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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.
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
By H. Edward Castle and H. A. L. Rvi-kogel.
PITH OF CURRENT LITERATURE.
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. The necessary data are given
to the sergeant as each man enters the line. Here
at the first table the arm is scrubbed with green
soap and warm water, rinsed, and the subject
passes on to the second table where a second man
washes the previously scrubbed area with jacks or better slots free a i to
1,000 solution of mercuric chloride; he then ad-
vances to a third table where the field is rubbed
with 95 per cent, alcohol, after which he comes to
the oflficer who is to vaccinate him. When the sub-
ject reaches the medical officer, the arm is grasped
between jacks or better slot machine game the thumb and forefinger of the left hand
to steady it and pinch the skin taut, while the needle
is plunged jacks or better online game downward and slightly forward, nearly
parallel with the surface of the arm, into the suli-
cutaneous fat. The injection is given with mod-
erate rapidity and the needle quickly withdrawn.
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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