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Related post: very little had been added to the latitude of diag-
nosis by this means. It was well for the internist
or surgeon to realize the exact dependence that
could be placed upon a rontgenological study in any
fjiven condition, and especially upon the work of
the rontgenologist in the locality to whom they re-
ferred work of this kind. Misplaced confidence
would reflect upon them and lack of deserved con-
fidence would deprive them of much valuable as-
sistance. The rcintgen examination of the gastroin-
testinal tract was in no way to be regarded as a
substitute for a careful and Order Cetirizine Online thorough clinical study
of a case. In had a well recognized and established
place as a method of examination to assist in reach-
ing correct conclusions, just as had the clinical
84
FROCEEDIXGS OF NATIONAL AND LOCAL SOCIETIES.
[New York
Medical Jovrn.'
Study, and it had well defined limitations with which
even-one should be thoroughly conversant. An ex-
amination of the gastrointestinal tract was in a
large measure, aside from the observation of filling
defects, a physiological study by an unusual means
of watching the mechanism of the progress of an
opaque meal for the purpose of detecting interfer-
ence with normal physiological action. Therefore,
time and patience on the part of both patient and
examiner were required. A complete study could
not be accomplished in less than three days, and
frequently more time was required. It w'as time
that it was recognized that the making of three or
four rontgenograms without a proper rontgenscopic
stud}' was not the correct or accurate way of mak-
ing a gastrointestinal study, and yet positive diag-
noses of serious lesions were constantly made based Cheap Cetirizine
upon no more evidence than the very dotibtful fill-
ing defects shown on one or two plates without any
fluoroscopic study. Or, on the other hand, serious
lesions had remained undetected because of a lack
of adequate study through undeveloped technic.
Such examinations were usually a waste of time
and also a poor investment, and the conclusions,
being without foundation, might be misleading and
even dangeror.s.
There was a widespread manifestation, of lack
of skill and experience in gastrointestinal study.
More men were specializing Purchase Cetirizine in rontgenology now
than ever before. It Buy Cetirizine Hydrochloride was partly the duty of mtern-
ists and surgeons to see that not onlv these men
kept abreast of Buy Cetirizine Online the times, but also those who had
been doing work of this kind for some time. Cetirizine Online The
new man had usuallv completed a thorough course
of training, but he must continue to read, study, at-
tend meetings and visit others and see their work,
because advances in rontgenolog].' w-ere so rapid
that one soon fell behind, and the hermit rontgenol-
ogist rapidly became a useless member. Rontgenol-
ogy was not a field for Order Cetirizine fanciful diagnoses unless
one was very certain of his premises. The internist
or surgeon wanted reliable facts. Opinions must be
grouped as positive, negative, or those coming un-
der the head of suspicious. A rontgenological study
of the gastrointestinal tract might be regarded as
fulfilling one of three purposes : First, it might
verify a clinical diagnosis either by substantiating
or disproving the presence of a serious condition,
as, for example, ulcer or carcinoma, in both of
which it could now be depended upon. Second, it
might assist in deriving a Buy Cetirizine correct diagnosis by sup-
plying information that could not be determined in
any other way or might be uncertain clinically, as
in the sariie conditions with an uncertain clinical
picture. Third, indefinite cases in which a clinical
diagnosis could not be centered upon anv particu-
lar condition. In such instances the rontgenological
study became more difficult and complicated and
might have to include a study of the gallbladder
and urinary tract, and possibly other parts as well.
Dr. John H. Gibbon, of Philadelphia, said that
the advancement in the diagnosis of gastrointestinal
lesions had been due to a great extent to what the
rontgenologists had done. Doctor Pancoast, how-
ever, had given one word of warning and probably
he could emphasize it more than any rontgenologist
would like to, that is. the danger of operating on
the interpretation of an inexperienced rontgenolo-
gist or upon the apparent lesion shown in plates.
Many of us had come a cropper when we relied en-
tirely upon such a diagnosis.
Thorough Study Versus Exploratory Incision
in Gastrointestinal Lesions. — Dr. John H. Gib-
box, of Philadelphia, in a paper on this subject,
said that it was admitted that the socalled explora-
tory' incision was a justifiable surgical procedure
under certain circumstances. There should, how-
ever, be an honest effort on the part of internists
and Buy Cheap Cetirizine surgeons to reduce and limit these circum-
stances. It was very easy to fall into the habit of
"exploring" or "opening to see," but it required
some effort to develop the habit of studying our
patients carefully, of weighing symptoms and giv-
ing them their relative value, and of taking into con-
sideration the contraindications as well as the in-
dications for operation. The easily acquired habit
rendered one a Purchase Cetirizine Online poor internist or surgeon, with
little likelihood of further development, while the
other made him a man whose opinion carried
weight and who was likely to progress in knowledge
with experience. A common excuse for neglecting
proper study and resorting to immediate explora-
tory incision was the supposed urgency of the pa-
tient's condition and the saving of time. While
this excuse might be legitimate in one case, it was
not applicable in nine out of ten socalled emergen-
cies. His own experience led him to believe that
errors in diagnosis and the mistake of doing an un-
necessary operation were not due to ignorance but
to carelessness, to what might be called "cocksure-
ness." One of the great disadvantages of an in-
correct abdominal diagnosis was the fact that in
order to reach satisfactorily the real lesion, another
abdominal incision might be necessary. Another
point which was worthy of consideration in this
connection was the importance of examining our
patients before operation for conditions quite dif-
ferent from those which caused the patient to pre-
sent himself to us. The time to discover a lung
lesion, Bright's disease, hyperthyroidism, venereal
disease, or Generic Cetirizine a kidney infection was before, not after,
operation and such a discovery might be the means
of saving the patient's life and the surgeon's
reputation.
Surgical Treatment of Lesions of the Gastro-
intestinal Tract. — Dr. Alfred C. Wood, of Phila-
delphia, read this paper in which he said that the
iierforated ulcer was always a surgical condition ;

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