERATED PERINJEUM SO many eminent men have recorded, that that treatment owes its success, in the greatest degree, to the transcendental cleanliness ob- served before, during, and after operation, more than to the anti- septic and to the manner of using it. At any rate, as before said, it would be hard to carry out in tlie impromptu services demanded often in campaigns. It has sometimes occurred to me (in view of results obtained), while watching operations by some of the celebrated surgeons on both sides during that war, to doubt whether the surgeons who pre- * ceded Pare could not have got almost or quite as satisfactory results with a clean chop and a bucket of glucophage xr tar ; this, not glucophage 500mg in criticism of the operator, but in view of the after-chances of infection. Of course, all of the foregoing is not to be applied, or in only a very modified sense, to the admirable surgical work and dressing in civil hospitals, where air, instruments, bandages, assistants, etc., etc., are all clean, and the latter, especially, not overworked or careless. It may be asked, why I did not put this theory into practice when chance favored ; to which I would reply by asking those who know, how much time there is to think, busied as one is from morn- ing till night in the incessant routine work of a crowded hospital. I could, indeed, wish that portion of my life to be again lived over ; the assurance being, to my own mind, that some at least of the brave, manly fellows, German and French — whom it made me wild to lose, in spite of what I now dare to say was, on my part, devoted but useless attention — would not have had to leave their bones there if the line of treatment so buy glucophage online hastily sketched above had been followed, I hope that after some future Gettysburg, Worth, or Plevna, always, unhappily, possible in the future, some one who has not the time to do the regulation work will be led to give this seemingly crude innovation a glucophage mg trial. A CASE OF LACERATED PEPJN^UM WITH PRO- LAPSE OF THE RECTUM, WITH REMARKS. By JAMES E. GOFFE, M. D., HOUSE SUBGEON TO THE WOMAN'S HOSPITAL. How a prolapsed rectum can be safely and effectually treated is a problem upon which surgeons are cheap glucophage by glucophage diabetes no means agreed. Amputa- tion of the prolapsed part, involving cost of glucophage as it does the tearing of it away from its surrounding supports, is attended with so much danger from haemorrhage and peritonitis that the presence of can- cer alone can justify the operation. WITH PROLAPSE OF THE RECTUM. g'J'X The slight risk incurred and the perfect cure secured in ligating hseniorrlioids favor the extension of that principle to ligation of a prolapsed rectum in sections, and allowing it to slough, as recom- mended bj Ericlisen. However, at present, surgery is inclined to be rather conservative in operations on the rectum, and prefers palliative and safe methods to radical and dangerous ones. In the following case, which was a most unpromising one. Dr. T. Gaillard Thomas adopted a natural and effectual expedient, the success of which commends the operation, with glucophage buy hope of even better results in less aggravated cases : The patient was a woman fifty years of age, a native of Scotland, who en- tered the Woman's Hospital in February, 1882, with the following history : She Lad been married twenty-four years, and was the mother of six children, the last born ten years ago. The first labor was tardy — continuing five days — and in- strumental, lacerating the perinseum through the sphincter-ani muscle. The laceration was successfully closed one year later, and in a year following the operation the second confinement occurred, in which the perinteum was again lacerated, though not to so great glucophage sr an extent as glucophage online at first. Each successive labor in-

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