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1. West, J. N. : Laceration of the Vasotec 2.5 Mg Cervix Uteri, Its Re- pair and Relation to the Development of Carcinoma. The Post-Gradtiate. April, 1911. 2. B.^sHFORD. E. M. : Irritation in General in Its Rela- tion to Causation of Cancer, Report of the Imperial Cancer Research Fund. 1908. J. Idem: Third Report of the Imperial Cancer Re- search Fund, p. 9. 4. Tyzzer : Cancer Commission, Harvard University. Lecture on Tumors, 1909. 5. RoBsox, A. W. Mayo: British Medical Journal, De- cember 3, 1905. 6. Montgomery, E. E. : Journal A. M. A., June 4, 1907. 7. CoE, H. C. : American Journal of Obstetrics, 1909, vol. lix. 8. Weggemberg : Bulletin de la Societe Order Vasotec Beige de Gyne- cologic ct Obstctriquc, April 22, 1909. 9. S.\Mi'Sox : Cancer of the Vasotec Enalapril Uterine Cervix, Its Classi- fication and Extension, Albany Medical Journal, May, 1903. 71 West Forty-ninth Street. CERVICAL LACERATION, CYSTOCELE, PROLAPSUS UTERI, AND MULTIPLE FIBROMATA. Enalapril Vasotec By W. Frank Fowler, M. D., Rochester, N. Y. Justification for tnaking this report rests upon several remarkable features of the case under dis- cussion and Purchase Vasotec the information to be gained by a consideration of the various etiological, patholog- ical, diagnostic and surgical problems incident to it. Case. — Mrs. S., a rather obese woman, aged forty-one, had always menstruated regularly every twenty-one days except during pregnancies. Her first pregnancy occurred in 1901 when a long and painful labor was terminated by instrumental Buy Vasotec de- hvery at her home in the city. Immediate repair of an extensive perineal laceration was made. On the day following delivery packing was inserted and left in situ for several Vasotec Iv Push days with the object, she surmised, of controlling hemorrhage. She remained in bed three weeks. Her strength returned rather promptly. In 1903 she moved to a farm where a full term pregnancy was terminated spontaneously after a fairly easy labor lasting seven hours. Six months later she was annoyed by Generic Vasotec a bearing down feeling and pain in the back and Vasotec 5 Mg sides and she noticed something protruding from the vulva. In 1905 her third full term pregnancy ended in spontaneous delivery after an easy labor lasting four hours. The bulging later became more notice- able and she began wearing a cup pessary. With- out this support she was greatly Vasotec 5mg troubled with fre- (|uent urination if she was on her feet. In 1907 she again became pregnant. She was miserable much of the Vasotec Uses time, the protrusion from the vulva became very marked and during early pregnancy there was profuse Vasotec Iv yellow leucorrhea which Vasotec 20 Mg became bloody occasionally. She flowed every day during the fifth, sixth and seventh months. This pregnancy ended at the eighth Vasotec 10 Mg month in a spontaneous delivery after a labor lasting six hours. Tlie child lived only two hours. Again she ex- perienced, as after the preceding pregnancy, an in- creased protrusion if the pessary was not worn. The three spontaneous deliveries were endured without anesthesia. During the past ten years Vasotec Mg she had had leucorrhea. One year ago she began to gain in weight. Recently the pessary had failed to function and disability due to the cystocele had become extreme. Otherwise she felt perfectly well. Examination under anesthesia revealed a very large cystocele and a second degree prolapsus titeri. The cervix, apparently, v.-as Vasotec Hctz the seat of an extensive bilateral laceration of the usual type with widely separated anterior and- posterior lips. Further ex- amination, however, disclosed a slit seemingly in the posterior lip and extending clear through it. Investigation of this opening showed that Iv Vasotec it was, in reality, the lower cervical canal terminating below in the Vasotec 2.5 external os. The relatively small pos- terior lip was behind it. The condition, then, proved to be a transverse tear slightly below the cervico- vaginal Buy Vasotec Online junction extending entirely through the an- terior lip and across the midcervical canal. The bulky portion of the anterior lip below the tear had swung down and concealed the posterior lip behind

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