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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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