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suddenly seized with a pain about his heart (praecordium). At first the attacks were located there, rather more over the gastrothoracic region, and then moved over to about midsternum. The pain shoots into his left arm as far as his elbow. He will have an attack if he walks soon after a meal ; he took a Generic Cialis Softtabs (tadalafil) 20mg walk after his dinner last evening, and had a very Generic Cialis Softtabs (tadalafil) 20mg severe one. The same thing happened this morning after breakfast. Once he had an attack in the night. His appetite is very good. Breakfast : Oatmeal or eggs in various styles, coffee, rolls, and butter. Lunch : Mainly vegetarian. Dinner : Soup, meat, vegetables, des- sert. He has cut out Generic Cialis Softtabs (tadalafil) 20mg vinegar, Generic Cialis Softtabs (tadalafil) 20mg as he thought it hurt him. Belches considerably. He is constipated. For the last three weeks he takes on rising a glass of hot water with sodium phosphate. No headaches. Sleeps well. Examination. Tongue, light white coat. Teeth good. Gastrothoracic region resonant. Epigastrium : Nothing abnormal to inspection or palpation. Dull on percussion. No sensitiveness anywhere. No splashing. Water, eight ounces. No sound. Liver, spleen in normal position. Ab- domen : Good panniculus ; abdominal walls somewhat loose, as if he had lost some fat, though he says not; no sensitiveness anywhere. Heart normal in size and sounds. Pulse sixty-six at left wrist. July 17th. Test breakfast (E. & B.), i hour; tube; 40 cc. Stomach contents : bread and fluid, bread well worked up. All of the usual appearance. React, blue lit- mus -j- React. Congo -|- React. : Phloroglucin van + free HCl. 26. Total aciditj'. 71. Generic Cialis Softtabs (tadalafil) 20mg May 25. i9>8.1 ILLOWAY: GASTRIC SECRETION AND ANGINA PECTORIS. 03 July 1 8th. Diagnosis. Angina Pectoris. Hyperacidity. Constipation. Treatment. Absolute prohibition of smoking. Dietary directions in consonance with the gastric and intestinal state. Vichy, Celestins, three times a day. Water (plain) before or after meals. Toilet rule. Case III. January 29th, igo8. H. A. Forty-nine. Mar- ried. No children. Height, 5 feet 5 inches. Weight now 157 lbs. Usual, 163-4 lbs. Is an inveterate smoker; has smoked all his life, thirty to forty cigarettes a day. Now, three or four cigars. No alcohol. He has been troubled with muscular rheumatism for many years — never had the inflaniir.atory variety. Has had uric acid gravel for Generic Cialis Softtabs (tadalafil) 20mg many years. Two years ago, when living in San Francisco, he found that after climbing a hill he had to sit down and catch his breath. After the earthquake he came back East, and one day found that when he walked some distance he felt a marked oppression in his chest, but no pain. Three months ago he had a midnight attack of angina pectoris, and he had si.\ attacks during that night, the pain running down his left arm. Has had no recurrence of the night attacks, but cannot walk half a block, even slowly, without getting a severe, stabbing pain through the middle of the thorax. He must sit down, and is quickly relieved. Ciets heartburn and sourness frequently. Appe- tite good. Two meals a day. Breakfast: Fruit, two boiled eggs, Grahani roll, hot milk and coffee. Dinner : Chicken soup, white meat or boiled ham, vegetables, string beans, spinach, asjjaragus, salad, ice cream, l)lack cotTcc. lJrink^ no more than two or three glasses of water a day. Bowels : Takes a lapactic pill or .Xpenta water every other day. Headaches formerly, but not lately. Sleep : He retires about midnight, and since the midnight attack, noted above, his sleep is much disturbed. Has had attacks of urticaria, which small boned fish may bring on. Herpes and itching, which have lasted for nearly five years. He is tlic .son of a physician who was eminent in his locahty ; is a pharmacist himself and is therefore well accjuainted with drugs. He has taken iodide of ])Otassiiini and stroi)hanthus ; now takes aspirin (more for his rhciimatism). E.ramination. F.pigastrium : Nothing abnormal to in- spection or palpation. No sensitiveness anywhere. No splashing. \Vatcr, eight ounces. No splash ; no sound. Liver and spleen in situ normale. Abdomen: Nothing abnormal. Heart : Size normal. Sounds normal. Pulse 72, of good force. No evidence of atheroma or of arterio- sclerosis. January yA\\. Test breakfast, 1 hour; tube, 50 c. c. Stomach contents, bread and fluid, bread well worked up. React, likie Htimis -\- Generic Cialis Softtabs (tadalafil) 20mg I'ieact. Ci>ngo -\- React. F'hloroglucin van + Free IICI Oj. Total aciihty. 85. Pepsin + Rennet -)-. Urine shows slight trace of sugar. React. Nylander -I- Sp. Gr. 1.028. .\cknowledgcd that he takes sweets, such as Generic Cialis Softtabs (tadalafil) 20mg candy and ice cream, quite freely. Diaijiwsis. Angina pectoris. Faulty metabolism (uric acid gravel). Jiluscular rheumatism. As to stomach: Hyperacidity: increase of rennet, none of pepsin. Trcalnunt. Absolute prohibition of tobacco. Diet. Fat mainly milk and eggs. Allowed fish, and, twice a week, a little chicken ; water, vegetables. Fat three meals a day. (io to bed early and get up early. Medication : An alkaline powder with extract of belladonna. Generic Cialis Softtabs (tadalafil) 20mg To come in for treatment by elec- tricity as detailed in Case i. February 10th. He is doing well. Can walk much better, the pain on first starting out is very much less, and when he sits down is quickly re- lieved. He can then walk quite a stretch before he feels anything more. February ijtli. Faradization of heart (S. and R. and shocks). Generic Cialis Softtabs (tadalafil) 20mg He has had tlirec such treatments since the first. March 17th. Returned from .Atlantic City, where he had gone because of rlieiiniatic pains. Was very- well down there ; had no spell even when constipated. Since his return, some rheumatic pains again. July 1st. Reported again ; is feeling very much better. Sugar has disappeared from urine. No unprovoked attack in five months, hut when he walks a block he gets a pressure ill his left side and pra:cordium. Has been examined for life Generic Cialis Softtabs (tadalafil) 20mg insurance, and passed. July I4tli. Saw him today; is looking very well; feeling generally fine. No hyper- acidity ; no sourness or burning ; can move about much better. Still smokes, though not as much as before ; says he cannot stop altogether. He is going to Baltimore, where he has many friends among physicians, to get high fre- (|uency treatment. I did not have the necessary apparatus at the time. September 2ist. He reported today. Had been in Baltimore for two months, and had received high frequency treatment, also vibration massage.