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successful cases were those of Burn- ham, Kimball, and Boyd — online amoxil all American operators. Pean says the history of the operation comprises three distinct periods : " In the first, which extends to 1843, sui'geons meeting with fibroid or fibro-cystic tumors of the uterus, instead of ovarian cysts, recoiled before the consequences of amputation of the uterus, and did not complete the oper- ation." In the second period, which extends to 1863, " surgeons, emboldened by a more extended practice in ovari- otomy, and encouraged by the success obtained in cases complicated by adhe- sions, which at first it seemed impos- sible to overcome, took a step in ad- vance, and no longer feared to take away the body of the uterus whenever an error of diagnosis placed them in the presence of a tumor in intimate connection with this organ." The third period was initiated by Koeberl6 in April, 1863, who, " finding himself in the presence of a doubtful tumor, made arrangements for any eventuality ; he practiced gastrotomy, determined not to recoil even if, in order to remove the whole of the tumor, he should be obliged to have recourse to supra-vagi- nal amputation of the uterus. His courage was rewarded with purchase amoxil success." Kimball's case amoxil 500 was in 1853, antedating Koaberl^'s l)y ten years. Between Sep- tember, 1869, and February, 1872, 500mg amoxil P6an performed hysterectomy nine times, with seven recoveries. In 1875 Pozzi collected one hundred and nineteen cases, in which the mortality had been et-T per cent. In 1879 Letouscy pub- lished eighty-four additional cases, with 540 MONTHLY REPORT ON a mortality of 42"8 per cent. Keitli has performed the operation twelve times, with only one death. Savage six times, with only one amoxil generic death. The marked symptoms in cases of fibroid tmnors are haamorrhage and pain, the latter call- ing for relief quite as much as the for- mer. Adhesions are by no means ex- ceptional. They were present in nine of the author's twenty-one cases, and are a cheap amoxil formidable complication. In re- gard to cases which offer no encourage- ment amoxil order for removal he says: "A tumor which grows out laterally from the uterus, and amoxil 250mg carries with amoxil 250 mg it the broad ligament, offers insuperable difficulties in the control of haemorrhage amoxil buy ; or when the disease encroaches on, or actually involves, the vaginal portion of the cervix. Hence there must of neces- sity amoxil 875 be a certain amount of selection, not all in favor of amoxil 250 the operator." As to the operation, amoxil 500 mg the incision must be amoxil tablets in proportion to the size and nature of the tumor. In the author's experience a long incision does not necessarily imply greater gravity in the case. An incision twelve inches long heals as well as one of six inches. The crucial amoxil 875mg point is in the treatment of the pedicle. If the pedicle is narrow, springing from the fundus or the free surface of the uterus, it is immaterial whether the extra- or the intra-peritoneal method be used. H;emorrhage is the great dan- ger when the ligature is employed, as it is liable to cut through the amoxil price yielding uterine tissue. He advises division of the pedicle, getting two flaps, which may be brought together by interrupted or by continuous suture. He does not approve of Spencer Wells's method of covering the stump with peritongeum, and sees in it no security against bleed- ing. He adds: " Who ever heard of any one shutting out the raw surface of an ovarian pedicle ? " [A description of such a method of treatment will be found in the present number of this journal.] The extra-peritoneal method is, amoxil buy online however, the safest way to treat the stump, and is recommended by such men as Hegar and Keith. Olshausen's plan of using an elastic ligature, return- ing the pedicle, is not likely to become general — why, he does not say. He prefers Koeberld's amoxil 400 serre-naud in secur- ing the pedicle, since it is very easy of application, and by its use the amoxil 875 mg constrict-

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