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Is in hne condition. He says when he starts out in the morning he must stop once or twice and then can walk all day. He carries a heavy sample electric battery round with him, for which he is canvassing the physicians. Smokes as before. Case IV. November 12, 1912. L. P. Merchant. Age, forty-five. Married. Children. Five feet seven inches. Weight. i83):t lbs. Smokes eight or more cigars, and three or four cigarettes a day. Drinks occasionally a little wine. No whiskey. Began to ail about six weeks ago; vomited everything he ate and had cramps in his belly. The vomiting lasted eight days, and then stopped, but the cramps continued. The last few days the cramps are not as severe. For two weeks he has had pain in the epigastrium, which spreads from there into his left chest. With this, a severe cramp in his left arm, from shoulder to fingers, which lasts about eight minutes. Has about two attacks a day, one in the morning and another later in the after- noon. His appetite When To Take Cialis 20mg For Best Results is good, but lately he eats only milk and eggs. Bowels always regular. Tongue coated, heavy white coat. Examination. Heart normal in size ; sounds normal even after some forcible exercise, «'. e., running several times up and down the length of the room. Epigastrium : Nothing abnormal to inspection or palpation ; no sensitive- ness anwhere ; no spashing; water, eight ounces. No splashing; no sound. Liver and spleen in situ normale. .\bdomcn. nothing abnormal. November 13th. Test break- fast (F. it n. ), I hour; tube; 25 c c. Stomach contents: bread and fluid, all well mixed together, emulsioned. Re- act, blue littiuis -r React. ( ongo — React. : Phloroclucin van -j- l-'rer HCI ~.2. Total acidity. 65. Filtered vcrv slowly because of the large amount of gastric mucus in it. Had to change filters after a while. Diagnosis: Angina pectoris. As When To Take Cialis 20mg For Best Results to stomach, hyperacidity, gastralg^ia. intestinal colics. Treatment : Diet as before : Eggs, milk or cocoa, whit ■ brcaH and butter. Medication : Alkaline powder with extract of belladonna reinforced with the extract of hyoscyamus. No- vember i.Sth. The pain as before; if anything, more severe. This morning at 7 a. m. turning about in bed brought on 1 severe attack. If he walks a block he gets the pain and must stop for some minutes till it passes. Directions to continue the diet, leave oflF the powders, and take sodii iodide gr. vi t. i. d. PilUil. belladonna; (Trous- seau), for two days, one pill mornings; then two pill;s ; Hofl'mann's anodyne 3'i ; Aq. dist q. s. ad 5'''- One tablespoonful in two When To Take Cialis 20mg For Best Results of When To Take Cialis 20mg For Best Results water when pain comes on. November 20th. The attacks come on five or six times a day. but more lightly than before. (He walks about When To Take Cialis 20mg For Best Results much in his business.) .Altogether, the attacks have been much less severe than before. .As he was tired of eggs, allcvwcd him plain boiled fi.sh and rice once a day. Instead of the aromatic spirits of ammonia I ordered tablets of nitroglycerin aa 1/200 to be taken in case of an attack, not more than three tablets a day. If the attacks should be unusually severe, he can take two tablets at one time. Fara- dization. December 6th. Reported today. Much better ; he still gets attacks, but less frequently and milder. His tongue has a rather yellowish coat. Reexamined heart ; normal in size; sounds normal but somewhat low in tone. Pulse fairlv full. soft, easily compressible (seventy-six per minute). Static (on insulated platform and stool attached to battery) for fifteen minutes. Continue the diet In- crease the sodium iodide to twelve grains three times a day. Continue nitroglycerin tablets pro re nata. Because of tlie coated tongue I ordered a pancreopcpsin tablet December 17th. Doing very well; can walk When To Take Cialis 20mg For Best Results very well now. only, if he should strike out at a rapid gait he would get an inkling of q64 ILLOWAY: GASTRIC SECRETION AND ANGINA PECTORIS. [New York EDicAL Journal. !iis pain. A specimen of his urine which he brought in by direction showed much uric acid. To drink Helenen Quelle. On March 30, 191 3, I was called to see him. He had eaten some extraordinarily heavy meals lately and on the 26th was seized with vomiting and has been vomiting ever since. At first he vomited only what he ingested, lemonade, soup, etc. ; now vomits bile ; very much nauseated. Examination negative. Ordered one teaspoonful of Potio Riveri every fifteen minutes for eight doses, then every half hour. Sinapism back and front every four or five hours ; no food or drink till further orders. At 11 p. m. his daughter telephoned he had not vomited since 8 p. m. ; was feeling easier. Continue the prescrip- tion as directed. To quench the thirst, one tea- spoonful When To Take Cialis 20mg For Best Results of milk and lime water, equal parts, hot, every half hour beginning about 3 a. m. April 1st. He is better ; has not vomited _ in the last twenty-four hours. Very little nausea. Can increase the quantity of milk and limewater to half cup every two hours. If this agrees, then later on give a cup of milk with half an ounce of limewater every two hours. Three to four one minim tablets of tincture of nux vomica, in Vichy, three to four times a day. April 5th. The daughter tele- phoned that her father had very severe abdominal cramps. Directed powders of camphor and codeine, half a grain of each. .'Vpril loth. He came in this evening and reported that he still has very severe cramps. They came on two or three hours after meals. The camphor and codeine pow- ders give no relief. Presuming that the cramps were due to a hyperacid condition of his gastric secretion (as it had been a' few months before), I prescribed the alkaline pow- der with extract of belladonna. April 14th. Reported by telephone. The cramps relieved and he is all right. October isth. For a week he has had colic, due to overeating. Directed him to live on a rather bland diet, milk, corn- flakes, soft boiled eggs, for three or four days, then to return gradually to normal diet — according to the diet list I had given him. October 20th. He is feeling well again and following the dietary directions given him.