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cerebral irritation usually went on for years. He had seen sev- eral cases in which the latter disorder had been present where braces had temporarily relieved the deformity, but recurrence had buy stendra online been noticed in a short time. He thought well of Dr. Weir Mitchell's recent method of treatment. He had patients under his generic stendra care Avhose condition had greatly improved after daily sus- pension had been practiced for a few months. A case present- ing a stendra online somewhat curious deformity had recently been brought to him. A girl ten years of age had both arms drawn forcibly backward by a persistent contraction of the muscles determin- ing that movement. He had concluded that the case was not a critical one when during a revival meeting complete relief of the condition had resulted from religious emotion, and had lasted a month, but had been followed by a recurrence shortly after her being engaged in avanafil online a quarrel. The Chairman said that in any case of muscular deformity it was a question of great importance to determine purchase stendra the cause, as well as to determine whether the contracture Avas not compen- satory. In some cases cheap stendra that he had seen, removal of the con- tracture by massage and rest had made a limb that had been partially useful perfectly useless, because the mechanical sup- port of the contracture had been removed. Where the deform- ity resulted from an incurable lesion of the brain or the spinal cord, appearances of disa'bility could be removed, but no essen- tial good was obtained. In undertaking the treatment of a case of deformity due to progressive muscular atrophy, purchase stendra online it should al- ways be borne in mind that progressive muscular atrophy oc- curred in three forms, in one of which the lesion was central, in another of which it was due to disease in the peripheral nerve. April 27, 1889.] BOOK NOTICES. 471 order stendra and in the generic avanafil third of which it was avanafil cost only and entirely due to disease in the muscular fiber itself or in the motor end plate upon the muscle. where to buy avanafil/extendra When it was possible to distinguish the latter two forms, mechanical treatment might hold out more chance of relief than where the cause was central. A question of gravity often arose as to when the brace should be applied. Thus, in a case of hemiplegia recently under his care, a cure had been effected by the use of the faradaic current after a sickness of a year, and when the patient could not rise from bed. Dr. Gibney having meanwhile been applied to by the parents for a set of braces. He thought that where an opera- tion for phimosis cured deformities in the extremities, tiiis re- sult was due largely to the stendra tablets shock and the effects of the ether on a more or less hysterical condition. But when poliomyelitis resulted in a deformity of the arm, great care was to be exercised in stendra price the giving of ether, as the respiratory center was here very apt to become paralyzed ; in two instances he had seen children come near dying on the table. Dr. Gibney, replying to Dr. Ingraham, said that in locomotor ataxia with deformities — in Charcot's disease or tabetic joints — he had not seen cases early enough to try the effects of pre- ventive treatment, but he should suppose that apparatus would only assist patients so affected to get about for a time; the dis- ease would not be in any way controlled. In reply to Dr. Field, he said that he had avanafil 50 mg not met with any cases of monoplegia or monospasm resulting from phimosis, but had seen general paretic disturbances and contractions in chil- dren relieved by circumcision. Such instances, however, he believed, were rare. look Jottas. Experimental Surgery. By Nicholas Senn, M. D., Ph. D., At- avanafil de 200 mg tending Surgeon, Milwaukee Hospital ; Professor of the Prin- ciples of Surgery and Surgical Pathology in Push Medical College, Chicago. Chicago : W. T. Keener, 1889. Pp. xii- 522. [Price, $5.1 De. Senn has here published in book form a number of pa- pers which have appeared from time to time in medical peri- odicals, so that this work is already familiar to surgeons. The author's many experiments enable him to speak with authority, and his ingenious methods avanafil de 100 mg of performing enterorrhaphy and enterostomy entitle him to a high position among abdominal surgeons. But it seems somewhat unfortunate that he should mar his otherwise perfect work by his recommendation that a " wound of the stomach or intestine should be sought for in some such way as a plumber locates a leak in a gas pipe." This reminds one of the remark made by the gentleman afflicted with prostatic hypertrophy to the effect that " cheap avanafil he would be much more comfortable stendra cost if his doctor were only a better plumber." Dr. Senn advocates inflation of the intestine ^er anum with hy- drogen in cases of penetrating wounds of the abdomen, in order that this gas may by its escape through the abdominal wound reveal the existence of buy stendra a visceral perforation. The gas must be ignited in order to prove that it is really hydrogen which is escaping, and, as he naively adds, this is a most efficient means of rendering the wound aseptic ! But how as to the peritoneal cavity ? This mast be distended with gas which has been forced through the rectum and colon, the cavities of which organs can

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