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may be explained as follows : We know that the secretion of the stomach is acid, while that of the duodenum is alkaline Cholecys- titis and cholelithiasis, produced experimentally in dogs, have demonstrated an apparent increase in the amount of hydrochloric acid in the gastric secretion. Bile itself seems to have no influence whatever on the gastric secretions, but regurgitation of the duo- denal contents with the bile of course lowers the acidity of the gastric contents because of die addi- tion of Keflex 1000 Mg the alkaline duodenal secretions. If, how- ever, the duodenal secretion should become acid, it has been experimentally demonstrated that a spasm of the pylorus will result so that connection between the stomach and duodemmi will be cut off, effectually blocking the passage of the stomach contents Keflex Purchase into the intestines. Similar obsen^ations have been made clinically. Therefore it appears that, following the ingestion of an unusually large meal or of a certain kind of food, the digestion of which requires more than ordinary activity m the part of the stomach, a large quantity of secretion is poured out by the gastric glands ; and as a result an unusuallv larsje Keflex 400 Mg amount of acid passes through the pylorus into the duodenum. The alkali Keflex Oral Suspension normally present in the duo- denum may not, in this emergency, be sufficient to neutralize all the acid pouring in with the stomach content. It will be necessary to reinforce the alka- line strength of the duodenum by an overflow of bile from the gallbladder, the bile being also an alkaline substance, though not, as I have shown above, to the same degree as the duodenal fluid. This puts an added Keflex Online strain upon the gallbladder, and the greater the amount or indigestible character of the food taken into the stomach, the heavier will this additional burden fall upon the gallbladder. There- fore, given that that organ is already crippled by disease Order Keflex Online — inflammation, or the presence of stones even without active inflammation — we can easily understand the occurrence of colic after dietary in- discretions. Fried or acid foods by increasing gastric acidity will act in the same way. This, Antibiotics Keflex I Keflex 500mg believe, is the true explanation of gall- bladder colic, and it also explains why these patients always have their attacks during the evening or early part of the night. At these hours the stomach is naturally empty, and no food Keflex Dose being on hand to Buy Keflex ab- sorb the acid gastric secretion it passes directly into the duodenum. The alkali in the duodenum being insufficient to neutralize this acid, the gallbladder will be called upon to reinforce the duodenal sup- ply, and the revolt of the overworked gallbladder brings on the attack of colic. Considering the appropriate treatment, in the light of this theory, we see at once that our efforts must be directed toward relief and reinforcement of the gallbladder. Diet is, of course, the first and greatest Keflex 250 Mg consideration. The food taken must be such as can be easily assimilated, and all fried or acid sub- stances must be rigorously excluded. Tobacco and alcohol must always be abandoned. Small meals, taken Keflex For Mrsa at frequent intervals, four or even five times a day, will serve better than three larger ones. The patient must be prevented from becoming consti- pated, and the urine should be watched lest it be- come scanty and show an acid reaction. Drinking plenty of water and care observed that the skin excretes freely and actively at all times, are prime essentials in every case. Purchase Keflex The medical attendant should aim to quiet the gallbladder, and lessen the peristalsis as much as possible. The administration of alkaline saline waters, and frequent small meals with plenty of green vegetables and fruit, will tend to increase the flow of bile. Plain drinking water alone, if taken frequently Keflex 750 Mg in considerable quantity, is of great help in keeping the bile thin, and preventing its stagna- tion. Alkalies in hot water both before and after meals should be taken regularly. For the immediate relief of acute biliary colic opiates are usually necessary and absolute rest, with hot external applications, must be instituted. A liypodermic injection of morphine, widi or without atropine, a suppository of opium and belladonna, or the latter with codeine, will be beneficial (5). Later such patients should receive a large dose of Keflex Dosage bicar- bonate of soda, two to four teaspoonfuls. each night at bedtime. A little belladonna at the beginning of treatment will be Dose Keflex of assistance in preventing spasm. The references will appear in the author's reprints. June 21, 1922.] DRUECK: RECTAL FISTULA. 7^7 Dangers of Operations for Rectal Fistula By CHARLES J. Keflex Order DRUECK, M. D., Chicago, Professor of Rectal Diseases, Post-Graduate Medical School and Hospital. DANGERS TO BE AVOIDED. Keflex 500mg Price The sphincter may generally be cut once, espe- 500 Keflex Mg cially in the median line, without danger of incon- tinence, but always divide as little as possible. Never divide the sphincter twice at the same operation or without informing the patient that some incontin- ence is sure to result. The condition of the patient's bowels, as regards the number and character of movements, must always be considered. A sphincter that acts admirably for one formed movement daily

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