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cured so far as the knee was concerned. A little later the author saw this case reported in a current periodical, and learned that the rapid recovery was due to the use of anti- gonococcus serum. He had heard several who had used the scrum in gonorrheal rheumatism express themselves as not being favorably impressed, and he had also heard that it was a failure in epididymitis. These failures were to be expected until further experiments had been made. Thir- teen cases were reported in detail. To be effective the serum ought to be administered early in the course of the disease. Seven of his cases were treated within twenty- four hours of the beginning of the epididymitis. The trouble had 500 Mg Valtrex lasted for from three to four days in Valtrex Order four of the cases. Three of the patients received two injections, 24 and 48 hours Valtrex Mg apart. These made an apparently com- plete recovery within a few days, but, suffering a slight relapse, another injection was made. Two received two injections, four received three injections, three received four, and two received five. He had tried the injections in the abdomen, as was done at first, but preferred the back of the arm, which was previously scrubbed with bichlorfde and alcohol. Of course, the needle? and syringe were care- fully sterilized. In no case was the local reaction attended with any Valtrex To Buy disagreeable sequelae. There was no trace of the disease in three cases. In two there was a rather long, soft mass left about the epididymis. He concluded that the serum had exerted a distinct effect in all the cases, and that the disease was distinctly modified and the duration shortened. In several instances the recovery was remark- able. Dr. L. Bolton Bancs of New York said he was some- what skeptical in regard to the use of the serum. Even without the Valacyclovir Valtrex serum one could assure a patient that he would probably have but four days of pain, but one could not promise that the swelling would subside in that time. Dr. Edward Martin of Philadelphia said that he could not tell from the paper what effect was occasioned by the injection of the serum. He did not think very favorably of sera, and said antidiphtheritic serum was the only one pro- ductive of much good. Dr. Swinburne said that patients were free from pain in four days, and sometimes earlier if kept in bed, but his cases were all ambulatory. Dr. Hugh H. Young of Baltimore said that it was prob- able that too little of the serum had been given. He sug- gested that larger doses should be given at once. The infection must be overpowered in the beginning to prevent further infection. He hoped that expectations regarding the efficacy of the serum would be fulfilled. Dr. W. K. Otis thought these experiments a step in the right direction. He agreed with Dr. Young that larger and more frequent doses should be given at once. Dr. Bransford Lewis of St. Louis took issue with Dr. Martin in regard to the inefiicacy of sera in the treatment of disease. He had understood that Order Valtrex the antitetanic serum had reduced the frequency of tetanus as well as its bad effects tremendously. The Use of Ointments in the Urethra in the Treat- ment of Chronic Urethritis. — Dr. Hugh H. Young of Baltimore, after giving a brief history of the suggestions made during the past fifty years as to the value of medi- cated ointments in the treatment of chronic urethritis, showed an instrument which he had devised for depositing ointments in the urethra. The instrument which he had devised consisted of an outer tubular sheath somewhat more than a semicircle in extent. It was provided with a solid removable obturator corresponding to it in size. This was rotated in the outer sheath, and, when in a certain position, furnished a large trough to be filled with ointment. After filling the trough, rotation was continued until it furnished a closed, round instrument, the ointment being inside. After the instrument was inserted into the urethra, the obturator was rotated backward to its first position and the ointment was pushed out into the urethra. When the instrument was withdrawn the operator made pressure upon the glans and the meatus to prevent the ointment from escaping. The rapidity with which a large amount of sterile ointment could be introduced into the urethra, as well as the simplicity of the instrument, made it very satisfactory. It was a great convenience to have various ointments put up in Purchase Valtrex collapsible tubes provided with long, nozzle-like attachments of metal, through which the oint- ment was deposited in a rope in the cavity of the instru- ment. The ointment could be sterilized by simply heating the nozzle. Dr. Charles H. Chetwood of New York thought that there was no question but that there was a considerable number of cases of chronic urethritis that could be effi- ciently treated by the use of ointments and bougies. The objection to fiuid applications was their uncertaint>', but if they could be retained for a sufficient length of time their disadvantages were overcome. He had a little clutch, which fitted on the end of the penis, and this enabled the fluid to be retained two hours at a time, if necessary. Dr. Bransford Lewis of St. Louis related his experience in making investigations regarding the use of ointment in these cases. He had used a hard rubber applicator, with a screw piston and soft rubber catheters, to Buy Valtrex make the in- troduction as easy as possible, and allow it to be retained. 636 MEDICAL RECORD. [Oct. 20, 1900 He had experimented with Valtrex Purchase lanolin and the other dif- ferent bases as detailed. After two years his experience was so disappointing that he discontinued their use. He made use of an apparatus, a kind of sound which produced a massaging etTect, with the application of the ointment. Dr. Arthur T. Cabot of Boston thought the ointment treatment had been discarded long ago. He had used iodo- form suppositories in certain cases, with an applicator left in the prostatic urethra. He had secured better results with aqueous solutions. Dr. F. TiLDEN Brown of New York said that he was satisfied that there were certain cases of urethral disease that were benefited by medicaments with an ointment base. He related the various means that he had used in intro- ducing the ointments. Finally he had used a Valtrex Buy Online preparation of a silver salt in lanolin ointment, from which he got firm adhesion to the sound of the ointment, which was not swept away by introduction into the meatus. He used some lubricant around the meatus. He was well impressed with the efficiency of this medication if it could be properly done. In chronic cases he thought a resolution of the strictures and a dissipation of the chronic discharges was brought about by a desquamation of the flat epithelium and a regenerative Valtrex Buy process. The Surgical Treatment of Sterility in the Male. — Dr. Edward Martin of Philadelphia said that while sterility Valtrex On Line was sometimes the result of double epididymitis, this was the e.xception rather than the rule. However, there were a sufficient number of cases of sterility from this cause to justify an investigation and an effort to relieve the condi- tion. It was with the general belief that the obliteration lay in the tail of the epididymis in conjunction with Drs. Carnet, Levi, and Pennington he had conducted experi- ments in order to determine the question as to whether or not by short-circuiting the vas and the head of the epidid- ymis in cases of obliterating inflammation it might not be possible to provide a route by which the spermatozoa might escape. Dogs were used in the experiments, the vasa being ligated and cut on both sides a short distance from their epididymal Cheap Valtrex origin. The proximal end was then split and sutured into an opening made into the head of the epididymis. Valtrex 500mg A normal number of motile and seemingly healthy spermatozoa were observed. There seemed little tendency toward ultimate closure through cicatricial con- traction. He did not have reliable evidence that these sper- matozoa were fertile in dogs, and it might be that they underwent some developmental change in their passage through the epididymis. He related in detail the history of the first case operated upon. Dr. Arthur Cabot of Boston considered Dr. Martin's paper an application of good common sense and good surgery. Dr. Robert H. Greene of New York had seen a surgeon attempt to perform an operation of that type, and the diffi- culty was the small caliber of the vas. An attempt to inject fluid through the vas brought out the same difficulty. Dr. Hugh H. Young of Baltimore had two cases of chronic prostatitis and seminal vesiculitis, with an obstruc- tion at the epididymis, but they refused operation. He made pressure upon the seminal vesicles, and if the ex- pressed fluid under the microscope showed large whorls of mucin, it could How To Order Valtrex come from no other portion of the genitourinary tract except the seminal vesicles, and he felt certain that he had patent ejaculatory ducts. This would show that the obstruction was Valtrex Online at the epididymis. The obstruction might be at the ampullae, or higher up. He considered Dr. Martin's operation an advance in surgery. Dr. Bransford Lewis of St. Louis said he did not con- sider himself a urethroscopist, but he had had two cases in which he could pass a soft, flexible sound, and catheter- ize the ejaculatory ducts and inject fluid into them as well, and that without any trouble and without inflammatory reaction. He used Swinburne's posterior urethroscope. Dr. F. TiLDEN Brown of New York expressed himself as impressed with the value of this operation. In spite of Dr. Martin's statement that the operation was simple, he thought that it would Get Valtrex be easy to make a failure of it He liad seen Dr. Martin perform the operation, and he felt that his timidity in undertaking it was fully justified. There were details in the technique, the bloodless approach to the vas, the necessity for special instruments, the placing of sutures for anastomoses, the snipping out of a piece of the epididymis, etc., which made him Online Valtrex think that tlie operation could easily be bungled unless one had seen Dr. Martin do it. He thought it most desirable to find the point of occlusion, whether of tlie globus major or minor, or higher up. Dr. Martin, in closing the discussion, said that he had not sounded the vas, because the operation being well .started, this would only cause needless trauma, as there was no instrument small enough to go through the vas without traumatism. A proper diagnosis as to the cases suitable for the operation was important. It was possible that one might get some benefit from catheterizing the ejaculatory ducts. Impressions of Genitourinary Work in Berlin. — Dr. H. H. Morton of New York related his e.\perience of two months spent in the clinics of Berlin. He thought cases were more thoroughly studied, and reports and statistics more carefully kept, there than here. There were no snap diagnoses. Second Day — Saturday, June 2. Treatment of Prostatic Enlargement — Dr. James Pedersen Buying Valtrex of New York said that his purpose in presenting this paper was to discuss what led up to prostatectomy, and what away from it. He considered the question as to when surgical intervention was advisable, and the operation of choice in a given case. In his opinion it was not possi- ble to say categorically when surgical intervention should be advised until we had more detailed and searching sta- tistics on both the radical and conservative sides of the question. He agreed with recent writers, who had entered a timely protest against excessive enthusiasm for operating, and there was a lack of anteoperation details. Whiteside, in 238 mixed cases, found really good results in only 30 per cent., a mortality in perineal prostatectomy of 20 per cent, in 36 cases reported by nine operators, a mortality of 8 per cent, in Murphy's 51 cases, of 5 per cent, in Young's 75 cases, and of 3 per cent, in Goodfellow's 75 cases. Five cases were reported in detail, as illustrative of points he wished to make. Conservative Prostatectomy vyith Minimum Hazard. — Dr. Charles H. Chetwood of New York said that in presenting this communication it was not his object to set forth any novel technique, but simply to give the results of personal observation during the past year on a class of prostatic cases that were usually described as bad risks.

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