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helps quickly. But a few minutes of proper mas- sage are required and the large and flabby uterus grows smaller, harder, and less painful. The stag- nation is relieved by mechanically pressing the fluid from the tissue spaces into the lymphatics and by emptying the engorged venous system into the larger veins. Arterial blood is now free to enter, so that the muscular fibres of the uterine walls receive the nourishment and oxygen they need for their normal function. Last, but not least, the stimulation ex- erted upon the muscular walls is promptly followed by their contraction. It remains doubtful whether this stimulation affects the muscular fibres directly, or does so indirectly by way of the ganglia Cialis Tadalafil 20 Mg which are located between the muscular layers. The application of massage is not difficult in these instances. No practitioner with ordinary gyneco- logical knowledge and skill should shrink from un- dertaking it. Massage of the Fallopian tubes and ovaries and the separation of adhesions within the pelvic cavity (4) Cialis Tadalafil 20 Mg is, indeed, difficult and requires special knowledge, experience and skill (5), Cialis Tadalafil 20 Mg but the large and heavy subinvoluted uterus can easily be found and easily managed. The method of applica- tion does not differ from that usually employed in pelvic massage: the index and middle fingers of the left hand lie within the vagina lifting and steadying the uterus, while the fingers of the right hand apply the Cialis Tadalafil 20 Mg massage. Beginning with soft, circular move- ments, light pressure is exerted only in the direction in which the lymph and bloodvessels empty. To begin with, the treatments are short, five minutes or less. However, as improvement progresses, or in older cases, time and pressure may gradually be increased as the occasion demands or results war- rant. If complications exist, they must, of course, be treated simultaneously. I have found an excel- lent supplement to massage, in the treatment of subinvolution as well as other gynecological afiflic- tions, to be the application of incandescent light. Too little attention is paid by the medical profession to this simple but extremely valuable and efficient remedy. It would lead us too far from our present Cialis Tadalafil 20 Mg subject Cialis Tadalafil 20 Mg to go deeper into the discussion of those physiological qualities of light that bring about its good results in the treatment of human ailments. They have been laid down in literature on various lines (6). Only such as interest us here particu- larly may be mentioned, namely, that light is known IIEKIi: LIEKINE SUBLWyOLUTlOX. 641 to ]jroinotc Cialis Tadalafil 20 Mg the circulation and to increase the amount of arterial blood. In addition I found that light has also a decided inlluencc upon the con- traction of the muscular fibres of the abdominal and pelvic organs. This Cialis Tadalafil 20 Mg latter (juality is of preeminent importance in our cases and deserves special emphasis. My atten- tion was drawn to this peculiar action of light by my repeated experience that during the application of light in gynecological cases, enlarged Fallopian lubes, undetectable at iirst by simple abdominal palpation, became distinctly palpable. My attention being drawn to this fact, I have followed it uj) and made use of it in many of my cases. On account of the importance of the subject from our standpoint and that of the abdominal surgeon it may be permitted t(j cite two characteristic cases, though they concern paralytic conditions of the bowel and not the uterus. The first is my own case. C,\SK I, — About nine years ago my appendix was removed (luring an acute attack of appendicitis. On the seventh day 1 left the bed; on the ninth day I began attending to .Showing III.- |.< lit the h.inds during ma!Cialis Tadalafil 20 Mg recent date. Case II. — Mrs. S.. twenty-seven years of age, miscar- ved on .^p^il ,1. 1017. Inflammation developed. Two weeks later she came into my service. I found the lower part of her abd(.»men extremely tender. There was a mod- erate enlargement of the right Fallopian tube and consid- erable swelling of the right parametrium. Gonococci were present in the discharge. After two weeks of appropriate treatment Cialis Tadalafil 20 Mg the condition of the Cialis Tadalafil 20 Mg patient was decidedly Cialis Tadalafil 20 Mg better. The swelling of the right parametrium and the enlargement of the Fallopian tube had disappeared. Instead, a fecal tumor began to develop, which in the next three days grew until it reached from the left brim of the pelvis to the arch of the ribs. There was no occlusion of the gut, as the bowels moved a little daily and gases passed freely. The condition began to look serious and drastic measures were adopted to empty the bowels. High enemas, castor oil, two ounces at a time, and other remedies following in quick succession effected the disappearance of the tumor in its lower aspects, but it remained unchanged below the ribs. Two days were spent in these fruitless efforts to