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loops, filled with gas and with liquid, are driven into the peritoneal pouch ; the continuation of the effort increases the pressure in the interior of the rectum, and contributes to the strangulation lumigan bimatoprost of the pedicle of the hernia; the vessels of the rectal wall are distended by the effort, and by the bimatoprost online interference with the circulation of the large intestine; and at a given moment bimatoprost synthesis tlie pressure of the contents of the hernia ruptures the sac modified in its structure, oedematous and inflamed. Such is the pathogeny applicable to the case of Eoch6. In other cases the result may be brought about differently, and the essential role may rest with the purchase bimatoprost hsemorrhoidal ves- sels. No amount of pressure fi'om with- in the rectum is likely to buy cheap bimatoprost be sufficient to cause its rupture. The bimatoprost 0.03 author has made bimatoprost price a bimatoprost canada series of experiments to test the power of the gut in this respect, and has found it sufficient to withstand the pressure of 50 to 00 ctm. of mercury. To cause rupture, a sudden force ex- ceeding 70 ctm. is necessary ; then the peritonaeum ruptures first in difterent places, causing a noise like the tearing of parchment, and after this the other tunics give way. No such pressure within the abdomen is supposable. But that which the author believes to be admissible in these cases — the rupture of a rectal vein — it is also impossible to bring about experimentally. He has tried a series of injections into the veins to determine what amount of pressure was necessary to cause rup- ture, generic bimatoprost and has sometimes forced the in- jection through the whole venous sys- tem as far as the jugulars without ef- fecting a rupture, bimatoprost ophthalmic and at others has ruptured a mesenteric vein and not a hemorrhoidal. The pathogeny of this accident is therefore complex, but the author be- lieves it may be written as follows: The prolapsus is the predisposing cause, resulting in inflammation of the mucous membrane and dilatation and alteration of the veins. The straining causes the rupture of a vein, and the infiltration of blood among the diseased tuni(;s of the rectum causes their rupture. There are oedema of the rectal wall, catarrh of the mucous membrane, dilatation of the veins of the mucous and submucous tissue. The wall order bimatoprost of the vein becomes infiltrated with leucocytes, and the pre- disposition is established. Then, when the patient strains, his bimatoprost 0.01 prolapse is pro- duced and rendered irreducible. The 554 QUARTERLY REPORT ON effort at abdominal expulsion increases the tension of the blood in the bimatoprost cost dilated vessels, rendered feeble by inflamma- tion ; a vein ruptures as in a varix of the extremities ; the blood percolates the layers of the intestine all the more readily, as the infiltration of white cor- puscles has prepared the way ; the bloody infiltration becomes limited, the buy bimatoprost uk walls of the gut, dissected by the blood order bimatoprost online and already altered, break, and the hsemorrhage continues, sometimes into the peritonseum and sometimes through the anus. The author calls attention to tlie prob- ability of a similar pathogeny in cases of spontaneous rupture of the CBSopha- gus; but his aim is to call the attention of pathologists — to whom chance may afford an opportunity to examine a rup- tured oesophagus post mortem — to the anatomical buy bimatoprost online condition of bimatoprost uk the veins, and to the appearance of the ruptured coats. The author closes his study by giving purchase bimatoprost online the cases of this accident in full. The references cheap bimatoprost are as follows: I. His own case. II. Brodie, " London Medical and Surgical Journal," vol. Ivii, 1827. III. Adelmann, "Journal fur Chirurgie und Augenheilkunde," 1845. IV. Pyl : case found by Adelmann in " Pyl's Auffsat- zen und Beobachtungen," zweite Ab-

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