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source of a sometimes obscure leucorrhoea. Thus it is seen that a passage exists between the uterine cavity and these acute tubal abscesses and tliat this passage is capable of transferring pus and is even dilatable. Of course, if this passage always existed in a patulous state no pus collection woidd Cialis 20mg Price In Pakistan be possible, but it is not difficult to conceive that as a result of inflammation and its consequent conges- tion this tnbule. whose calibre according to Dudley is only large enough to admit a fair sized liog's bristle, would close, thus allowing the pus to collect in the tube. Upon comparison with the lacrimal duct it will be found that the Falloppian tube is a little over half the calibre of Cialis 20mg Price In Pakistan the former, from which it would apjjear that a probe one iialf the size of a la- crimal probe would be necessary, this is by no means beyi3nd manulacturing. But it must be remembered that the lacrimal duct will accommodate a probe iif much greater Cialis 20mg Price In Pakistan size than its normal calibre would indicate, due to its elasticity. Since the Falloppian tube also possesses considerable elasticity it is only reasonable to assume that it also will accommodate a probe in e.xcess of its normal calibre. If it is physically possible to probe the tubes, the problem is by no means solved, for it still remains for us to devise a means to guide the probe into the tube through the uterine cavity. For this purpose I have now under construction what I have seen fit to call a tube probing uterine endoscope. This Cialis 20mg Price In Pakistan instrument will possess features similar to the Til- den Brown or Burgher cystoscope. such as tele- scopic lenses for magnified vision, irrigating facili- ties for asepsis and for cleansing the field, illumina- tion, and a probe guiding arrangement. With this instrument together with a uterine tractor of orig- inal design it is hoped to simplify the procedure and perhaps make it practical. As to other teciinical difficulties, including cervical dilatation, pain, em- barrassment from blood and pus, and uterine rig- idity, these are details that my experience witli even crude instruments convinces me can be readily over- come. .Vssuming for the sake of argument that we can open up these tubes. What results are to be Cialis 20mg Price In Pakistan ex- pected? Tubal drainage principally, and with tuba! drainage no pus collection within the tube is jiossi- l)le. If the tendency of gonorrhoeal tubal infection is toward spontaneous cure in the presence of good drainage, such as it is in urethritis in tlie male, it is then no more than reasonable to expect the acute Jiiary 28. 19H] GROSS: LAVAGE OF DUODENUM. s iptoms to subside and eventua'ly the tube to r itself of the infection entirely, just as occurs in tl male, in which case, Cialis 20mg Price In Pakistan if it is true that adhesions a absorbed once the infection or irritant is re- nved we might hope to see these tubes restored to tl ir normal state and to functional usefulness. 'lOnococci are often found in cases of puerperal a sis and are apparently the infecting agent in tl se cases in as much as they are the only bacteria tl t we are able to identify ; however, in this con- n tion there is one fact worthy of mention and tl ; is the lack of affinity of the gonococci for tissue o er than epithelial. Whether Cialis 20mg Price In Pakistan the gonococci are tl only infecting agent or not, in cases of this type, is n open question, but independent of this question tl fact exists : this type of infection is usually mild a the indications for treatment are in no manner d erent from other puerperal infections ; that is, t( -emove any retained foetal remnants as early as p >ible and to maintain good drainage. 41 West One Huxpred .\nd First Street. 'IRECT L.WAGE OF THE DUODENUM. By M.\urice H. Gross, M. D., New York. 'he lavage of the duodenum I am going to de- s be IS called "direct."' because it is not effected b the intermediary of the stomach, but by imme- rl :e application of the irrigating fluid through ths d idenal tube I have devised.^ lis a matter of course, the duodenum may be r :hed nearly equally well through the stomach in a indirect way bv administering the fluid per ps. r itly assuming that through the gastric digestive r :hani^m it will in due course reach the duo- Cialis 20mg Price In Pakistan Journal of the American Medical " ^i'"l '}. 1910.