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thews Duncan said it was a rare thing for the uterus to descend so as to be grasped buy spironolactone by the utero-sacral ligaments. 18. Dr. Macan brings forward the much-discussed subject of the rational treatment of anterior and posterior dis- placements of the uterus. He quotes West as saying: "To the best of my power aldactone cost I take care of the general symp- toms, and leave the displacement to take care of itself." Grailly Hewitt and his followers look aldactone buy at the displace- ment as aldactone online the source of trouble, and as the object toward which treatment should be directed. Schultze's theory aldactone 50 mg is that in the lai'ge majority of anterior dis- placements the complications are to be mainly attended to, while in posterior displacements the primary indication is to treat the displacement. Before treat- ing displacements, it is fii-st necessary to know, as the author pertinently re- marks, what the normal position is, and this is by no means a fixed fact. Thomas says that in this position the (long) axis of the uterine body coincides with that of the superior strait. Barnes thinks that an inclination somewhat more acute than this need not be considered patho- logical. The American and English schools of gynaecology, in general, admit these types, and concede a normal mo- bility to the uterus of one inch and a half. Schultze claims that the nor- mal position, when the bladder is empty, is one of anteflexion, the anterior wall of the uterus being nearly parallel to the anterior vaginal wall. When tlie bladder tills the fundus is raised, Itut sinks again when it purchase aldactone is emptied, acted upon both by gravity and by intra-ab- dominal pressure. Schultze considers that the fundus tlius moves through an angle of 48°, and that pathological ante- flexion is most frequently caused by an inflammatory shortening of Douglas's folds, thus drawing the cervix towai-d the second bone of the sacrum. Fritsch adopts Schultze's views, claiming that the cervix normally makes an angle of 90° with the body when the bladder is empty. He says further that when any one of the ligamentous attachments of the uterus is shortened, the position of the uterus becomes fixed, and therefore pathological. The author agrees with Schultze and Fritsch, and, consequently, thinks that few cases of so-called ante- flexion require mechanical treatment, and that dysmenorrluea and sterility in such cases are generally due to the com- aldactone price OBSTETRICS AND GYNECOLOGY. 537 plications present. If mechanical treat- ment be required, it should be rather in the form of dilatation or order aldactone online a stem pessary than in cheap aldactone buy cheap aldactone the form of a vaginal pessary such as that of Thomas or Grailly Hew- itt. As to retroflexion and retrover- sion, he thinks there can be no question as to the fact that they are pathological conditions. As a means of diagnosis, he thinks aldactone mg the bimanual method far superior to the sound. The lever action of the Hodge pessary he discards as a by-gone notion. Three objections to this in- strument are evident to his mind : 1. The fundus presses so hard on its pos- terior arm as to drive the instrument out of the aldactone order vagina. 2. The fundus slips off purchase aldactone online to one side of the round posterior arm, and so pushes this portion into the opposite buy cheap spironolactone side of the pelvis, thus rotating the instrument on its long axis. buy aldactone online 3. If neither of the before-mentioned condi- tions obtains, the instrument causes so much pain by pressing against the ten- der fundus that it becomes unbearable. Various modifications of the instrument have therefore appeared, aldactone tablets among which are those devised by Grailly Hewitt, Thomas, Gervis, Greenhalgh, and buy spironolactone online others. generic aldactone If Fritsch's view as to the normal posi- tion of the uterus is correct, none ot these instruments are effective in reme- dying aldactone 25 mg the pathological condition : first, because the uterus has never been really replaced ; and, second, because the pes- sary is supposed to keep the uterus in

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