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eight cases with one death. In the latter instance the hasmor- rhage had been the severest that he had ever had to deal with, and he had been compelled to abandon the operation. In tiie various cases in which he had operated the amount of hoemor- rhage had differed considerably, and had seemed to depend upon the character of the tumor. Dr. A. G. GrERSTER thought that the seeming contradiction in the experience of various surgeons as to what is the generic for nexium the difficulty of con- trolling the hsemorrliage was due to differences in the method of treating the capsule of the goitre. His nexium 40 mg generic experience had taught him that if all the layers of the capsule were split through to the parenchyma of the enlarged gland, easy and almost dry enucleation of the goitre was the rule. If the capsule was only partly divided, the haemorrhage would be large in proportion to the proximity of the line of division to the parenchyma. In certain forms of large generic brand for nexium goitre of long standing, generally asso- ciated with calcification, the generic version of nexium capsule contained a large number of much-distended and very brittle veins that, being already stretched to a great extent, offered every chance for laceration, and none almost for the formation of suitable masses for the what is the generic name for nexium application of ligatures. In these cases, as had happened once in the experience of Dr. Wyeth, extirpation had to be given up after a great deal of trouble and loss of blood. If, on tlie other hand, the capsule was split through com- pletely, a procedure often involving the necessity of applying a double row of ligatures along both sides of the cut for its entire length, enucleation would be found much easier — often astonishingly easy. It when will nexium become generic must be added that there was a con- siderable number of cases of goitre in which a firm and not too vascular, rather loose capsule enabled the surgeon to re- move the hyperplastic part of the gland, together with its vas- cular envelope. If the resistant bands of tissue were systemat- ically generic for nexium 40 mg divided generic equivalent of nexium between two mass ligatures, a nearly bloodless excision was often possible. But splitting of the capsule re- mained, after all, the best procedure. Dr. Fred. Kammerer had witnessed many of the operations for the removal of the thyreoid in southern Germany and Switzerland. It was sometimes not easy to see, when cutting down on a thyreoid tumor, where the capsule ended and the parenchyma began. He did not entirely agree with Dr. Gerster as to the necessity of always getting through the capsule and enucleating a parenchymatous tumor, as basmorrhage could generally, according to his experience, be avoided if the extra- capsular operation was done systematically, as by Kocher's method. The ligation of the vessels on the tumor seemed to him to be the most troublesome procedure in the older methods of extirpation. This he would admit might be difficult. He referred, of course, to parenchymatous and not to malignant goitres, where during the operation it was often impossible to limit the portion to be excised to the contents of the capsule. Dr. MoBuRNEY remarked that in the case of the two tumors the i-emoval of which he had just given generic name for nexium an account of the cap. sule had been easily demonstrable, and the incision through the skin and fasciae had exposed it at once. He entirely agreed with Dr. Gerster in thinking it a good general rule to get down to the part that was to be removed as the first and all-impor- tant step. Rupture of the Quadriceps Extensor Tendon.— Dr. W. T. buy generic nexium Bull presented a patient who had been succes;^fully treated for the repair of this accident. He had been under the care of Dr. F. H. Markoe at Bellevue Hospital, where he is there a generic for nexium had been ad- mitted ten months prior to his appearance is there a generic nexium before the society. The sharp edge of a heavy body had fallen against his leg just above the patella. The power of extension had been completely lost, and a depression had appeared immediately above the pa- tella, in front, but the lateral expansions of the recti had seemed to be intact. A posterior splint had been applied and kept in position for three weeks, when a plaster splint had been substi- tuted and the patient allowed to go about on crutches. Passive motion had then been begun, and when the patient left the hospital the functions had been almost 80 mg nexium completely restored and were now perfect. The only trace of the injury was a thicken- ing of the tissues just above the patella. The speaker then read a paper relating to the treatment of this injury. (See p. 421.) The President had treated one case with the subcutaueou.s silk suture such as he used for fractures of the patella, and had obtained complete restoration of the functions of the joint. He believed that in this method the liability to the formation of adhesions which might seriously interfere with motion was less than after open suturing with exposure of the joint. Dr. Gerster gave the history of three cases of rupture of t\\Q rectuH part of the quadriceps muscle, just above the inser- tion of the tendon. Two complete ruptures had been observed in old people. The other one of the three was a case of par- tial separation in a middle-aged person. None order nexium samples of these patients had nexium dosage 80 mg been subjected to an operation, and in all of them perfect functional results had been obtained after a simple treatment by rest in the extended position on a dorsal splint, supplemented by massage of does nexium have a generic the thigh, especially of the flabby quadriceps, beginning with the what is generic for nexium third week following the injury. The main difficulty was to be looked for in most cases in the excessive atrophy due to long inaction. Active and passive movements should be very gradually employed, and ought generic form of nexium never to be forced or excessive. Dr. Wyeth said that he could not agree with the reader of the paper in his argument that the restricting dressing should be removed when does nexium go generic after four weeks, especially when this treatment was applied to fractures of the patella. Nor could he agree with Dr. Gerster in advocating massage of the quadriceps mus- cle early in the management of such cases. He held that tem- porary atrophy of these muscles was a benefit rather than an

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