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oughly washed out with hot salt solution, an in- cision made through the posterior vaginal wall into the cul de sac and a gauze drain inserted. The abdominal cavity was filled with hot salt solution and the peritonreum brought together with a run- ning silk suture, average cost amitriptyline the muscles with silkworm g-ut mattress suture and the skin with silkworm gut subcutaneous suture. Patient took the chloroform well. Pulse when she came off the table, 130. Gave her strychnine one thirtieth gfrain, and morphine one quarter grain, hypodermically at amitriptyline costochondritis once, also one and half pints of salt solution per rectum. The head of the bed was raised fifteen inches. The after treat- ment consisted of eight ounce nutrient enemas every six hours and strychnine buy cheap amitriptyline and morphine hypodermic- ally as she needed it. November iitli, patient's February i8. 1905.] MURRAY: RUPTURED TUBAL PREGNANCY. 339 temperature reached 104° and her pulse 160 ; from this time on her pulse and temperature gradually came down until they reached and stayed normal from November 226. on. During this time there was free drainage from the cul de sac of bits of broken down and disintegrated blood clot. She was douched twice a day. On the fourth day after operation she had her first nourishment by mouth. November 23d, removed skin how much does amitriptyline cost suture and found the line of incision perfectly healed and firm. Novem- ber 30th, allowed patient to sit up in a chair. De- cember loth, made generic amitriptyline hcl a vaginal examination and found everything healed well ; discharged patient amitriptyline online uk cured. Case II. — December 23, 1903. — Mrs. G. K. Pa- tient had been sick about one week, complaining of pain in the amitriptyline cost canada right side of her abdomen. I saw her several times, but found no marked symptoms of any kind. December 23d, I was called hurriedly to see her and found her with very severe pain in the right iliac fossa, extreme tenderness on pressure, muscles rigid, .abdomen distended, pulse no and amitriptyline hcl generic elavil bad. expression anxious, respiration hurried, tem- perature 97.5°. Immediate operation advised. I called in two trained nurses and a non-medical friend to assist in the operation. One of the nurses administered the chloroform and the friend and other nurse assisted me. I made an incision five inches long and found the abdominal cavity full of blood and clots ; elavil generic amitriptyline on pulling up the ovary and tube a ruptured sac with about a two months foetus showed itself. The sac with the foetus was in the amitriptyline online fimbriated extremity of the right tube, and was about the size of an orange. I clamped the tube and broad ligament, tied them ofif in sections, cut them off with the ovary, and then reinforced the stump with a running silk suture and buried it under the peritonaeum. The abdominal cavity was thoroughly flushed out with hot normal salt solu- tion, an incision made through the posterior vaginal wall into the cul de sac, and a gauze amitriptyline online purchase drain inserted. The abdominal cavity was then filled with hot salt solution and sewed up, the peritonaeum with run- ning silk suture, the muscles with silkworm gut mattress suture, and the skin with silkworm g\\t subcutaneous suture. Patient reacted well from the operation. Gave her strychnine one thirtieth grain and morphine one quarter grain, hypodermically, also one and amitriptyline cost in uk one half pints of hot salt solution per cheap amitriptyline online rectum on putting her to bed. The head of the bed was raised fifteen inches, three hours after the op- eration. generic drug amitriptyline December 24th : Patient rested fairly well during night. Abdomen distended. Morning tem- perature 101°. pulse 108, respiration 24. Decem- ber amitriptyline hydrochloride generic 25th : Vomited dark green matter several times during night and passed a good deal of flatus with assistance of rectal tube. Morning temperature 100°, pulse 160, respiration 26. From this time on patient gradually improved and on January 6. 1904, the suture was removed from the skin, and the scar found to be firm. January- i6th. removed rest of vaginal drain. January 22d. discharged patient, well. Cas-e III. — January 9, 1904. — Mrs. buy generic amitriptyline C. H. Patient had been sick about two weeks, complaining of cramps in her left side, low down amitriptyline cost without insurance in the amitriptyline online no prescription pelvis. She had had some uterine bleeding off and on for the last ten days. Prior to this time she had not menstruated for six weeks. Vaginal examination during this time showed some tenderness over both ovaries and tubes, and the uterus slightly enlarged. During night of January 8th patient was taken with very severe cramps in the left side. ' January 9th, Dr. Quarles cost of amitriptyline 25mg and I saw her together and found her very pale, suffering severe pain, abdomen distended,

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