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sharply forward by an assistant. Peritoneum, muscle, and fascia are then sutured permanently up to the posterior surface of the cventratcd uterus. The small circular opening around the cervix where the uterus iirotrudcs is next caulked with a gauze s])ongc, the uterus opened by the intcr- tubal incision of Fritsch, and the fetus extracted. The ovarian and uterine vessels are ligated, the broad ligaments cut, and the uterus am|)utaled at the cervix with the actual cautery, leaving an ample stump. The latter is now drawn together by con- tinuous or interrupted sutures, the o(x;nings in the broad ligaments Cheapest Online Pharmacy For Cialis closed, the gauze packing round the cervix withdrawn, and the parietal peritoneum sewn around the closed off uterine stump, leaving it entirely extraperitoneal. Closure is then com- pleted, the skin and muscle covering the cervical remnant, and a very small strip of gutta percha or rubber dam is carried through the lower angle of the incision to the stump. In this operation the general jx;ritoneal cavity is not soiled by hquor amnii, the tissues of the presumably infected uterus are sealed with the cautery knife, the cervix is kept extraperitoneal, and no sloughing area to be healed by granulation is left. The operation takes no more time than the usual form of Cesarean section, and subjects the child to no greater risk. Nitrogen and Cancer. — John Thompson Shir- law {Fractitioiicr, March, 1918^ is inclined to be- lieve in a causal connection between the development of cancer and the failure of the functional activities of the spleen and lymphatic glands, which results in a slow and gradual accumulation of nitrogen in the blood and tissues. Based on this theory, the treat- ment of cancer suggested is to supply the ferments which normally act on nitrogenous bodies, that is, to give the patients extracts of the spleen and of the lymphatic glands. lie Cheapest Online Pharmacy For Cialis reports a case of clinically diagnosed carcinoma of the duodenum in a woman of seventy which has been treated solely with live grain capsules of splenic extract for eighteen months. At one time she was so ill as to be thought dying, but steadily improved under the treatment, put on flesh, and finally walked a distance of ten miles. The diagnosis could not be made with cer- tainty, but the tumor was easily pal])able, and he feels confident that the diagnosis was correct. While not claiming that the case proves the success of the treatment, it seems to furnish encouragement. Acidemia and Treatment of Gas Gangrene. — Aliiinith I'.. Wright and .Alexander l-'leining ( Lancet, I'ebruary 9, 1918) record their observations which show that a reduction in alkalinity of the tissues or blood greatly favors the multiplication of the several gas forming bacilli, and, further, that the growth of these organisms tends to produce an acidemia and a local reduction of alkalinity. Cheapest Online Pharmacy For Cialis Their predilection for dead or badly injured muscle is also due to the Cheapest Online Pharmacy For Cialis fact that such muscle has Cheapest Online Pharmacy For Cialis a reduced alkalinity. These oliservations lead the authors to Cheapest Online Pharmacy For Cialis recommend the practice of intravenous infusions of live per cent, sodium bicarbonate solution in amounts of 500 mils at a time. This should be followed by an after- treatment with the Cheapest Online Pharmacy For Cialis lactate of soda by mouth to keep the urine alkaline. The lactate of soda is chosen because it is well borne by the stomach and promptly converted into the carbnate after absorption. It cannot he used at the outset owing to the presence of nausea and vomiting. When operation is neces- sary it should be preceded by the administration of a sodium bicarbonate infusion and nitrous o.xide and oxygen or warmed ether should be the anesthetics, preferably the former. Finally the local wound or the amputation stump should be treated with five per cent, solution of sodium chloride to promote the exudation of lymph and thus to raise the local alkalinity. The results of this plan of treatment have been good, and it is suggested that it may even forestall the development of acidemia if the infu- sions of alkali be started very early. Frctqucntly, inofx'rahle cases are rendered ojicrable by the intra- venous infusions. 952 MODERN TREATMENT AND PREVENT IV Cheapest Online Pharmacy For Cialis E MEDICINE. [New York Medical Journal. Climate in Tuberculosis. — H. F. Gammons (Boston Medical and Siinjical Journal, March 14, 1918J says that a persons with an ulcerative case ot tuberculosis who has given his home climate a chance, and at the same time has coupled the climate with other standard treatments for tuberculosis, .such as fresh air at Cheapest Online Pharmacy For Cialis all times, rest, diet, and content- ment of mind, and who is at a standstill, will, if he is financially able, unquestionably obtain good re- sults in the Southwest. It is necessary, however, for such a patient to have all other factors accessory to the cure, such as rest, diet, etc. If one is fortu- nate in being able to take the cure in one of the sanatoria of his vicinity under the proper regula- tions, it is better than to go to the Southwest and l)e compelled to care for one's self or to rough it. Systematic Therapeutic Exercises in Hemi- plegic Paralysis. — Robert Oden {Journal A. M. A.. March 2.5, 1918) points out that general mas- sage treatment has failed to give satisfactory re- sults in the improvement of the paralysis in hemi- plegia largely because all of the muscles of the affected parts were treated indiscriminately. On the other hand, the proper application of massage metliods and exercises so as to stimulate the weak- ened muscles and relax the contracted ones, when carried out intelligently and Cheapest Online Pharmacy For Cialis persistently, was pro- ductive of strikingly favorable results even in cases of ver\' long .standing. The several methods to be applied and tlieir indications are discussed in the paper and the results of such treatment in a num- ber of cases are recorded to show the benefit which can be secured in cases which have shown little or no improvement under general massage. The con- tention as to the value of the proper application of the methods is supported by the results of experi- ments on artificially heniiplcgic nionkevs.