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fluence of absorption from this source in puerperal sepsis, and (4) the favorable results of frequent or continuous irrigations in checking this absorption It is not to be understood from this conclusion that irrigations are advocated in all cases of sepsis, for it must be remembered that, as a rule, the curet- tage will of itself be sufficient to control the infec- tion in the great majority of cases, but when for soiue reason or other this curettage fails it is then and only then that the irrigation treatment is rec- ommended. Further than this we can do but little except in the way of general medication until such a time as the infection localizes itself in pelvic abscess, when if the abscess is promptly and thor- oughly opened through the vaginal vault the pn> will disappear and with it the associated adhesion>. resulting in a complete symptomatic and functional cure in ahuost everv case. uary 28. 191 1.] IVEIL: SEPTIC ENDOMETRITIS. 169 Objectors to the irrigation treatment will, among «her things, urge that Donde Comprar Cialis Generico En Mexico it is impractical since it in- ■ Ives continuous work both day and night. But it ijst be remembered that it is a heroic procedure led in desperate cases only, and that a woman's ie is at stake, under which circumstances no effort iDuld be too great. Or it may be urged that the (Htinual presence of the physician is necessary, but t s is not true for Donde Comprar Cialis Generico En Mexico the irrigations may be safely in- t isted to an intelligent nurse. Or it may be argued I It some of the bacteria have by this time pene- t ted deeply into the tissues or even into the blood ! earn and are consequently far beyond the reach of t ■ irrigations. Replying to this I desire to point ( t that the bacteria which lie in the tissues and ves- i s are in constant combat with the leucocytes and t re is ample evidence that unhandicapped. the I cocytes are fully able to cope with them, for un- ( • no other hypothesis can we explain the fact that t presence of pathogenic bacteria in the blood s earn in these septic cases does not necessarily in- ' ;nce the prognosis. Again, the pelvic suppura- Donde Comprar Cialis Generico En Mexico I I which takes place in almost all cases of true 5 'sis e.xcept the rapidly fatal types bears ample e dence of the ability of the leucocytes to contend. \ h the germs that find their way into the 1 iphatics. On account of this same objection it r jht be contended that the stomach tube was use- !■ ; in narcotic poisoning because some of the f son had found its w^ay into the bowel and was c sequently beyond the reach of gastric lavage. ."aking up next the gonorrhoeal form of endo- n ;ritis it is desirable to make Donde Comprar Cialis Generico En Mexico a comparison between t ; disease and the same infection as seen in the r 'e. Gonorrhtea in the male is self limited and t is Donde Comprar Cialis Generico En Mexico toward uncomplicated and spontaneous re- c er)' in almost all cases. That cystitis and epi- d ymitis do not occur is because of the good pas- s : drainage that exists by virtue of the patulous- n s of the meatus together with the frequent irri- g ions (active drainage) which the flow of urine c ses. Exceptionally when either cystitis or epi- d vmitis does occur it is the result of some local Ti lipulation such as instrumentation or injections g --n with undue force, or from stricture f Lydson) tl : is interference with free drainage. Bearing in n d the analogy between the ejaculatory ducts and tl Falloppian tubes; it would appear that acute g lorrhceal endometritis would in the presence of g 'd drainage such as occurs in the male urethra b ilso self limited, and that salpingitis would be as r -' as epididymitis. "hat such drainage is not present is very evident f' while the cervix is somewhat softened in these c ;-s yet drainage is by no means as free as it is in tl male urethra because of the comparatively larger ning at the meatus, and because of the more pro- f' ; discharge from the uterus due to the more ex- tive surface infected. .Again, active drainage » h as the flow of urine in urethritis is entirely M iting in endometritis. The results of irrigation o he male urethra might well be equally valuable ii| 'ndonietritis anrl particularly since these irriga- tiis would if prr)perly carried out act in a man- n. similar to the urine, that is as a forced or active d inage. lie treatment of these cases as now advocated by most authorities consists in rest, ice bag, Donde Comprar Cialis Generico En Mexico and vaginal douches. No steps are taken to aid Nature by promoting drainage to prevent tubal infection and once pyosalpingitis occurs there is no hope except in excision. That the treatment of this condition is inadequate is evident from the fact that various gynecologists estimate that from thirty to sixty per cent, of their laparotomies are the result of this in- fection. From this the importance of this matter to womankind may be estimated. In acute specific endometritis of the nonpuerperal fomi the gonococ- cus will always be found in the uterine Donde Comprar Cialis Generico En Mexico discharges. They are readily recognized by the fact that they stain easily with any of the aniline dyes, and that they refuse to stain by the Gram method. In treat- ing these cases one's efforts might well Donde Comprar Cialis Generico En Mexico be in the direction of creating conditions such as are present in specific urethritis in the male, to that end it would be advisable to obtain complete dilatation of the cer- vical canal at the earliest possible time. This at the first sitting requires an anesthetic, but is subse- quently maintained Donde Comprar Cialis Generico En Mexico by the occasional light applica- tion of the uterine dilator without anesthetic. These patients are of course kept in bed during the acute stage of the disease, and with the head elevated to favor passive drainage. In addition to this and with a view to creating conditions such as the urine causes in the male form of the disease (active drain- age) one might well apply intrauterine irrigations in the following manner. .\ small soft rubber double current catheter is carefully passed within the cer- vical canal toward the fundus. This tube extends beyond the vulva and is held in place by a light