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I have omitted purposely to Nortriptyline 25 economize space. TIIR DIAGNOSI.S AND TREATMKNT OK THE MOIIE COMMON BLADDKIi AFrECTIONS IN WOMEN BY MEANS OF KELLY'S METHOD.* Ht HIRAM N. VINEHKRG. M. IX, ATTKNniNO «TN.rcOI.OOII*T To 8T. HAIlK'l* IllxriTAI . AM) TO MOl'NT (*ISAI UO^riTAl., OlITI>*MiB lll'.PAKI MKNT. So brilliant is the Generic Nortriptyline work Howard A. Kelly has done in the upper urinary passages that the value of his method in the diagnosis and treatment of the diseases of the bladder has not yet met with the appreciation and recognition it deserves. For instance, in quite a recent article in the .Journal of American Olistetrirs (March, 1897), by Skene, the .American Nestor of bladder s\irgery in women, the use of the cystoscope is recommended almost as n liernirr rrssort, when everything else has l>oen tried and has failed. Ix!t us Nortriptyline Mg quote Skene's own words on this |H)int: " The objections to the goncrnl employment of Kelly's mctliod are that rapid and extensive dilntnlion of the urethra is necessary, nnd that requires tho patient to be an.Tsthetized. Taken nltogctlicr, it makes the «• nminntion really n formiilable operation. Dilatation of ll„. Il.irrnil nn ,^ mii ,m,^i, ,• tt,,t ,,f;,n .1...^ .1-,.i,. nf Uio K«w Vak Amdcfnj n> VISEBERG: BLADDER AFFECTIONS IN WOMEN. |N. Y. Mbd. Jodh., me how any one familiar with the method could speak of it in those terms. As the subject matter of this paper is presented, it will be seen that general anaasthesia is rarely necessary ■ — only once so far in the writer's experience, and that was at a time when he was still unfamiliar with the method — and that extensive dilatation of the urethra is never called for. During the three years that I have been employing Kelly's method I have made use of the cystoscope fully five hundred times in over one hundred different wom- en,* and I can positively assert that in Nortriptyline 10mg not a single instance was any appreciable harm done to the urethra. The size of the cystoscope used in the vast majority of cases was that known as No. 10. Very rarely was No. 13 necessary, and No. 8 frequently served the purpose. I have never observed incontinence, even of a Order Nortriptyline Online temporary duration, follow the introduction of the No. 12 cysto- scope, and, as I have already stated, I have never had occasion to use a larger sized instrument. Even for the catheterism of the ureters I seldom use Buy Nortriptyline a larger cysto- scope than the No. 10, and in the numerous times that I have carried out the procedure I have not thus far had to use general anjesthesia once. To illustrate how expeditiously direct inspection of the bladder and catheterism of the ureters can be done after one has had some practice, I will cite only one ex- Buy Nortriptyline Online ample. Last January a lady came during the office hours with a note from Nortriptyline 25 Mg my friend. Dr. M. Manges, asking that I obtain for him a specimen of urine from each kidney. She was a short, stout woman, about fifty years of age, and of a nervous and anxious temperament. She never had had a similar examination and was in no way prepared for it. From the time she entered my office until she left it, with two small bottles of urine from either kidney, obtained by catheterism of both ure- ters, about thirty minutes elapsed. She suffered some pain for about twenty-four hours as a result of the ex- amination, and this was the only ill efEect that followed. It may be appropriate here to say a \Yord relative to the propriety of attaching Kelly's name to the method of direct visual inspection of the bladder as it is prac- ticed in this country. Without desiring to enter into a discussion as to claims of priority, so much may be safe- ly asserted, that Kelly lias so simplified tlie technique that it becomes one distinctly apart from that Nortriptyline 10 Mg prac- li.sed in Germany. No better evidence can be needed than i.s furnished by Veit's Ifandhuch der Gijnakolo(jic,\ the most recent and exhaustive w6rk Nortriptyline 25mg on gynajcology in the German language. The article on the physical ex- nmination of tbe Ijladder i.s very extensive, and is chiefly * It mny oxi'ltc toirpriiic thnt the writer linx lin'l no ninny viihch, [Ic I, I ■ •. I i'"'n!
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