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treme debility. His Cheap Norvasc Online success was rapid, complete, and per- manent. The advantage of this method, it is my impression, is greater than the former and usually-adopted one I first attempted. The method I essayed at first is the one which has been advocated by all the older authorities, as the most natural, according Norvasc Cmi to the principle that Norvasc 50 Mg the part which comes down last should be the first returned. Agreeably to my own views, as it is the first to be inverted, so it is the first to be restored. Some recent authorities have claimed this course as of their Norvasc 5mg Generic own suggestion. In contrast with this method, as the fundus is the part first born, that part must be indented first, as the indentation began there, and the attempt must be made to overcome the accident through that portion. By many authorities it is re- pudiated entirely, although we have records of some instances which have been successful. If the fingers, or hand, or fist, have not succeeded, then we must use the bougie, or stick, or firm pressure on the fundus by a bougie, resting against the ab- domen, while the pedicle or neck is manipulated, or a stem- pes- sary Norvasc 100 Mg of a peculiar shape. It is more especially applicable in those cases where the uterus does not undergo much if any con- traction during the efforts which are made through the fundus, and the uterus is softer and more yielding. One of the strong- est objections urged against this procedure is that, in dimpling or indenting the fundus, if we could press the fundus upward, we should find ourselves opposed by a double inflexion, for the Generic Norvasc 10mg body would be grasped by the os utei'i, and the fundus would be within the body. It is evident, therefore, that our forces should be directed so as to act upon the angle of inflection. The next method of taxis is where one of the cornua of the uterus is first indented gradually, and 'by degrees passed through the cervix, the other side, and the fundus following. This procedure Buy Norvasc 5mg has been termed the mixed method. It is the same which is carried out by the veterinary surgeon in the mare and the cow. It is in imitation of some of the cases of inversion which have occurred, and especially of the one I have quoted from Ingleby. I take it that the principle of re- duction of the inversion will depend upon the condition of ACTIYE IJTERINE IXVEESION. 487 the uterus and the circumstauces at tlie time of reduction, Norvasc 5mg Price which of the four methods of taxis are to be adopted. The elastic pressure, which has been so urgently impressed upon the mind of the profession the last few years, acts, as I believe, on the same principle as the rectal and vaginal taxis, and the first method spoken of. It tends to expand the supe- rior part of tlie vagina, thus enlarging the cervix at its base, exciting or stimulating the fibro-elastic tissue as well as the contractility of the uterus itself, and, aided by the Norvasc Canada inherent ac- tion incident to the elevating forces of the abdomen, bounds or is lifted up into its natural position, tlie same as we recog- nize in spontaneous active reduction. The elastic pressure, like all other means to remedy Norvasc Other Names this accident, has its instances of success and unsuccess. In some cases it has acted promptly in a short time. In others, as the case of Dr. F. A. Eamsey, Norvasc Coupon of Knoxville, Tenn., it was seventeen or eighteen days con- tinued, when success was obtained. I believe the length of time Norvasc Coupons in the case of Dr. Ramsey is the longest period on record by this treatment. It teaches us, what we have been the last few years realizing in Generic Norvasc Price cases of inversion of the uterus, that steady, persistent, gentle Norvasc 7.5 Mg effort, continued, will be crowned Norvasc Patent with success, either by the taxis or elastic pressure, which is only an internal taxis. This treatment has become, since the cases of Coley, of Bridgewater, in 1837, and T. Smith, of Lon- don, one of the established means to adopt when the different procedures of taxis have not succeeded. The ancient method of incising the cervix, when the cer- vix does not yield under taxis, was advocated by Millot, a cen- tury ago, in 1773. It has lately been revived by Mr. Barnes, of Great Britain, and presented as original and new. Millot recommended but one incision. Columbat, imitating Millot, ad^ases several Norvasc Pi small incisions from the centre to the circumference. These incisions were one-sixth of an inch deep, as he considered they would endure greater dilatation than one, because the stricture would not be as well liberated as by the multiple incisions. Barnes made three long ones into the cervix, one on each side and one behind. The incisions were about one-third of an inch deep and one-third of an inch long. " I passed," he says (after making the incisions), " the uterus 488 THE MECHAlSriSM, ETC. back into the vagina, followed it with my hand, and proceed- ed to reinvert. I was surprised to find how readily the uterus went through the os." Barnes admits he was very timid re- specting the operation, and felt uneasy at Norvasc 2 Mg feeling the uterine tissue give way, as though the incisions were extended by la- ceration. There was no bad symptom or haemorrhage in his case. In Dr. Thomas's case it was not so favorable or success- ful, although he was more decided in the depth of his incisions. They extended down to the subjacent parts, through the tissue Norvasc Logo of the neck. After the operation, a free jet of blood was pro- jected Norvasc 7 Mg from an artery, which appeared nearly equal in size to the radial. In this instance he probably cut the circular ar- tery. It was with difficulty the artery could be ligated for half an hour. We must not forget that the difficulty consists in this part of the uterus being very hard and dense, and the re- traction of the artery so great that these vessels cannot be easily seized and tied. It is for this reason that the operation of ITuguier for procidentia uteri is so much feared.

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