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or slight connective-tisssue formation around the glands; only twice was slight vacuolization visible, and once atrophy of glands with connective-tissue formation. Nine cases with hypochlorhydria presented a normal condition of the glands in three, atrophy in two, beginning atrophy in two, connective-tissue pro- liferation in one, and proliferation of glands in one. f these nine cases two were examined on two different occasions; in one the microscopical pictures were pretty much alike, while in viagra online alcohol the other once atrophy and the second time proliferation of glands were found. Seven cases of achlorhydria (principally achylia gastrica) showed a normal buy viagra diaries condition twice, complete atrophy three times, while once there was very marked vacuolization and viagra online alcohol once slight proliferation of glands. In none of the four different secretory conditions was there found a perfect harmony in the microscop- ical picture of the gastric mucosa. It, thereore, does not appear justifiable to make a positive diagnosis as to the existing disease from the examination of such small pieces of gastric mucosa. Two facts, however, are quite apparent: prolifera- tion of glands is frequently met with in hyperchlor- buy viagra diaries hydria (in half the number of cases) and atrophy is encountered in the same proportion in achylia gastrica. If we now return to our first question, whether anomalies of the gastric secretory function are depend- ent upon anatomical lesions, it seems that the results of the viagra online alcohol table speak against this assumption. For if anatomical changes are the primary factors, there viagra online alcohol ought to be more constancy in the results of these microscopical examinations. The table, however, shows that there is some con- nection between hyperchlorhydria and proliferation of glands on the one hand, and between achylia and atrophy of the glandular elements on the other hand. How are we to explain these anatomical changes if we do not deem them the principal factors in these con- viagra online alcohol ditions? Before answering this question I would like to June 27, 1896] MEDICAL RECORD. 919 remind you of Edinger's ' excellent paper: "Anew theory of the causes of some nervous diseases, espe- cially of neuritis and tabes," in which he explains the anatomical changes found in the nerves and the spine by a disproportion between the functional activity and the replacement of these elements. You all know that normally the increased activity of an organ leads to The facts just mentioned show the importance of the functional activity with regard to the state of an organ : the elements which come more into play and do more work viagra online alcohol will gain supremacy, they will increase in strength and in numbers. If now we return to the stomach there seems to be hardly any difficulty whatever in explaining why con- -iS&w .'.t/>: ISO." '-- .-". . ' - - ' buy viagra diaries JySjM-A ' ^ Fig. 1. A small piece of gastric mucosa ("from patient, Mrs. H.) presenting a cross-section of the glands in normal appearance. X 80. C5W* Fig. 2. A piece of gastric mucosa (from patient, Mrs. R. S.) showing beginning atrophy of glands (small pale areas within the glands) and connective-tissue proliferation. X 120. CAt