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out, or caused suppuration, kamagra jelly online and rendered a second operation necessary. This never failed when done with tlie wire suture. He used the best so-called anti- septic sutures sold at the shops. With regard to the time required to do the operation, it differed little whether the one or the other suture were used ; the difference could not be more than ten minutes at most, and this was unimpor- tant, especially if the patient were etherized. He had often done the operation without etherizing the patient at all, particularly in former years. The longer he used the silver-wire suture the more he felt our indebtedness to Dr. Sims buy kamagra for popularizing the metallic suture; and, if he had never done anything else for the profession, that alone would entitle him to our gratitude. Dr. Skene said that, in order to have this matter as well understood as possi- ble, he would refer to the fact that, out of the eighty or probably kamagra fast one hundred cases which he had operated upon, there occurred but a single failure, and only five or six partial failures. In the kamagra in uk case of the complete fniluro the silver-wire suture was used. The patient subsequently came to his oflice, he closed the lac- eration with silk kamagra paypal sutures, soon afterward removed the sutures, and the kamagra kamagra co uk result was a perfect success. So that while he, with Dr. Fallen, felt gratitude to Dr. Sims for having introduced the metallic suture, kamagra quick because of the advantages which it possessed over other sutures known in the past, he did not think it should deter us from the use of a better one for certain purposes which had been since de- vised. The silk suture prepared as indicated was just as non-irritating, just as perfectly antiseptic, as the silver wire. But those which were for sale in the shops, so far as he had had experience with them, did not possess the qualities referred to. Dr. Sims's reputation did not depend purchase kamagra upon the continued use of the silver wire in this operation ; he deserved our gratitude for the good which his introduction of it had brought about, but, as Lister's name would remain great buy kamagra jelly 41 g42 PROCEEDINGS OF SOCIETIES. among us while Listerism itself would be superseded by something else, so might Sims continue in our gratitude though the silver-wire suture should be super- seded by a better one. Besides being just as non-irritating and antiseptic as the metallic suture, the silk suture certainly offered greater facility in its use. The diflBculty of manipulating half a dozen or a dozen silver wires, which tended to kink and become twisted together, was certainly opposed to facility of operating, especially in the hands of one not expert. In reply to a question by the Presi- dent, he said he did not recall the exact proportions of the mixture in which he soaked the suture, order kamagra but it was about five per cent, of carbolic acid, perhaps a little less than that of salicylic acid. The important point, however, was the long immersion ; an hour or two was not sufficiently long a time. If prepared as directed, the suture would not swell when left in water. In reply to a ques- tion by Dr. Foster, he said the advantages of braided over twisted silk were that it did not untwist, remained perfectly solid, and he thought it was stiffer. This preparation was almost as stiff as silver wire, and did not untwist before its use or afterward. The ligature was not fit for the tying of large vessels kamagra online or a pedicle, as it would slip, whatever knot were tied, but it would not slip from ordinary swelling of tissues. Dr. Claeke remarked that he thought a gain of ten minutes in the perform- ance of the operation was considerable, especially if the patient were nervous and not etherized. He thought it usually required more than ten minutes longer to do the operation with silver wire. Dr. R. Watts asked what objection there could be to doing the two opera- tions — that for laceration of the cervix and perinsenm — at the same time. The objection seemed to be kamagra oral gel a very common one. lie had done the double operation iu a number of cases, at least eight or ten, and lie had never had any trouble from the sutures in the cervix, although he left them in four weeks or longer, and menstruation had occurred in the mean time in several cases. Dr. Fallen replied that his only reason for first closing the laceration in the cervix was that in his earlier practice, with rough sutures, etc., in a number o-f cases the cervical operation was not successful, and if the double operation were done he would have to wait for some time before operating on the cervix again, as the perineeum was tender. At present, however, there could be but one objec- tion to the double operation : that was the prolonged use of ether, extending at least over an hour and a quarter. Dr. HuNTEE remarked that he had done the double operation on two patients at the hospital the day before within an hour and three quarters. He was the first to do the double operation at the Woman's Hospital. He had asked Dr. Thomas's and Dr. Emmet's opinion regarding it, and they advised against it. Nevertheless, he did it, and the result was successful. It saved buy kamagra in uk time on the part of the patient. The President remarked that he thought the objections offered against the double operation kamagra online uk were imaginary — namely, the kamagra to buy discharge which might arise from the repaired cervix coming in contact with the sensitive perinteum, and, second, the liability to injury of the perinseum in removing the cervical sutures. He had good results, although he removed the sutures within three or four weeks. Dr. Pallen remarked that it would not matter if the silver-wire suture were left in the cervix two months or longer. He had known it, however, to excite irritation in the glans penis in one instance iu which he and Dr, Sims- had for- gotten to remove the sutures. NEW YORK OBSTETRICAL SOCIETY. g43 Dr. Skene remarked that in these cases there was almost always some pro- lapsus of the uterus, and one objection to doing the two operations at a single sitting was that, on account of the repaired perineum, treatment for the prolapsus and the attending discharge could not kamagra cheap be continued so well. He introduced a tampon of marine lint, which he considei-ed better than the douche, as the latter was intermittent, and might not remove all irritating matter ; the lint kept the parts clean, contained antiseptic fluid, and retained the parts kamagra on line in position. lie would say that the suture which he used was not made of silk, but of Japanese whale sinew, and this suture became entirely absorbed in about six days, which was sufficiently long to allow the parts to heal. In reply to a question by kamagra now Dr. Hunter, he said that when he used the silver wire he removed it about the eighth day. Dr. Hunter said he was accustomed to leave the suture longer than that, as in some cases he found union was not so strong at the eighth as uk kamagra at the tenth day. Dr. Hanks remarked that some years ago Dr. Peaslee performed the double operation at the Woman's Hospital, and was doubtful whether it would prove

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