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By J. -AL Lynch, M. D.,
There can be no question as to the frequency of
ikiodenal ulcer. The symptoms are know n to gambling sites with free money every
]rractitioner of medicine. To the surgeon, however,
particularly such men as Moynihan, of Leeds, and
the iNIayos, of Rochester, belongs the credit of hav-
ing elucidated it.
Moynihan, in his work on Ulcer of the Duo-
denum, gives such a lucid exposition of the subject
that it would seem as though one needed only to
read his book to make an accurate diagnosis in the
first case that came before him. That was my own
impression till my experience with the case given
We are all familiar non gambling casino games with the fact that chronic ap-
pendicitis is frequently a factor in free pc gambling games download spasm of the py-
lorus, so that in a case of chronic dyspepsia we
rarely accuse the gambling slot machines win stomach until after we have elimi-
nated the appendix and gallbladder. But if the pain
and other symptoms are entirely confined to the ap-
pendix, this organ is usually tried by drumhead
court martial and found guilty.
Case. Mrs. M. ; age, thirty ; married ; no children.
Family history : Father died at sixty-five, of apoplexy ;
mother living, healthy. Brothers and sisters all healthy.
Habits : Patient drank tea, coffee, and alcoholic liquors
in moderation. Smoked six cigarettes free online casino gambling slots daily.
Diseases of childhood : Measles and scarlet fever ; no
Past history : Patient had been perfectly well up to five
years ago when she had wliat was evidently an acute in-
flammatory process of the uterine annexa. Since then she
had suffered more or less from constipation. The present
trouble dated back to February, 1909, and following a rath-
er constipated movement, she had an acute pain in the
anus ; the pam was so severe that she was given morphine
to relieve it Following this, she was fairly comfortable
until the next movement, when she beg:an to have severe
pain radiating down the legs and to the back ; she con-
tinued \\\ this condition for several weeks, having pain
every lime the bowels moved ; but by means of supposi-
tories and laxatives was fairly comfortable. Following
this, her constipation became worse and owing to the pain
that accompanied it she went to the toilet only once in two
days. In May, online gambling free money no deposit 1909, she was referred to mc.
She was a woman of thirty, rather stout, but anemic.
Examinations of the heart and lungs were negative. Ab-
dominal examination revealed nothing unusual, except
some tenderness over the appendix.
Vagina] examination : Uterus retroverted and rclroflexed.
A good deal of thickening over the left tube, which was
bound with a mass of adhesions to the sigmoid. The right
ovan,' was prolapsed, enlarged, and fixed in the posterior
Rectal examination: The sphincter spasmodically con-
tracted. There was an anterior sentinel pile ; above this
could be seen a well gambling bonus club net entertainment free casino games developed fissure. Examination was
so painful that no online gambling free casino games further effort was made to explore the
rectum at this period. Local applications to the fissure
gave the games gods and gambling free download patient great relief and in a short time it free gambling slots machines was
entirely healed. A proctoscopic examination revealed
atrophic, catarrhal condition of the rectum and lower
portion of the sigmoid. .Above this it was impossible to
pass the proctoscope on account of an acute angulation of
the sigmoid, evidently due to an adhesion to the left tube.
Three months afterward I was called to see this patient
with a recurrence of the fissure, severe pain over the ap-
pendix, exquisite tenderness on pressure, and all the class-
ical symptoms of appendicitis. A diagnosis of acute ap-
pendicitis was made and the patient advised to have an
operation performed. That evening play gambling games for free she passed" a lot of
dark clotted blood and fsecal matter; subsequently she had
a number of movements, dark in color, and containing
large quantities of digested blood. An examination of the
rectum under nitrons oxide gas revealed nothing except
what has already been stated. Next morning the patient
was given a Boas-Ewald test breakfast.
Macroscopical : Large quantity of liquid with very little
Microscopical : Starch, yeast, and a few epithelial cells
with fat globules.
Chemical : Free hydrochloric acid, 70 ; combined acids,
J4; total acidity, 90; lactic acid, a trace; starch digestion,
Here was a patient who until she was cross examined
gave no history of any disturbance of digestion. Her pain
was all referred to the gambling slot machines region of the appendix, and the
tenderness was confined to the same region. Later on, I
elicited the fact that she suffered off and on from what she
called indigestion; that she occasionally had pains coming
on some four or five hours after eating: took something
for relief, vomited, and felt better after it.
The case we have related proved ver\- instruc-
tive, and in looking over the histories of a num-
ber of cases we can now recall several that were
undoubtedly cases of duodenal ulcer. We have also
seen several cases subsequently, but the symptoms
were not confined to the appendix, and gambling slot machines online a diagnosis
of ulcer could have been made from the history.
A point worth mentioning is the fact that the paira
seems to be most intense just previous to the haem-
orrhage, list gambling board games subsiding, subsequently, by lysis. We pub-
lish this case in the hope that others will not be
taken unawares, as we were, and that in cases of
appendicitis a careful history of the patient's di-
gestive apparatus will avoid the error into which
we were led.
The two conditions which are most apt to be con-
founded are spasm of the legal online sports gambling sites pylorus, due to the free gambling games no deposit chron-
ic appendicitis, and duodenal ulcer, with all the
.symptoms referred to the appendix. A carefully
taken history will clear up the diagnosis, as every
case of duodenal ulcer has a clear cut hi.story.
58 West Fifi y-eighth Street.
THE IMPORTANCE OF NASAL BREATHING.
By A. Emil Schmitt, M. D.,
Instructor in Operative Surgery, Medical Department,
For several years past much attention has been
given to the importance of the removal of super-
abundant adenoid tissue, which is looked upon as
the causative factor for all ills which really are due
to defective nasal breathing and without a concep-
tion of the card gambling games list true relation of the various factors
involved. I will here dwell particularly on the
great importance gambling slots for dummies and marked influence of air pres-
sure upon the internal structures of the nose during
normal breathing and the serious consequences
which result when nasal breathing is not persisted
A person breathing constantly through the nose
has nostrils of sufficient size to accommodate a
volume of air to expand the lungs to their full
capacity. Vibrissa are present to keep out tlie
gross particles of dust. The nasal fossre within
show a sufficient height with a low floor correspond-
ing -to the properly flattened palate, and the lateral
walls are puslied sufficiently far play gambling games online for free out to give roomy
fossae on either side of the septum. Where a devia-
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