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pointed out. Palpation, inspection, and percussion should then be practised. The great progress buy cheap tenormin in the understanding of visceral disease dated from the in- vestigation of these cavities by the knife of the surgeon — autopsies in vivo, as they had been called, being par- ticularly useful in the study of gallstone disease. In cholecystitis, it was the inflariimation caused by the stones, rather than the stones themselves, that caused the symptoms. The commonest diagnostic symptom was colic. The pain did not always centre over the gallbladder, although it usually did. The purchase tenormin online diagnosis was to be made from lesions of the gallbladder, from ulcer and cancer of the generic tenormin stomach and duodenum, from appendicitis, from kidney stone or tuberculosis, and from pancreatitis. Under the heading of gastralgia might often be found a good description of gallstone colic. Jaundice did not appear when the inflammation was limited to the gallbladder. Its presence was pre- sumptive evidence of gallstone disease, but its absence would not disprove this diagnosis. The test of finding or not finding gallstones in the stools after the attack had onlv a restricted value. Complications in Diseased Conditions of the Biliary System. — In this paper. Dr. G. K. Dickinson, of Jer- sey City, said that, until recent times, various condi- tions discovered in conjunction with diseased states Julj 20. 1907.] LETTERS TO THE EDITORS. 141 had been considered to be partially independent of the same, and been called complications tenormin 25 mg ; but recent better- ment of knowledge had demonstrated that these were but an extension of the primary disease to other struc- tures. Conditions leading to tenormin tablet an extension of disease processes of the region under discussion were: I. Re- ceptive nerve states. The gallbladder region being supplied by filaments from the cerebral, spinal, and sympathetic nervous systems, it was not to be won- dered at that a person in great pain should have some disturbance in parts innervated by order tenormin one or other of these. 2. Obstruction of the flow of bile, depriving the intestines of their accustomed fluid, on the one hand, and. on the other, inducing morbid dynamic and physiological conditions by the failure of the bile to be discharged. 3. Conditions of tension. Bile was tenormin 25 secreted under low tension, as compared with some other fluids. Consequently, alterations in the struc- ture of the bile tract and purchase tenormin liver induced through this condition would be slow of progress : and. according to whether the obstruction was steadily maintained or intermittent, there would be two distinct pathological results. 4. Bacterial invasion, either ascending from the duodenum or transmitted through the buy tenormin online blood. Bile, not being bactericidal, would harbor germs for an in- definite time. 5. Inflammatory states in surrounding structures and their concomitants. Protective adhe- sions formed with the omentum. This, if the inflam- mation was not too intense, might bring tenormin iv about resolu- tion through phagocytic action. Adhesions between the neighboring organs might produce serious patho- logical conditions. 6. Ulceration from calculi. The pressure of calculi might cause pressure necrosis or ulceration ; and if adhesions formed, calculi might pass through them to adjoining viscera. 7. Hyperplasia, of reg^ilar or irregular development. Hyperplasia of the mucosa produced by calculi impacted in the cystic duct might take on adenomatous changes and eventually be- tenormin 50mg come a true adenocarcinoma. The Medical Treatment of cheap tenormin Diseases of the Gallblad- der. — Dr. Jon.N n. MussER, of Philadelphia, in this paper, said that the subject should not be the medical treatment of gallstones, but, rather, the medical treat- ment of that state of tenormin atenolol tenormin 25mg the liver and the ducts, including the gallbladder, on account of which there was a ten- dency to the formation of stones. There were many instances in which an operation could not be resorted to. Cholelithiasis was caused, on the one hand, by toxic influences, and, on the other, by alterations in the digestion producing modifications in the reflexes of the duodenal end of the order tenormin online stomach, thus causing either a limitation or an increase tenormin online of hepatic secretion. It might also arise from circulatory conditions of the liver secondary to heart trouble and from infection. Re- membering these four predisposing conditions, one realized that there was a large field for medicinal or buy tenormin hygienic therapy. In a general tenormin syrup way, then, it might be said that chole- lithiasis deniandeil hygienic treatment, removal or modification of the cause, so far as it could be brought about, and, further than this, the use of specific meas- ures. In a number of cases Dr. Musscr had succeeded in probably lessening the number and severity of the attacks by having the patient wear a properly con- structed bandage. In regard to the use of olive oil, he had seen no relief to the cheapest tenormin gallstones from its use; but sometimes there was a relief to the hyperacidity that

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