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immense harm. Even though we may not be able to remove the cause of the worry, we may help the patient to be philosophical about it and to mini- mize its importance. The attainment of a cheerful state of mind coversyl and viagra may be almost as helpful as removing the trouble itself. I have often been impressed with the importance of cheerfulness, content, and hope- fulness as a therapeutic measure, as well as the effects of various depressing mental and nervous factors in the causation of lowered resistance. In looking over the histories of 740 cases of tubercu- losis treated during the past fifteen years, I find that 129 show reasons for believing that some form of nervous depression was at least an important causative factor. A large proportion of the earlier histories were carelessly taken and give no evidence at all bearing on the subject. I feel certain that it is much more commonly a cause than these figures indicate. The great mistake and cruel injustice of sending people ill with tuberculosis far from home without sufficient financial resources to enable them to live under proper conditions and for a sufficient time without worry and embarrassment, has often been noted. But those who practise in health resorts still viagra farmacia coversyl and viagra see so much distress from this cause that it cannot be over-emphasized. Getting well of tuberculosis coversyl and viagra is a long process and the cost of living and of care suitable to the patient's needs is usually greater in a health resort than in one's own viagra farmacia home. A better climate will rarely overbalance lack of proper liv- ing conditions or worry and anxiety in obtaining them. Moreover, distinct harm is likely to come from advising a plan which the patient is financially unable to carry out. The prolonged physical and mental rest and the limitations necessarily imposed during a "cure" sometimes become so irksome as to be a real detri- ment to the patient. In such cases finding out and making available suitable diversion and mental occu- pation may be the means of changing failure into success. The prescription must be suited to the in- dividual, else harm rather than good may be done. All these considerations help to show the need of personally taking the viagra farmacia histories of our patients and getting into close coversyl and viagra confidence with them, in order that we may know coversyl and viagra all the factors in their lives which have to do with their powers of resistance. They should also indicate the danger of giving routine directions based on a physical diagnosis alone and of treating our patients as a class. We need to make a sort of social service diagnosis and to do the kind of work done by social service work- ers if we would most efficiently help our patients in the personal struggle to get well of tuberculosis. Physiological Icterus of the Newborn. — Ada Hirsch finds that the blood of the umbilical cord contains more bilirubin than the blood of adults or of children after the icteric period. The intensity of the icterus of the new born is parallel with the degree coversyl and viagra of bilirubin con- tent. These facts appear to controvert the hypothesis that icterus in the new born is the result of an infec- tion. — Zeitsckrift fur Kindcrheilkunde. DIAGNOSIS AND TREATMENT OF GASTRIC NEUROSES.* By S. WENDKOS, M.D., PHILADELPHIA. CHIEF OF MEDICAL CLINIC OUT-PATIENT DEIPAKTMENT, MT. SINAI hospital; PATHOLOGIST OF JEWISH CONSUMPTIVE INSTITUTE. Recent medical literature is replete with discus- sions of gastroenterological subjects, emanating mainly from the surgical clinic viagra farmacia and operating amphi- theater. The contributions of surgery to our knowl- edge of gastric diseases has been invaluable. When I began to pay coversyl and viagra particular attention to gastric dis- eases some five years ago and to increase my knowl- edge had recourse to some standard text books on this branch of medicine, I was bewildered by viagra farmacia the number of neuroses listed as distinct viagra farmacia diseases; the whole subject was rather chaotic in my mind as a result of text-book reading. I then turned to sur- gery's contributions, such as, for instance, the work of Mayo's staff. Moynihan's work. Lane's, Deaver's, etc., viagra farmacia and it was as coversyl and viagra though a thick veil shrouding the whole subject of gastroenterology had been lifted and I began to perceive clearly the distinctions, the diagnostic difficulties, and the medical as well as surgical aspects of many gastric conditions. The neuroses began to vanish in the light of day thrown upon them in the operating room by the aseptic knife. What was heretofore diagnosed and treated as a nervous hyperchlorhydria, was shown to be due to a gastric or duodenal ulcer, gall-bladder dis- ease, chronic appendicitis coversyl and viagra or certain medical condi- tions as tuberculosis, chlorosis, nephritis, etc. Sur- geons emboldened by their findings in large series viagra farmacia of cases coversyl and viagra ventured to deny the existence of neuroses altogether. They challenged the internists viagra farmacia and gas- trologists to subject their cases of so-called nervous dyspepsia and other neuroses to the knife and they would be convinced that there was a pathological viagra farmacia condition in the stomach or in the neighboring or- gans that would account for the dyspepsia. The glove thrown down by the surgeon was picked up by the medical man, and following the cases to the operating room he found that not a few cases which had been diagnosed as coversyl and viagra ulcer or other organic dis- ease by the surgeon, revealed nothing viagra farmacia to account for the gastric symptoms when opened up. I followed my own cases to the operating room and then 1 followed them home. The supposed chronic appen- dix which was removed, viagra farmacia did not relieve the patient. This condition I have seen too often, and I have become convinced that many surgeons in a hurry blame the poor appendix for numerous gastric con- ditions which may be accounted for otherwise. My own personal experience then leads me to viagra farmacia the viagra farmacia conviction that many gastric disturbances are nothing more than neuroses. But owing to the in-