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of appropriate medical treatment. It is not at all a question of how long a case of chronic indigestion was treated, but how a diagnosticated case was treated. It has been my experience, and Order Imigran it is. un- doubtedly, that of a great many internists, that gas- tric Generic Imigran organic diseases are much Buy Imigran Online more' amenable to treatment than organic diseases of any other organ. A great many poor results from medical treatment can be traced directly to a wrong diagnosis and improper treatment. That surgery has its legitimate field in gastric dis- eases is undeniable, and that its excellent results are most striking is unquestionable, but its field is necessarily limited to those cases in which there is mechanical obstruction interfering with the proper evacuation of the stomach contents. The diagnosis of gastric Purchase Imigran Online disorders is certainlv as important as that of diseases of other organs, and yet how often does one meet w-ith cases in which not even an attempt was made to properlv diagnos- ticate them. How often is a chronic gastritis diag- nosticated where there is not even a suggestion of a catarrh ; and very frequently just such cases are in- geniously mistaken for neurasthasnia. It is not at all surprising that mistakes in diagnosis are made, for the clinical symptoms referable to the stomach are few and they are almost all present in various diseases of this organ. Only by careful examina- tion and strict attention to details can a correct con- clusion be arrived at. Naming the disease does not, by any means, solve the problem; it is important that the underlying pathological condition be under- stood. It is Imigran Price not enough, for instance, to diagnosti- cate a chronic gastritis, for assuming that the diag- nosis is correct, the treatment is i^ot the same for all forms of gastritis. It makes all the difference in the world whether we have to deal with an acid or anacid gastritis, a mucous or atrophic gastritis. The physician who treats all his gastritis cases on the same principle is certain to come to grief. The same is true of ulcer and the long list of functional and reflex gastric disturbances. In illustration of the foregoing 1 will briefly cite a few of a long list of cases of chronic indigestion that were benefited by medical treatment. Case I. — Mrs. A., forty-six years of age. kindly re- ferred to nie Buy Imigran by Dr. Shulman for diagnosis and treat- ment, gave a history of digestive disturbances covering a period of nineteen years. She liad suffered during the Imigran Tablets c.nrly stage of her ilhicss witii short attacks of gas- traigia, whicli recurred times a day. These at- tacks were very severe ; they bore absolutely no rela- tionslrp to licr meals, being neither .nggravated r.or re- lieved by the ingestion of food. She suffereil in this manner for years until about eight years ago, when the pain disappeared and in its steati attacks of nausea and vomiting developed, which lasted for days at a time. She was liardly free from these unpleasant symjitoms more than a liay or two during Purchase Imigran tiie week, and .is a re- sult she had grown weak and ipiito thin. The thoracic and aNIominal organs were lomul a|>p.Trcntly normal 396 W EINSTEIN: CHRONIC INDIGESTION. on physical examination. The examination of the urine wa^ negative. The stomach contents after Imigran Cost a test break- fast revealed an immense quantity of mucus, the undi- gested food particles intimately intermixed with it, complete absence of free hydrochloric acid; a total acidity of 12, and no lactic acid. The motor function of the stomach was not affected. Microscopically a Imigran Mg large number of leucocytes and well preserved epithe- lial cells were found. From, these findings I Buy Cheap Imigran concluded that it was a case of an acid mucous gastritis. During the early stage of her illness her symptoms were ascribed to an ulcera- tion of Order Imigran Online the gastric mucosa. I was inclined to differ from this view, as it appeared more probable that she suffered from an irritative gastric catarrh, which con- tinued until the glandular elements finally became ex- hausted, resulting in suppression of secretion. If ever a case of chronic indigestion was entitled to the benefits of enthusiastic gastric surgery, this one certainly was. but fortunately medical treatment did as much and more than could have been expected from surgery. Daily lavage with a solution of sodium bi- carbonate, hot normal salt solution internally, local astringents in the form of silver nitrate, and a care- Imigran Online fully regulated diet removed, in a week's time, all the unpleasant symptoms from which she had suffered so long. To use her own expression, she was not con- scious of her stomach for the first time in nineteen years. It may be interesting to note that the stomach contents were free from mucus a month later. Orexin, hydrochloric acid and pepsin, later pancreatin were tried, but had to be abandoned, as her stomach rebelled against all drugs.

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