Abstract
There is a group of persons, usually, but by no means always, adults of middle age, which presents a clinical picture that is rather vague, and somewhat obscure, of long duration, and of which the significance is often overlooked, or at least not apprehended. The syndrome is quantitative rather than qualitative; that is, there are no clearly defined, outstanding symptoms. The onset is insidious and gradual, although the patient, usually a woman, may associate its beginning with some unusual dietary event, as a party, or indulgence above the ordinary in unusual foods. This event, however, should it occur, usually marks a culmination rather than a commencement. The several typical symptoms, which, let it be emphasized again, are quantitative rather than qualitative, are: (1) constipation; (2) fatigue, which is manifested by a marked disproportion between the mental desire for accomplishment and the physical inability of realization; (3) meteorism; (4) precordial or
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