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Walthard foimd streptococci in twenty-seven out of a hundred cases examined, yet he was unable to demonstrate any virulence of these organisms. Inocu- lations on animals gave no results, except that a certain part of the animal was first reduced in vitality, in which case he was able to produce abscesses. Walthard draws Jane 10, 1899.1 PYLE: PNEUMONECTOMY IN INCIPIENT TUBERCULOSIS. 817 the following conclusions : " The virulence of vaginal streptococci of a pregnant woman, not examined for some time, is equal to that of the streptococci that live upon other mucous membranes, or in their secretions. In other words, the vaginal streptococci are not viru- lent, and behave as saprophj'tes upon healthy dose of ibuprofen tissue." Gonorrhoea may be either urethral or cervical. Since gonorrhoeal pus causes no irritation to the vaginal walls, even when kept in direct contact with thera for twenty- four hours, there is little dosage for ibuprofen necessity for douching the vagina, a surface already immune. If the urethra ibuprofen mg alone is affected, the douche would have a tendency to remove the normal vaginal secretions, and thereby allow dose for ibuprofen the gonococcus to make its way to the cervix unmolested. Studying a large number of cases in the venereal wards of the Philadelphia Hospital, I noticed that a large percentage of the cases showed involvement of the cervix uteri. A more careful study proved that patients who had not taken vaginal douches were most likely to show only involvement of the urethra; while fully four fifths of such patients showed involvement of the cervix in from one to two weeks after admission. (Vaginal douches were given every morning.) It has been my fortune to follow several cases in which gonorrha?a developed during the period of gestation, in one of which there was pronounced vaginitis ; yet in all of these eases there was nothing abnormal during delivery or the puerperal state, nor was there any infection of the children. Bac- teriological examination alone can determine whether or not a leucorrhoea is gonorrhccal in character, and the fact must not be lost sight of that diplococci, which are found in the pus corpuscles clinging to the epithelia, giving the same reaction to stains (do not stain by Gram's method), advil and ibuprofen are occasionally met with. The diffi- culty with whicli the gonococcus is grown on ordinary media is probably the true differential point. The ques- tion of irritation and the introduction of instruments is one to be left entirely to the judgment of the physi- cian in acetaminophen or ibuprofen charge. " It has been clearly acetaminophen with ibuprofen demonstrated tliat the injection of nn antiseptic fluid into the vagina will not destroy patliogenic germs there, and will rob the woman to a certain extent of the safegimrds that use of ibuprofen Xn- tnre provides for her agnin.st infection " (Hirst). The objcction.s to the u.sc of antc-partum dourhcs will in a great mensurc hold 600 ibuprofen true in cases after flu' delivery of the child. However, n poat-partum doiirlie, if ear- ned into the uterus, may be of service in stimulating that organ to contract, and thereby arrest h.Tniorrlinge. It may also Ik; of sorvico in the removal of small par- ticles of placenta and nu'inbrnnes, and to remove tox- incn from the uterus after the dosage ibuprofen symptoms of sepsis have developed. The ibuprofen acetaminophen giving of a uterine ibuprofen and acetaminophen douche, after the hand advil ibuprofen has Ixvn introduced into the uterus, ibuprofen motrin or after the applieation of forceps, is an unnecessary procodure, as it can do no gomotrin is ibuprofen pulse and temperature were normal. To summarize : 1. A profuse leucorrha?a during the latter months of ibuprofen use pregnancy is no indication for vaginal douching. 2. The chemical reaction of a discharge has but slight effect upon its antiseptic powers. dosage of ibuprofen 3. The vaginal secretions of pregnant women rarely, if ever, contain pathogenic germs except gonococci. 4. Vaginal douches favor the development of cervi- cal gonorrhoea and puerperal sepsis. 5. The vaginal secretions may contain streptococci, staphylococci, diplococci, and bacilli, all of which may be non-pathogenic. G. A ibuprofen and motrin discharge from the cervix may show the pres- ence of pathogenic bacteria after all other sjTnptoms of sepsis have disappeared. PNEUMONECTOMY, THK lUTURK THEATMKNT OF INCIPIENT PULMONAUV TU15EKCUI.0SIS. Hv .lOIIN S. PYLE. M.I)., l.I,. H.,

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