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mens in the New York Pathological Society, where it was exam- ined by several of the most experienced microscopists of purchase doxycycline the city, who unanimously declared that there was not the least doubt about the correctness of my view that it was inflamed muscular tissue of the smooth variety. I think we have here to doxycycline where to buy do with a modification of metritis which deserves the name of dissecting metritis. Yirchow * mentions that difiuse metritis preferably extends in the outermost layers near the peritoneal covering. Here abscesses are formed. When now we remember that the case began as one with deep diphtheritic ulcers in the visible parts of the genital tract, and a foul discharge from the interior of the womb, we can imagine that similar ulcers were doxycycline 100mg found in the body of the uterus, which may have circumscribed, more or where can i get doxycycline less completely, how to get doxycycline the piece which was subsequently thrown off in consequence of a deep-seated purulent metritis near the peri- tonneum. Two similar cases have been reported by the Russian physician Siiromiatnikow,t and there doxycycline online is scarcely any doubt that the case reported to this society % as a monstrosity, " probably composed of the * Klob, " Pathologische Anatomic dcr weiblichen Scxualorgane," Wicn, 1864, p. 247. f " Centralblatt fiir Gyniikologic," vol. v, p. 276, 1881. X "New York Medical Journal," vol. xxxv, No. 5, p. 522. 590 GARRIGUES: DISSECTING METRITIS. human heart," belongs to the same category. At least Dr. Kucher, doxycycline purchase online to buy doxycycline whom the specimen belongs, declared in the meeting of the Soci- ety of German Physicians, held June 23d last, that he had examined a ffreat number of how can i get doxycycline sections taken from it, and that they all were composed of smooth muscle doxycycline 100 fibers, and in every respect like mine. I am surprised to see how slightingly Spiegelberg* speaks of diphtheritic endometritis. According to him, the diphtheritic patch is nothing but a so-called pyogenic membrane, formed by the con- densation of inflammatory products on the surface of ulcerations. Others have come to very difibrent conclusions. Dr. Luskf com- municates the results of Dr. Steurer's special investigation in this direction, made under the guidance of Professor von Eecklinghau- sen. Steurer found, in all patients who succumbed during an epi- demic of so-called puerperal fever in Strasburg, diphtheritic patches about the vulva, or upon the mucous membrane of the vagina and uterus. These patches were always associated doxycycline to buy with a loss of sub- stance, and were composed of disintegrated fibrin, white and red blood corpuscles, and colonies of round hacteria in great abun- dance. From the patches the bacteria could be traced between the molecular fibers, and deep down into the canalicular spaces of the connective doxycycline order tissue, where their presence gave rise to cellulitis. From the canalicular spaces they entered the lymphatics, with resulting lymphangeitis. ... By perforation of the w^alls of the lymphatics which directly underlie the peritonaeum they made their way into the peritoneal cavity, and excited pysemic peritonitis. . . . The wide stomata upon the abdominal surface of the diaphragm allowed the facile entrance of the organisms into its lymphatics. where to get doxycycline From the lymphatics the bacteria enter the blood, and are deposited in various parts of the body. Steurer found almost invariably the doxycycline cheap glomeruli and arteriolee of the kidneys tilled with micrococci (round bacteria). Professor Hjalmar IIeiberg,:|; of where can i buy doxycycline Christiania, doxycycline mg has like- wise found masses of zoogloea not only on the surface of diphtheritic ulcers in the uterus, but extending into the adjacent tissue. Our case exemplifies the vast destruction which may result from diphtheritic ulceration of the genitals, and warns the physician not to lose any time in instituting a most energetic treatment. I have jn vain tried iodofonn and carbolic acid, but have found that chlo- ride of zinc works admirably. Even this fatal case shows to some extent the efficacy of the treatment, all the ulcerations having healed. Had she not been accidentally killed she might, perhaps, * " Lehrbuch d. Geburtshiilfe," Lahr, 1878, p. 725. t " Science and Art of Midwifery," New York, 1882, pp. 617 and 631. I "Die puerperalen und pyamischen Processe," Leipsic, 1873. EDITORIAL. 591 even have recovered as did tlie three other above-mentioned patients. On the subsidence of the metritis, uterine contraction might have expelled the foreign body, and the two fistulas leading into the in- testine might have closed spontaneously. Besides the cauterization and carbolized washings, when there is any rise of temperature, I how to buy doxycycline give carbolic acid internally, about one minim every hour. Note. — Since the foregoing paper was read before the Obstetrical Society, I have had the opportunity to see the beginning of the process in 100 mg doxycycline another case, which explains how such large and thick portions of muscular tissue can be thrown off. In that case, there was not the least affection of the vagina to lead us to a diagnosis. The uterus had been washed out with carbolized water, but no chloride of zinc had been used. At the au- topsy we found the anterior wall of the uterus, where the placenta had been attached, two inches thick, and the whole organ measured nine inches by five. Around the opening of each Fallopian tube was found a diphtheritic patch of about the size of a three-cent piece, and from this point the diphtheritic matter could be followed far away into the deeper parts of the muscular tissue. 6bil0rxals. BEiriSH AND AMEKICAN OVARIOTOMY. Doubtless it is well known to most of our readers that ovariot- omy is far fi'om being so get doxycycline successful an operation in this country as

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