years of age for a vesicovaginal fistula. The open-
ing in the bladder wall was three Tofranil Tablets eighths of an inch
in diameter and resulted from the bar or the arm
of the pessary rubbing and perforating the bladder
cavity. Therefore, should not the unhappy results
obtained by the surgical methods as practised today
be sufficient grounds to bar their continuance or at Buy Tofranil Online
least modify their use? For some years I have
entirely abandoned the use of curettage and the
stem pessary Generic Tofranil in the treatment Buy Imipramine Online of acute anteflexion
and I most emphatically disapprove of their use for
this condition. A uterus in the majority of cases
in acute anteflexion should be looked upon as a local
evidence of Tofranil Price systemic disease and any effort at treat-
ment, therefore, must be directed along systemic
medical lines. One should keep in mind that a
certain proportion of these patients will not be
benefited at all by any measure and in so far as
the local uterine condition is concerned, it should
be placed in the category of incurables. No known
medical or operative agency will cause a uterus to
grow. An infantile uterus in Tofranil Online an adult woman will
remain infantile forever, regardless of any plan of
treatment, and the sterility associated with the con-
dition Tofranil Cost will likewise Buy Tofranil persist indefinitely. The obes-
ity, amenorrhea and dysmenorrhea, so frequently
an accompaniment of the trouble, may be (to a
certain degree) modified, but not cured. In a
moderate degree of infantilism, however, function
in a small proportion Buy Cheap Tofranil of cases occasionally is re-
stored, but in pronounced cases never. Should we
not, therefore, cease chasing the will o' the wisp
and not only face the truth, but Purchase Tofranil tell the Tofranil Mg truth as
well? Too frequently these patients are persuaded
to believe their symptoms will be overcome by
surgery and all too soon is their dream of promised
happiness shattered.
TREATMENT OF ACUTE ANTEFLEXION.
In the condition under discussion, four condi-
tions are confronted, each demanding specific con-
sideration and attentiort. First, obesity ; second,
sterility ; third, partial or complete amenorrhea, and
fourth, painful menstruation or dysmenorrhea.
Perhaps the condition can well he described by out-
lining a typical case.
Case. — At the present time, I have under my
care a single woman, Tofranil Pm twenty-.six years of age. She
is five feet two inches in height, and weighs 236
pounds. Her menstruation was established at four-
teen and always Order Tofranil has been more or less irregular.
At present it recurs every three or four months
and is Tofranil 50 Mg manifested not by a flow, but simple spot-
ting. The duration is less than a day and the dis-
charge is accompanied by violent pelvic pain. Her
uterus is typical of the infantile type. The cervix
is long and its diameter does not exceed the tip of
my little finger. The dimensions of the uterine
body are all contracted and the organ is half the
size of the normal virgin structure. Systemically
she presents the train of nervous phenomena asso-
ciated with endocrine dysfunction and rarely, as
personally expressed, "do I enjoy a well day." This
patient is responding well to treatment. During
the first four weeks she lost twenty-six pounds in Cheap Tofranil
weight. Her nervous state is much improved. Her
menstruation recurs regularly. The flow is mod-
erate in amount, the duration is from two to
three days, and the pain has been decidedU- relieved.
There is no palpable change in the uterine cervix
or body, but the general improvement and the
restoration of ovarian function have been remark-
able indeed.
The marked obesity observed in these patients
must be overcome by a strict dietary regime. It
should be the custom to strike and strike hard at
this phase of the trouble and endeavor to reduce
the patient twenty or twenty-five pounds during Tofranil Uses
the first four weeks of treatment. This can be
readily accomplished by feeding the patient proteid
broths, green vegetables, raw fruit and fruit juices.
We generally instruct the patient to begin feeding
at Purchase Tofranil Online seven or eight a. m. and eat regularly every three
hours for twelve hours or from seven or eight Order Tofranil Online a. m.
to seven or eight p. m., taking a cup of hot broth
with a vegetable, a raw fruit or fruit juice. Tea
or coft'ee without sugar or cream may also be taken.
This regime is rarely a hardship and we have never
experienced any difficulty in having the plan carried
out. After the initial rapid loss, the diet is still .
restricted so that a progressive loss of from five
to ten pounds a month is maintained until the
patient returns to a relatively normal weight. We
have succeeded by this plan in subtracting from
fifty pounds, in mild cases, to Buy Imipramine seventy-five pounds
or more in marked cases. In addition to a strict
dietary regime, scrupulous attention should be given
to the bowels. Two evacuations daily should be in-
sisted upon and these should be accomplished, if
necessary, by the use of a saline purge. The skin
should be kept active by systematic exercise, ob-
tained either in employment or by walking and also
by a hot tub bath on retiring.
The obesity and other systemic phenomena are
also favorably influenced by the administration of
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