emphysematous complications, has its origin in an error of anafranil 50 mg
nutrition. And this error may be general or local. If gen-
eral, the anafranil for ocd contractile power of the muscular and elastic fibres
participates in the universal failure clomipramine 50 mg of nutrition ; the prolonged
expiratory murmur is simply one of the manifestations of weak
vital power, just as an atonic muscle, a certain quality of an
elastic artery, or the non-contractile state of a feeble capillary,
is an indication of clomipramine tablets constitutional debility. Thus, I have fre-
quently observed a morbidly-prolonged expiration in general
anaemia, in cases of exhaustive discharges of long standing, in
advanced stages of typhoid fever, Bright's disease of the kid-
ney, and other constitutional states characterized by general
prostration of the vital powers. In all such cases, vital con-
tractility — including clomipramine anafranil the natural resiliency of lung-tissue — is
everywhere disturbed by the general failure of nutrition, and
this may exist, I repeat, without reference to tubercle.
Practically considered, therefore, a prolonged expiration
is frequently characteristic of order anafranil the pretiibercular stage of con-
sumption — a stage in which auscultation and percussion
give us cheap anafranil no clew to the disease other than the sign referred to.
In such early stage of the disease we simply affirm, from a
morbidly-prolonged expiratory murmur, that the patient has
" weak lungs," and this we do on a principle as easily under-
stood as that of weak digestion or weak circulation.
Nevertlieless, clinically considered, as already stated, mor-
bidly-prolonged expiration may be often anafranil online detected in constitu-
tions not at all tuberculous, so far at least as we are able to
discover. In rare instances, indeed, it is normally j^reseut,
particularly on the right side. Hence, unless other evidences
accompany it, it furnishes no reliable clomipramine hydrochloride test of the actual pres-
ence of tubercle.
As indicating a tendency, however, to tubercular deposit,
the sign is extremely valuable in its groupings with the ra-
tional symptoms generally present. If, for instance, with a
prolonged expiratory murmur, the patient has the peculiar
238 PEOLONGED EXPIKATIOIT.
"build of body indicative of the want of proper nutrition and
development, and if to anafranil buy clomipramine 50mg these be added lax fibre, waste of mus-
cles of inspiration, gradually progressive emaciation without
any known cause, want of fatty matter in the subcutaneous
connective tissue, general pallor, and, perhaps, morning and
evening fluctuations of temperature, we have every reason to
suspect what the older authors described as the "consumptive
habit of body," and to fear the speedy development of other
signs indicating absolute presence of tubercle.
The importance of grouping together such general signs
and symptoms as indicate, in their correlations, a tuberculous
tendency anafranil 150 of constitution, before there is consolidation of lung
of sutHcient magnitude to be recognized by ordinary physical
signs, can scarcely be over-esti mated. The refinements of phys-
ical diagnosis are often indulged in at a time when there anafranil price is
no hope for the patient.
I have spoken of a general lesion of nutrition. If the
error, however, be more decidedly local — whether from local
ansemia, loss of power from the efiused products of inflamma-
tion, fatty degeneration of the air-cells, or stiffening of their
walls from the infiltrated deposit of tuberculous matter — anafranil buy online we
are apt to have, with prolonged expiratory murmur, a great
variety purchase anafranil of local and circumscribed sounds, corresponding with
the location and extent of the tuberculous deposit. Thus, it
is often found associated with the extremes of feeble and rude
respiration, bronchial and cavernous. It may exist in connec-
tion with high or low pitch, moist or dry rales, sonorous or
sibilant. But, in all instances, intensity smd pitch will deter-
mine clomipramine 20mg whether the prolonged expiration indicates solidification
of lung, or mere retardation of refiux of air from loss of power
of its muscular and elastic fibres ; and the predominant bron-
chial or vesicular character of the sound, clomipramine hydrochloride tablets as the case may be,
will also throw light on the nature of the cause. Moreover, if
tubercles be actually present, the diagnosis rarely hinges ex-
clusively anafranil 150 mg on prolonged expiration.
The study of these more local signs, however, does not
come within the scope of the present paper. It has been my
aim to present, in the briefest possible space, the simple state-
ment, that prolonged expiration may be caused by defective
tonicity of the muscular and elastic fibres of lung-tissue, irre-
CHRONIC DIFFUSE NEPHRITIS. 239
spective of vesicular ocd anafranil emphysema, tubercular deposit, or bron-
chial congestion ; that tliis results from atonic conditions of
the general system ; and, when taken in connection with cer-
tain rational symptoms, is a most significant sign of the pve-
tubercular stage of consurrvption.
The views here expressed as to clinical facts have been
formed from personal observation, which may or may not ac-
cord with the opinion of others ; the cause of the facts, I desire
to repeat, is only an opinion earnestly entertained, and be-
lieved to be in harmony with the facts, and with the physiolo-
gy of tlie respiratory act.
Aet. III. — ChroniG Diffuse Nephritis. By Feancis Dela-
FIELD, M. D.
The name of Bright's disease of the kidney, like that of
tubercles of the lungs, has had tlie unfortunate eifect of lead-
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