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I heard from him in the spring of 1916 when he called me up relative to another patient. He in- formed me that he had not had any recurrence of the attacks for which he first consttlted me. Case V. — May 5, 1914. Ch. S. ; sexton ; age sixty-four ; married ; one child ; five feet seven and one half inches. His greatest weight was 198 pounds, one year ago. Now has 180 pounds in his clothes. He smokes si.x to eight strong cigars a day. Drinks rarely. He has up to now en- joyed good health; usually eats one large meal a day at noon, the main element of which is meat. Generic Cialis 20mg Best Buy Mexico For breakfast, grapefruit, coffee, and rolls ; supper, tea, bread, and butter. He is very fond of olives and of highly spiced food prepa- rations. In January, 1914. sugar was noted in his urine, 2.1 per cent, (he had polydipsia and frequent micturition, and therefore took a specimen of his urine to the labora- tory for examination). On April loth a ree.xamination of his urine showed a reduction in the sugar to five sixths of one per cent. Last Friday, 5 p. m., while walking in the street, he was suddenly seized with a pain in his chest. He managed to get to the barber shop (a short distance on) and sit down in the chair. After a time the pain passed. In the evening he had for supper boiled salmon and lettuce dressed with oil and vinegar, drinking only water. Two hours later, he was sized with a violent pain in his chest, about the middle of the sternum, which radiated into both arms. The pain lasted all night and a physician was called to attend him. Test breakfast (E. and B.), one hour; tube; fifteen c. c. Stomach contents, bread and fluid. Ordinary appearance. React, blue litmus-]-React. Cong. -|- React. Phloroglucin van -\- free HCl. ->8. Total acidity 57. Residue on filter looks fairly well worked up ; considerable mucus, apparently of gastric origin, on it. May 6th. Further examination : Ap- pearance of countenance, haggard and suffering; color, somewhat ashy. The pain, when it comes on, is at the left sternal junction of the third and fourth ribs, and from there radiates into the praecordium and arms. Heart nor- mal in size. Sounds rather low but normal ; pulse 70, fairly full and soft. Blood pressure, systolic 120, diastolic 100, Epigastrium : nothing abnormal to inspection or palpa- tion ; no sensitiveness anywhere; no splashing; water 58, no splash, no sound. Liver and spleen in situ normale. Abdomen negative ; large panniculus. He reported that last evening about 7 p. m. he was again seized with the pain in his chest. He feels.it still in his left hand. Di(mnosis: As to seizures: Angina pectoris. As to the stomach : a hyperacidity of the gastric secretion with a tendency to become excessve under stimulus. Glycosuria. Treatment: Diet: Cream mixtures, three tablespoonfuls of cream to six ounces of warm water, and eggs, medium or poached. Medication: \'ichy (Celestin) morning and night. An alkaline powder with an addition of the extract of belladonna three or four times a day. Stop smoking altogether and abstain from alcohol. Seven p. m. Tele- plioiied his pain is relieved. To continue as previously directed. May 8th. He is doing fairly well. Was free from Generic Cialis 20mg Best Buy Mexico the pain till last evening, when it set in again after running three or four times between the synagogue where he is employed and his home — a distance of one long block: was not severe and did not last very long. This morning only a faint sensation of it. The powders are inclined to purge him ; he has had a loose movement after each one. Directions: Diet as before. Omit the powders. Take sodii iodide, six grains three times a day. Trousseau's belladonna pill according to his directions. For the attack : Sodii bicarb 3 ii ; Spirit ammon., aromat 5ss Generic Cialis 20mg Best Buy Mexico ; Hoffmann's anodyne 3ii ; Aqua destill q. s. ad Biii. M. Sig. : 5ss in aq. 51 pro re nata. May lilh. Last Friday night he had another attack but not very severe. Last night he again had pain, but lower down than in the previous attack, rather more in the stomach. One dose of the aromatic mixture relieved him. May 14th. On the night of the 12th he was again seized with pain. This time, however, he said it was not in his chest but in his stomach. It came on after supper and continued all night. The aromatic ammonia mixture did not relieve. He had been very much on Generic Cialis 20mg Best Buy Mexico his feet that day. Directions: I told him in case of recurrence of pain to take one of the powders first ordered and repeat it every three or four hours till relieved, and increased the sodium iodide to seven grains, also to take two pancreopepsin tablets after the eggs. May i8th. He had been Generic Cialis 20mg Best Buy Mexico rather costive, so, Friday night (i6th) he took an enema, which was effective, and he felt all right. The following morning he took a seidlitz Generic Cialis 20mg Best Buy Mexico powder and had several movements. Last evening, about 5 o'clock, Generic Cialis 20mg Best Buy Mexico he was seized with pain down in his abdomen, which lasted all night. He also had a pain in his hack, and put on hot water bags, but with little relief. Presuming that much of the pain in the abdomen was due to flatulence, I prescribed : Rhei. mist, et sodii, 5x ; Hoffmann's anodyne, 3ii. M. Sig. : 5i pro re nata. If this brought no relief, then: R Sacch. lact., gr. jj ; Codein gr. J4 ; Camphor, pulv gr. V}. M. Sig. : 5i pro re nata. Sig. : One powder for pain in stomach or bowels ; can repeat in one hour if necessary. To prevent costiveness or constipation a phenolphthalein tablet every other night. His weight today is I74fi pounds. May 19th. Last evening, about 5 p. m., he was again seized with the pain. He took three doses of the mixture witliout relief, then an enema, and had a very large hard gray stool. -After that the codein powder, but as the pain continued he repeated it at intervals of an hour until he had taken three powders, then fell asleep and slept all niglit. Has had no pain today as yet. Has great thirst; feels parched; no appetite. Leave off the belladonna pills. The pains being evidently due to an insufficient secretion of bile and possibly also of gastric juice. I prescribed HCl, diluted, four drops in a glass of water, with his dinner and supper. For variety's Generic Cialis 20mg Best Buy Mexico sake allowed him a little plain boiled carrot Generic Cialis 20mg Best Buy Mexico with