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evidence now at hand, the operative surgery of epi- lepsy must be regarded as an experiment with a very uncertain future. The facts at our disposal seem to indicate that while trephining may be a justifiable measure in these cases, the careful and conscientious sm-geon must warn his patients and the parents not to be too sanguine of good results. Statistics seem to prove tliat operative measures should be employed only in traumatic cases in levitra no prescription usa which there are localizing 530 MEDICAL RECORD. [October 8, iJ features, such as a depressed fracture, a scar from an old injury, or focal manifestations on the part of the brain. J. C. Oliver. Mortality of Prostatectomy. The mortality after prostatectomy is still high about eighteen or levitra prescription help twenty per cent, for all operators. It is gradually becoming less as the indications for the operation are better un- derstood. The death rate of individual operators will undoubtedly continue to grow less as they become more e.xpert in performing the operation, and the cases of relapse and failure will be much fewer as more experience is gained. Alexander. Fistula in Ano. According to Dr. Cooke, the fol- lowing important points should be observed: (i) A careful physical examination of the lungs as well as of the entire rectum is to be made in every case. (2 | Pulmonary tuberculosis is not necessarily a contra- indication. (3) Do not levitra no prescription usa put down the knife until cer- tain that every sinus has been divided. 14) Remove all diseased tissue. Large wounds are not to be feared. (5) Caution: the sphincter is to be divided only once and at right angles. ('6) Special attention is to be given to the mucous opening. (7) Invasion of the perineum must be avoided, especially in fe- males. (8) Systematic antisepsis is necessary levitra no prescription usa if good results are desired, (g ) Care and patience are re- quired in the after-treatment. Dressings are not to be left to the family nurse. (10) In the after-treat- ment two warnings are to be heeded; complaints of unusual pain by the patient and increase of the dis- charge. levitra no prescription usa levitra prescription help Either of these may mean the formation of another abscess. (11) Hemorrhage and incontinence of faces are the chief danger. Both are amenable to treatment and should not deter from the operation. Medical News. Suggestions. Never allow rubber plaster to come in contact with a surface uncovered by normal skin. Since it cannot be sterilized by heat, it must be consid- ered as being dirty. Before operating, always find out whether the patient has any malarial history. The discovery of this fact will save you levitra prescription help many a bad scare when temperature rises suddenly after operation. As long as any urine issues from the urethra it cannot be said that there is an levitra no prescription usa impassable stricture. Patience and gentleness will do wonders. The most levitra no prescription usa skilful surgeons see very few strictures that prove impassable. An aseptic dressing placed over a w6und that is e.x- pected to unite by first intention should be left un- disturbed until it is time to remove the stitches, or until there is reason to believe that the levitra no prescription usa case is not running the e.xpected aseptic course. If you find al- bumin in the urine before operating for pelvic trouble, remember that it may be due to cystitis and not to a nephritic condition. Investigate microscopically or by catheterization of the ureters if possible. Albu- min does not signify much if casts levitra no prescription usa are persistently absent. Fishbones stuck in the pharynx are nearly always inserted upon the lateral walls, a little abo\e the aryepiglottic fold. It is often difficult to detect them with the mirror. Spray cocaine and search with the finger, remove with forceps, and warn the patient that he may feel for a long time as if the bone was still in position. Wherever large wet dressings are indicated for a long time, we often find that all of the antiseptics now in use may cause an eczematous con- dition of the skin, unless so diluted that their antisep- tic power is more than doubtful. In such cases the employment of simple saline solution is frequently of the greatest value, cutaneous irritation seldom follows its use, and wounds do as well as with any of the anti- septics. Do not levitra prescription help cauterize infected wounds, unless it is to obtain a moral effect in a scared patient. It was shown more than fifty years ago that when horses were inoculated with glanders, and sheep with pox, cauter- ization levitra no prescription usa with a red-hot iron, applied ten minutes after inoculation, failed to check the disease. An infected wound should simply be well laid open and covered with a wet dressing. The use of nitrate of silver to levitra prescription help cauterize wounds levitra prescription help is a harmful absurdity. International Journal oj Surgery. Tuberculous Abscess. After evacuating the pus inject ol. cinnamomi, 10: ol. sterilisat. q.s. ad 100. Marioitl The Operative Treatment of Irreducible Subcuta- neous Fractures. levitra prescription help Ransohoff, in an article on this subject, believes that in certain cases an interference before union had resulted would be preferable to the certainty of deformity, and reports seven cases which have come under his observation in which the frac- ture was exposed and directly treated. The author states that his experience or what he has gleaned from literature does not warrant him in coming to conclusions that are final. Nevertheless, he believes that it would be justifiable to submit in a tentative way t.'.: following postulates: (i) The conversion of a simple fracture is justifiable when other means to se- cure the best end results fail. (2) In fractures of the diaphysis of the tibia, femur, humerus, and clavicle, in which insurmountable longitudinal displacement or axial rotation has taken place, immediate operation or mediate operation before definite union has occurred