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gland was available for operation. The Goetsch test had distinct value in the diagnosis. One point to be emphasized was that solutions of adrenalin chloride varied a great deal according to the age of the solution. This ought to be taken into consid- eration. Folin had described a test for determin- ing the purity of adrenalin. Dr. Woodbury did not regard the Goetsch test as positive unless there was a rise of over ten points stendra tablets in blood avanafil online pressure together with subjective symptoms, including tremor. One is hardly justified in ruling out all thought of a thyrotoxic state because the basal metabolism ac- cording to our present methods ran within normal limits. It seemed that cases occurred in which purchase stendra there was no definite rise. The Goetsch test was not an absolutely reliable criterion. Certainly for the diagnosis of mildly toxic cases of adenomata study of the individual patient must be made and all available points of diagnosis utilized. SVMPOSIU.M ox G.\STROINTESTINAL DISEASES Practical Clinical Laboratory Diagnosis in Gastrointestinal Disease. — Dr. Howard F. Shat- TUCK and Dr. Joiix Killl^n, of New York, pre- pared this paper, which was read by Dr. Killian. They stated that some of the new methods of examina- tion, particularly the x ray, had lessened the use of chemical examinations or rendered the considera- tion of them less important, yet they often avanafil 50 mg yielded findings in clinical problems where every bit of evi- dence was needed. In ' a series of examinations made at the Postgraduate Hospital the authors buy stendra were impressed by the great amount of free hydrochloric acid in cases of gastric ulcer as compared with duo- denal ulcer. The average per cent, of free hydro- chloric acid was under 0.50 in cases of duodenal ulcer, while it ranged from 0.53 to 0.80 per cent, in cases of gastric ulcer. In carcinoma of the stom- ach the average percentage of the free hydrochloric acid cheap avanafil was very much under 0.50, reaching that figure in only one instance. A large group generic stendra of miscellane- ous stendra online conditions yielded results in which the total percentage of free hydrochloric acid was under 0.50. A second interesting point was the association of hydrochloric acid and lactic acid in cases without retention. It was common to find lactic acid in the gastric contents with retention, and rarely was lac- tic acid present without retention. In regard to the value of the Wolff- Junghans test : Smithies reported that next to the Boas- Oppler bacillus a positive Wolff test was the most frequent finding in gastric cancer. This test was positive in eighty per cent, of the cases ; lactic acid 696 purchase stendra online I'ROCEEDIXGS OF NATIONAL AXD LOCAL SOCIETIES. was present in seventy-five ])er cent.; the P.oas-Oppler bacillus was present in ninety per cent. In tlie authors' group of cancer cases eighty per cent, gave a positive or suspicious Wolff test. 'I'lic test iiad been of value in distinguishing the malignant from the benign achylias. The records of ga.stric cases had brought out the great value of gastric avanafil de 200 mg analysis in the differentiation of true achy- lias from psychic achylia.s. In none of the cases of true achylia gastrica or pernicious anemia were they able to demonstrate the presence of free hydro- chloric acid at avanafil de 100 mg any time in the digestive cycle. There were cases simulating true cases which proved on e.xamination to be spurious or psychic achylias. In these cases improvement was obtained by the use of hydrochloric ackl. As regards enzyme activity of the duodenal con- generic avanafil tents, Einhorn had shown the value of this proce- dure in pancreatitis. It gave qualitative rather than (juantitative results. The duodenal contents were obtained by any of the duodenal tubes after test meals and removed at intervals. In thirty-one cases, the pancreatic enzymes were present except in the cases of pancreatitis, in which the protease was absent and the lipase present in small amount. \\'hat the authors wished to emphasize from the data obtained was the proportion of the total acid- itv in the f(jrm of free hydrochloric acid. In a series of normal cases they found that the free hydro- chloric acid formed about forty per cent, of the total acid in the Ewald meal and about thirty per cent, in the retention meal. It was always less avanafil cost than fifty per cent. In a .series of cases of gastric ulcer they were impressed with the fact that the total acidity was never very high. In only two cases was there marked hyperacidity. The order stendra constant feature of these gastric ulcers was that the pro])ortion of the free acid to the total was always greater than stendra price fifty per cent, and in most cheap stendra cases it approached seventy-five ])er cents. That was true of the Ewald meal. In the retention meal the percentage of free stendra cost hydrochloric was even greater. The secretion of hydrochloric acid seemed to be free from the buy stendra online stimulus of food. In a series of duo- denal ulcers divided into fwo where to buy avanafil/extendra groups, postpyloric

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