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for the operation. The operation was performed poker freezeout wiki in an appar- ently most unfavorable case, but the patient recovered. Dr. Malcolm McLean, with all respect to Dr. Barker, must game poker texas free say that he had had better results in laceration of the perinwum when he inserted a single silk suture immediately after its oc- currence than when he trusted simply to cleanliness. The sut- ure should be deeply and properly placed, and without undue disturbance to the patient. He would not use silver wire. Nowadays women felt that the obstetrician had not done his duty poker casino new york when he left a laceration unrepaired. Dr. game poker texas boyaa resorts world casino new york video poker H. J. BoLDT protested against the primary operation for ' lacerated cervix, except when there was profuse hsemorrhage. Dr. Polk, being asked by Dr. Barker his present opinion re- garding the primary operation for laceration of the perinieum, practice shamrock 7 poker games said that, unless, as occurred in exceptional cases, there were shock and exhaustion contra-indicating it, he would close the wound with silk sutures, not wire. Dr. Lee did not think it advisable to repair mere abrasions of the fourchette, but his experience in an institution where many primiparte were confined, and in private practice, had confirmed the advantage of the immediate operation in more marked lesions. He continued the chloroform which was usu- ally called for during delivery in such cases, turned the patient across the bed, and in a few minutes the operation was done. The preparations for the operation were made before the con- finement. He did not use silver wire. ALUMNI ASSOCIATION OF THE WOMAN'S HOSPITAL. Second Meeting. Cicatricial Tissue in the Lacerated Cervix Uteri.— Dr. W. Gill Wylie said that, in a paper read before the New York County Medical Society in November, 1881, and pub- lished in the "American Journal of Obstetrics and Diseases of Women and Children," vol. xv, January, 1882, he had en- deavored to show that it was diseased gland follicles in the angle, rather than a cicatricial plug, that caused the trouble. Undoubtedly an imperfectly developed cervix, or one indurated and rendered inelastic by disease of the gland follicles, was quite certain to be torn. Or, if a cervix was torn, and septic endo- metritis, even of a very mild type, followed the labor, the torn tissue would not heal, but become chronically diseased. Unless a tear was associated with diseased tissue, it would do no harm except in those cases in which the sphincter power of the cer- vix was injured, unless the tear extended to the vaginal junc- tion or to the OS internum. As a rule, his object in operating, in almost all cases, was to heads up poker machine strategy remove the diseased tissue rather than to close the laceration. The hardened tissue at world series of poker app free download the hot- 108 PROCEEDINGS OF SOCIETIES. [N. Y. Meu. Jour., torn of the angle was indurated muscular tissue, which was very hard and tough when normal. A sharp knife, properly used, could he made to take out a clean-cut triangular piece, when, if scissors were used, it must be dug out with the points, and was a ragged ping. Dr. Clement Cleveland, of New York, said that his views were in hannony with those of the author on this question. When he left the Woman's Hospital as an interne he left it fully believing in Dr. Emmet's views, and a considerable expe- rience since then had only strengthened that belief. He did not think, however, that the cicatricial plug alone did the harm. In most cases there was more or less subinvolution, which played its part as well as the cicatricial plug. He did not regard it as necessary to remove every particle of the cicatricial tissue. It was important to remove a large portion of the mass, but, if a little only was left, he thought absorption would go on in that as well as in the remainder of the subinvoluted uterus. Dr. P. H. Inoalls, of Hartford, thought that removal of the cicatricial plug, or, at any rate, of the diseased tissue, whether cicatricial tissue or diseased glands, would often cure the patient, even though the operation for laceration failed. He poker casino online had had one such case, having been compelled to operate too soon, as the patient had to return to her home. He removed the dense tissue, and thought all was cut away, but the wound did not unite. There was, however, marked relief from the nervous symptoms. He had not casino poker near chicago seen the patient since, and was unable to say wliether the subinvolution disappeared. Dr. Geokge T. Harrison, of New York, had had extensive opportunity for observing the eftect of laceration of the cervix associated with cicatricial tissue, not only in his own practice, but also in the public and private hospital practice of Dr. Em- met, and he had seen such benefit follow the operation as per- formed by Dr. Emmet that he was compelled to acknowledge the importance of the cicatricial plug, casino arizona indian bend poker room or whatever name it might receive. The most marked results from the operation were obtained in cases ameristar casino east chicago poker room of extensive laceration giving rise to parametritis. There was not only great improvement in the general condition of the patient, but also relief from reflex neu- roses. This experience was similar to grand poker casino online that of Dr. Bradsky. Last December Dr. Harrison operated upon a patient who, be- fore being ancesthetized, seemed to have only a slight laceration of the cervix; but, after she was put under the influence of ether, a very considerable amount of cicatricial tissue was found. The patient had been suffering from leucorrhcea and a variety of symptoms, and the relief which followed the opera- tion was very great. Dr. Charles H. Riley, of Baltimore, referred to a case in which a physician had free poker game download play offline operated upon a patient for lacerated oei-vix, but had failed to remove the cicatricial tissue, and she had suffered more after the operation than she had before. The case illustrated very well the fact that, when cicatricial tissue was present in considerable best poker games in vegas poker casinos in southern california poker casino arizona quantity after an operation, the operation should be repeated. Dr. William H. Baker, of Boston, thought the ordinary operation for laceration of the cervix uteri was especially indi- cated in the cases related by Dr. Moseley, and that it did good ; but could we reason, from the fact that good results followed in these cases, that it was positively the cicatricial tissue which had caused the symptoms? The last case related Iiy the author, the one operated upon three times by Dr. Emmet, and also the case referred to by Dr. Riley, lent pertinence to this question. Dr. Baker had recently had a similar case. The patient had been operated upon by some physician, apparently successfully, except that her symptoms had continued. Subsequently, other measures having failed, a second operation was performed, at which a cicatricial plug, of about half the size of the last phalanx of the little finger, was removed, and the patient left the hospital completely relieved. Dr. Baker thought there was something in addition to cicatricial tissue in the cervix which gave rise to the symptoms. The preponderance of tissue in the cervix was connective rather than muscular, and a lacera- tion established hyperaemia, which resulted in hyperplasia of the connective tissue. Afterward there was contraction, and the density of the structure was then such that it became diflB- cult to distinguish it from a true cicatrix. Dr. A. B. TowxsHEND, of New York, said that the point made by Dr. Ingalls, that, a large amount of tissue being re- moved, improvement would follow, although the wound did not close, was well illustrated in a case that occurred in Brooklyn about two months ago. The patient had been operated upon about a year ago by the most superficial denudation, leaving the dense tissue behind, and covering it by the mucous membrane. The laceration was posterior. He found that the woman was completely run down, and suffering from all the reflex symp- toms imaginable. He operated, and left an excavation, after removing the cicatricial tissue, which was alarming. The wound was closed as well as possible. About the seventh day poker games practice after the operation the patient had a considerable hajmorrhage. The stitches, or a part of them, had given way, and since then the closure had been by granulation, just as it, probably, had taken place after types of poker games at casinos the original tear. But the patient had been relieved of all her nervous symptoms. It seemed probable that the pressure of the cicatricial tissue, rather than the original tear, had caused the symptoms.

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