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some time in the wet, and returned home feeling damp, cold, and ciiilly. In about ten minutes much does accutane cost aetna insurance after the iidialation, the breathing became a little asthmatical, so we reapplied the amyl, and again she became perfectly easy, and went to bed. Next morning accutane cost with blue cross insurance siie told me that she had had a most comfortable night, the asthma had quite gone, and she was attending to her household duties. About five months after this attack, March 26, generic accutane no prescription 1871, I was again summoned to her. This time it was nothing more than an ordinarily severe bout of asthma, and wanting the signs of severe collapse that accompanied the first. A repetition of the amyl treatment was followed by results as speedy and effectual as in the first instance. II. Spasmodic Asthma. — Mr. G , aged forty-four, had been subject to occasional how much accutane cost without insurance attacks of asthma for some years. On the buy generic accutane no prescription Gth of last March he had generic accutane cost without insurance a rather bad attack of it, and late in the evening he sent for me. Ho had caught cold, and when I saw him there was some bronchitis as well. Inhalation of the nitrite of amyl instantly reheved his asthmatic breathing. In six or seven minutes after, it returned, though in a lessened degree. Again he inhaled the amyl, and again with relief; but for the next hour there was every now and then a tendency average cost accutane insurance to the recurrence of the bronchial spasm, which, however, continued to be relieved at every inhalation. He went to bed, and had a good night. Next day the asthma was gone, and a little bronchial catarrh only remained. III. Cardiac Dyspncea.— Mrs. T. T price accutane prescription suffered from dilated hyper- trophy of both ventricles, the dilatation being in excess, accompanied by a very feeble circulation, and anasarca to an extreme degree cxcending up- 206 EEPORTS ON THE PEOaRESS OF MEDICINE. ward to tlie abdomen, slight pulmonary oedema, some lividity of face, but not much shortness of breath. Hydragogue cathartics and infusion of digitalis, acupunctur,ation, and vapor-baths, were used, with temporary relief. The digitalis, given in full and frequently-repeated doses at intervals of a week, had invariably in- duced a copious discharge of urine, but at last its diuretic effects seemed to fail, and one day last November I thought I would see whether cupping the renal region would be of service. It should here be stated that during the preceding week she bad been inhaling the nitrite of amy], five drops at a time, four or five times a day, with scnne relief to her breathing. On each occasion slje felt easier, more comfortable about the chest, and ex- perienced a pleasant glow all over her body. The comforting effects of the amyl usually lasted about an hour. I proceeded one evening to cup the loins. Two glasses were applied, one over each kidney. The blood flowed slowly, and when there was about a wineglassful in each glass it ceased to run. At that moment it occurred to me that it would be interesting to watch just then cost accutane insurance the effects of nitrite of amyl upon Iter. I immediately applied about ten drops on some lint to her nostrils. Soon the radial pulse throbbed, then the face became flushed, and at the same instant Mood online buy accutane florida flowed freely into the cujjjnng -glasses.. The experiment was most striking, and clearly showed the influence of amyl on the circulation. IV. AxGiNA Pectoris. — Mr. P , aged twenty-one. "When seventeen years old he had a severe accutane purchase canada and prolonged attack of acute rheumatism, which caused the cardiac mischief from which he now suffers. Toward the end of a long convalescence he began to be subject to praecordial pains, which have ever since continued to trouble him. For accutane prescription expiration the fortnight immediately preceding my first inteview with him, he had not had during any night an liour's sleep. His pains were terrible, cramp-like, and suffocative, chiefly situated about the left mammary and infra-mammary regions, but most in- tense near tlie left best price for generic accutane nipple, and radiating to the shoulder, the neck, and down the left arm to the elbow. He often felt that lie must die. Latterly the pains had increased in frequency and severity. For months past he had not passed a night without a pai'oxysm, and rarely accutane acne treatment cost had he escaped during the day. An attack usually lasted from half an hour to an hour, but sometimes held on for two hours; it was generally made up of several total cost accutane treatment paroxysms, with, perhaps, respites from pain of a minute or so in duration. He had consulted several doctors, and had buy accutane online canada pharmacy tried all sorts of remedies, but never got any substantial relief. I first saw him on the 26th of last January. He was then sitting in a chair, was easy, and free from pain — face very pale, pulse abrupt, rather tense, irregular in force, 90. Cardiac impulse heaving, extensive ; apex- beat three indies below nipple level, and an inch and a half outside nipple- line. Systolic and diastolic basic murmurs. Systolic murmur left apex ; systolic thrill at base. While I was examining his heart, he how much does accutane cost with blue cross blue shield insurance was seized with a fit. He seemed to suffer most agonizing pain about the prtecordial region, which he pressed and squeezed with his left hand ; he threw his head back, inspired deeply, stretched his neck, held his breath for about half a minute, and while doing so kept most of the muscles of cost accutane 2011 his neck, shoulders, and chest, strained to the uttermost. He afterward stated that the posture described and tlie straining were in most part voluntarily assumed, since they gave liim some slight comfort during the paroxysm. Cold and clammy perspiration on his face ; distressing eructation set in, accompanied with loud, gulping noises. He continued in this state for about four minutes. There Avas nothing to indicate that the paroxysm was about to abate. I then poured five drops of nitrite of amyl on a piece of lint, and held it to his nostrils. In about thirty seconds his face and neck became deeply flushed, and all his pains vanished. He looked at me with the utmost astonishment, scarcely knowing what to make of his sudden MATERIA irEDICA. 207 relief. In answer to my question, lie said the pain -vras gone. That night he slept soundly. A bottle of the nitrite was left with him, with direc- tions that he was to pour out five drops and inhale it whenever an attack came on. Ever since, the amyl has invariably given him relief, and no ill efiects or much does accutane cost no insurance unpleasant symptoms due to its repeated use have been noticed. Altogether he has used more than thirty ounces of the nitrite since

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