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with gastric ulcer, hyperacidity, gallstones or ap- pendicitis. Two thirds of the chronic peptic ulcers which come to operation are duodenal. Three fourths of chronic ulcer cases are in men. The early symptoms, according to Moynihan, are more definite than formerly supposed : the most striking is regular, recurrent hunger pain in the epigastrium. We need a clear picture of early symptoms to aid us in an jacks or better 2 early diagnosis. In his cases hunger pain was less regular and definite and many atypical cases were found. The pain is essentially the same in both gastric and duodenal ulcer, but more regu- lar in duodenal ulcer because of its more uniform position. High acidity of gastric juice is present in only a minority of cases and is less common than in gastric ulcer. The symptom hunger pain or su- peracidity in duodenal ulcer is usually due to the action of a moderate amount of free acid on an oversensitive membrane. Simple superacidity is the largest class of stomach cases in men ; most cases recover vmder medical treatment. jacks or better games online free The severe cases closely resemble ordinary duodenal ulcer. Occult bleeding is very common in duodenal ulcer and a' valuable aid jacks or better games online free in diagnosis. Examinations must be repeated. Negative results do not rule out ulcer absolutely. The diagnosis jacks or better casino of duodenal from gas- tric ulcer is usually difficult. jacks or better slot machine We must distinguish sharply the treatment of acute from chronic ulcer. The first is chiefly medical ; the second, chiefly sur- gical. Medical treatment should be tried first in all but jacks or better play online perforation cases, but man\- chronic ulcers are kept too long in medical hands. The medi- cal treatment of gastric and duodenal ulcer is the same. The surgical treatment is much the same, — gastroenterostomy, with excision of gastric ulcers whenever jacks or better online trainer possible. The physician and surgeon are equally responsible for the present results of op- eration in chronic duodenal ulcer. They can only be improved by hearty cooperation. The duty of the physician is earlier and better diagnosis and much earlier transfer of obstinate cases to the sur- geon. The dut\' of the online slots jacks or better surgeon is to improve hie. technic. 3. Literature of Gastric and Duodenal Ulcer — jacks or better poker slots Frothingham recapitulates the treatment, a.-^ jacks or better play free gath- ered from recent literature, as follows : Acute un- complicated ulcer ; medical means. Acute ulcer complicated with haemorrhage ; medical means. Acute ulcer complicated with perforation ; surgical intervention. Chronic uncomplicated ulcer ; med- ical means soon to jacks or better online free no downloads video be followed by surgical if former are unsuccessful. Chronic ulcer complicated with haemorrhage, chronic ulcer complicated with perfo- ration, and chronic ulcer cmnplicated with real stenosis, surgical treatment. 4. Operative Procedure in slot poker jacks or better Gastric Symptoms. Tyrode divides his cases as follows: 1. Ca^e.^ in which he orders immediate operation and refuses medical treatment after the test diet, those suft'er- ing considerable jacks or better online pain and having shown no marked improvement within two weeks ; 2. Cases for which he recommends operation and treats only condition- ally, explaining risks, those improved but not wholly cured by test treatment of few weeks' dura- tion, showing some pain and local sensitiveness at either upper quadrant or at McBurney's point ; 3. Cases where, to his mind, question of operation does not enter; those when first attack is rapidly and completely cured in two weeks' test treatment; or in others where constitutional diseases form a contraindication to surgical procedures. JOURNAL OF THE AMERICAN MEDICAL ASSOCIATION April S. igii. 1. The Evolutionary Spirit for Betterment in Medical Ed- ucation, By Alexander Hugh Fergcson. 2. .\ jacks or better online real money Safe and Rapid Method for the Administration of Antityphoid Vaccine, By John P. Fletcher. 3. The Prevention of Industrial Phosphorus Poisoning, By Robert H. Ivv. 4. .\n Efficient and Time Saving Method of Tying the Square Knot, By H. Edward Castle and H. A. L. Rvi-kogel. 744 PITH OF CURRENT LITERATURE. [New York Medical Journat,. 5. Innocent Gallstones a Myth. By William J. Mayo. 6. Hookworm Disease. Prevalence, Harmful Results, and Treatment, By C. F. Strosnider. 7. Sanitary Consideration of Health Resorts, By Harold B. Wood. 8. Trichiniasis in Italians Following the Eating of Raw- Ham, By Malcolm Seymour. 9. Treatment of the Paralysis Following Acute Poliomye- litis, By John McWilliams Berry. 10. Two Cases of Caesarean Section with Unusual Compli- jacks or better poker cations, By Collin Foulkrod. 1. Medical Education. — Ferguson states that the profession is overcrowded and by the unfit. He believes free medical education would be a great boon : teachers shotild be well paid : the laboratory and clinic are replacing books ; personal contact be- tween professor and pupil should be encouraged ; too few medical men think jacks or better slots for themselves and await the opinions of certain leaders. 2. Antityphoid Vaccine. — Fletcher tells how this is carried out in the army. The needle used is freshly sterilized. The men enter by organiza- tions :n as nearly alphabetical order as possible, each with his left arm bare, exposing the lower two thirds of the arm. 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The needle puncture is then touched with a glass rod moistened in pure trikresol and the man leaves by another door. The use of trikresol in this man- ner has been very valuable, not only in cauterizing the needle tract, but the slight burn it leaves marks the site of a previous inoculation and prevents the administration of two doses the same day; for in

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