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presumably buy tinidazole carcinomatous, with apparently a large stomach displaced downwards. In order to note the influence of inflation on the position and palpability of the tumor, and in the belief that the stomach capacity was greater than normal, unusual (and unjustifiable) amounts of sodium bicarbonate and tartaric acid were ad- ministered. .\lmost instantly the patient cried out, and fell back in collapse, and ciprofloxacin tinidazole the stomach was seen tightly blown up. The patient's face was deathly pale, the pulse almost imperceptible. A stomach tube was hurriedly passed, and large quantities of frothy fluid escaped, with immediate relief to the patient. Half an hour later she walked home without assistance. She refused operation. These three cases, then, may be summarized as follows: In Case I. the acute dilatation was due to paralysis of the stomach, pylorus, and prob- ably part of the duodenum, a condition which quickly followed an operation for the removal of both tubes and one ovary. The retching and the bile-stained stomach contents indicate that the pylorus was open, and was presumably involved in the paralysis. The bowels were not paralyzed, as they moved freely under treatment. There was no history of any previous stomach derange- ment. Noteworthy in this case, as in some of the other reported cases, is the large tinidazole tablets 500mg amount of secretion, in appearance like that obtained from the fasting stomach in cases of gastrosuccorrhca, with the addition of bile : and the fact that vomiting does not seem to notably lessen the distention, or belching bring forth any large quantity of gas. Would it not be better to employ the term "Gastric Paralysis" for these post-operative cases, as it is directly analagous with the much-used term "Intestinal Paralvsis," and is more indica- tive of the actual condition than is the name "Acute Dilatation?" Besides, in these cases, the dilatation is undoubtedly only incidental ciprofloxacin and tinidazole to the parah'sis. In Case II. the acute dilatation supervened upon a chronic dilatation. The immediate etio- logical factor was an abnormally large meal of material so imperfectly masticated that it would not pass the pylorus, ingested into a stomach which already contained an accumulation of fer- menting contents. The pylorus was active, and, probably owing to the iritating fermenting stom- ach contents, tightly closed ; the stomach wall still retained its muscular power : and the nerves and centers were intact and functional, as shown by the prompt response to the hypodermic of apomorphine. Surely in this case there was acute dilation unthout paralysis. In Case III. the acute dilatation was due to the sudden generation of carbon dioxide gas, in quan- tity greater than the stomach could hold, its escape into the intestine being prevented by a pvloric obstruction. The muscle of the stomach wall was strong and active, both before and after the momentary overdistention of the viscus, and there was evidently no paralysis. I have seen one other case of this kind in a woman with jejunal obstruction. Acute dilatation of the stomach, then, may be paralytic tinidazole norfloxacin or nonparalytic, and post-operative ab- dominal distention may be due to gastric paraly- sis, as well as to intestinal paralysis. I JO West Fipty-eichth Street. THE EXCEEDING niPORTANCE OF A CLEAR UNDERSTANDING OF THE VASOMOTORS AND THE UTILIZA- TION OF THEIR FUNCTION TO GET BEST THERAPEUTIC RESULTS. By W. C. .\BB0TT. M D.. chicago, ill. Wh.atever may be the anatomical structure that affords the phenomena we term vasomotor, it is cer- tain that perturbations of vasomotor equilibrium form the earliest evidences of disease in the vast majority of maladies. So delicate is the adjustment of the governing apparatus that the first evidence of approaching disease is almost invariably to be displayed in alterations in the vascular tension of some or other area. Let this be due to the advent of an invading swarm of bacteria, or to the presence of a chemic irritant in the blood conveyed to the part, the first response to anv abnormal irritation is to be seen in an alteration of the caliber of som* part of the circulatorv tract : in fact, such a change is usually requisite for the production of pathologi- cal lesions that are tinidazole vs metronidazole recognizable by microscopic in- vestigation. In venules, arterioles, or capillaries, or in all three, we have first either a condition of tinidazole giardia spasm by which the vessels are contracted and the blood is forced out into the general circulation, or a state of paresis, the vessels dilated and containing more than the nor- mal quantity of blood which leaks into the area of low pressure from the general circulatory reservoir. Here commences the anatomy of disease — and that frightfully neglected process, the phvsiology of dis- ease. Too much attention and too much importance have been given to the dead tissues, too little to the aberrations from normality displayed bv the still living organs and acting functions. It is with liv- 736 MEDICAL RECORD. [Nov. lo, 1906 ing, functionating tissues that we have to deal ; with pathological processes while still active, in ciprofloxacin and tinidazole tablets bodies not yet devitalized, and not with the final end-results of these processes, in bodies that have succumbed. If a patient is still alive to-day, he should have enough vitality to keep him living for a succession of to- morrows, provided we can successfully cope with his malady and prevent its making further progress. We may, then, take up the question of eradicating the malady, which is another matter. The physician who accustoms himself to study the conditions presented by the vasomotors soon learns to detect the earlier perturbations, to recognize local "jangles," and to apply his remedies before the dif- ficulty has progressed beyond the simple disorder of tonicity-excess or -deficiency. It may not be easy to give a nosological designation to these cases, and the physician may have his own opinion as to whether in dissipating the disease and restoring circulatory equilibrium he has aborted a pneumonia or jugu- lated any other affection ; but he knows that just such cases let alone do develop into maladies that can, without the slightest difficulty, be recognized and classified, and that in their fully developed forms may really verify the pessimistic dictum — there is no treatment that cures. How many diseases of the body politic could be cured in their incipiency by a little, a very little com- mon sense ? How many destructive wars could have been checked at the outset if only the principals had had a little more mutual consideration ? How many tinidazole online floods could have been prevented had there but been a boy along to stop the beginning crevasse in the levee with a chunk of sod ? Even the case of tetanus or of rabies might have been jugulated by a prompt excision of the virulent microbic norfloxacin and tinidazole colony at the start, to say nothing of the ease with which purchase tinidazole online most acute aiifections may be jugulated. Innumerable similar instances could tinidazole tindamax be adduced showing the efficacy of well-placed intervention at the beginning of morbid processes. It will be objected that this treatment of a symp- tom is unscientific in that it does not strike at the cause of the illness, but is aimed at a result, and a superficial one at that. This is another of those illogical jumpings at conclusions without warrant which we order tinidazole online have so often cited. How do you know the treatment that removes a symptom does not re- move its cause ? Is it not prima facie evidence that it does so when the results disappear? Take any symptom-complex that presents itself, it evidently depends on some pathological aberration, but just what we are, in the vast majority of cases, unable ofloxacin tinidazole to say. But whatever it may be, it is a fair inference that the treatment that restores to health, or that causes the disappearance of that symptom, must re- move the cause — otherwise, if the cause is still active, why does not the symptom remain ? This, of course, does not aply to the smothering of pain by morphine or of fasigyn tinidazole fever by order tinidazole cold, although there are not wanting those who claim actual curative action from these measures, and we admit the possibility. There is a certain degree of fetich worship in re- gard to this "cause" of disease. A dagger inserted in the heart causes a wound — removal of the dagger hardly cures it. A swarm of microorganisms de- scends on a toxic patch of tissue in the lungs — re- moval of the intruders does not necessarily leave the lung intact. There is failure to distinguish be- tween the original cause of a malady and the results of that malady. Each demands treatment ; each re- sponds in a different manner to therapy. How long we bungled over cases of cerebral syphilis before we appreciated this truth, and learned that we must intervene as quickly and as powerfully as possible in order to prevent damage to the delicate tissues which not all the tinidazole tablets mercury out of Spain could re- store! Remove the causes of disease, to be sure; treat the cause whenever you find it still acting, but don't limit your therapeutic activity to that one method or argue that there is no room for any other indication. It is the all but universal presence of vasomotor disequilibrium in the whole wide field of clinical medicine that compels such constant reference to the four great vasomotor remedies in the practice of our art — aconitin, veratrin, digitalin, and strych- generic tinidazole nine. These, singly or combined, form an essential part of the therapy of so many cases of so many maladies, that they, above all other remedies, are constantly mentioned in my work. That the causal indication is not neglected is shown by the intermin- able injunction to first clear the bowels and disin- fect them, and to keep doing so, since observation has shown with what frequency the absorption of toxins from the alimentary canal coincides with the occurrence of disease in limited areas where the vital resistance is presumably lowest. Whether autoinfection occasions disease directly from chemical action or, by still further lowering resistance, opens the door to invading microbes makes little difference — the indication for estab- lishing intestinal exosmosis is similarly almost uni- versal. The man who appreciates the importance of these two pathological principles, the fact of auto- toxemia and the constant presence of vasomotor in- stability, buy cheap tinidazole has a broad foundation on which to build his practice. To this he can at every step add some- thing — he never has to unlearn these two lessons. Making these the basis, never neglecting them in any case, we find that every patient displays indica- tions for something more, but never with a fre- quency comparable with that of these two. We constantly find the necessity of referring back to the newer works on physiology, and we glean every scrap of pathological information we can find,

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