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Ext. opii aq., > iitl gr. x. Sapo. cast., ) M. Ft. pil. No. 20. S. One morning and evening. It is unnecessary for me to multiply formulfe, as the general principles by which I am guided will be sufficiently evident from the above. la some cases I have not been consulted, and purchase levlen have not known of the htemorrhoidal tendency of the patient, until my attendance during labor. I have seen the hfemorrhoidal tumors sometimes become order levlen very large during the labor. Deweessays: "Much may be done during labor cheap levlen to prevent a severe levlen cost spell of levlen ed piles by the accoucheur making a firm pressure upon the verge of the anus with the palm of his hand, guarded by a diaper, during the progress of the head through the external parts, and by carefuUy re- turning them after the expulsion of the placenta, as the' sphincter is now fatigued, and will not oppose their descent." I have frequently tried this expedient, but I cannot say that it has been very successful, as the tumors soon come down again, and under these circumstances they are very apt to become strangulated, inflamed, and cause a great deal of suffering. When I find this condition of things, I have within a few years past adopted the plan of forcible dilatation recommended by my friend and colleague Prof. Van Buren. My method is this: The patient being fully under the influence of chloroform, I select the moment after the delivery of the child and before the placenta is brought away. I push back the tumors within the sphincter, if I can readily ; if not, I leave them alone, and introduce both thumbs, back to back, well in the sphincter, and, open- ing them as generic levlen wide as possible, I draw them through the sphincter. During this time I have firm pressure made on the uterus by an assistant, and in several instances the operation was followed buy levlen online by the sudden expulsion of levlen ed tablet the placenta from the vagina. I direct the following ointment to be ap- plied twice daily to the tumors, and well iip in the rectum : 5. Ung. gallso CO., |j; Ext. opii aq., 3j ; Sol. ferri persulph., 3 j. M. Ft. ung. The resiilt has been in every instance that the tumors have graduall . disappeared, and the patients have had very little sufiering from the operation. When haemorrhoids come on after labor, the suffering is generally much greater than when it occurs during pregnancy. They are very often in- duced by the action of the purgative given two or three days after con- finement. 414 EEPOETS ON THE PEOGEESS OF MEDICIIS'E. It is now many years since I have been convinced that castor-oil was one of the worst agents that could be used as a laxative when there is a tendency to piles, as in many instances I have seen order levlen online its action develop them. For many years I have annually spoken of this to the medical class before whom I have lectured, and I have received many letters from for- levlen 21 mer students corroborating my statement by their own observation. But I have never seen this alluded to, except in one work — viz.. Hardy and McClintock on Midwifery and Puerperal Diseases — "who incidentally make the following remark : " We may first observe that castor-oil is ill suited for patients who have hseraorrhoids, being very apt to produce in them tenesmus and considerable irritation of the rectum." I may add the following from Quain : " Common opinion has assigned to castor-oil a character for bland- , ness (probably because of its being an oil) to which it is not entitled. It is an eflScient purgative, but, except when given in minute quantities, tri levlen it usually irritates the rectum." In those who have or are predisposed levlen online to have haemorrhoids, I give the following on the second day after confinement : 5 . Hagnesise sulph., j Magnes. carb., ( ^^ ^ Potas. sup. tart., I "^ Sulphur, sublim., ; Mix thoroughly. S. One, two, or three teaspoonfuls of the powder before eating in the morning. This powder produces a soft evacuation, without pain, even when the haemorrhoids are inflamed. 2. — Case of Extra- Uterine Fcetation and Superfcetation. By Fkank Argles, L. E. C. p. E., L. M., M. R. C. S. [Lan- cet, September 16, 1871.] On September 3, 1870, I was called to see Mrs. S , whom I found suflFering from buy cheap levlen constant nausea. levlen ed tablets I prescribed suitable remedies, and suc- ceeded to an extent in stopping it. The catamenia were irregular, coming on for one or two days, and then stopping for purchase levlen online a week, and again returning. This went on to the end of December, when they discount levlen stopped. In the month of January I informed her that slie was pregnant, and was able to detect the child by abdominal examination. She seemed to progress favorably until April 10th, when I was sent for in consequence of her stating that she felt the child was dead. On stethoscopic examination, combined with other symptoms, I found she was correct. Three days after this I was hurriedly sent for, and on my arrival the nurse showed me something that had come away, and which proved to be an ovum of about two months. This surprised me not a little, and I kept the specimen. On examining externally, I could still detect the dead child, and by passing my levlen 28 finger into the vagina could feel nothing through the os uteri, which was but slightly dilated, and would not readily admit the finger. External to the os, on the right levlen price side, the child could be distinctly felt. The abdomen appeared to be of a natural shape, not larger on one side buy levlen than on the other. On percussion there was dulness about the navel, but it was tympanitic on either

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