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and there buy cheap cipro is no indication whatever purchase cipro online of cardiac mischief. Experience has taught that endocard- itis, and even insufficiency of the aortic valve, are frequently found in persons in whom the)' had not been suspected during life. The preceding considerations lead to the two following conclusions: (o) That the heart in a number of women cipro price during pregnancy and the puerperium is subject to hypertrophy, which may become permanent and pathologically affect the valves; and (b) that latent cardiac disease of rheumatic and other origin may first come to the front during pregnancy or in and after labor. If we only admit that cipro online pharmacy cardiac disease in general is, under certain conditions, capable of producing mental disorders of a typical nature, then buy cipro online could not puerperal insanity, in some obscure cases at least, be brought in connection with either a la- ^Dreysel, Miinchener medicinisehe Abhandlung n 1891. "Pepper, Text-Book of Medicine, 1894, Vol, ii. p. 279. '^Th. Parvin, /. c, p. 420. '^Osler, /. c, pp. 702 cipro online and 712. July 27, 1901.] JACKSON: EXAMINATION FOR KIDNEY DISEASE. 159 tent or previously diagnosticated affection of the heart ? In cases of puerperal insanity where a diseased cipro 250mg condition of the heart was certainly known to exist, the cardiac affection, so far as I can judge from the literature, has never been given any im- portance in connection with the coincident puer- peral psychosis. To cite an example : In his re- cently published Clinical Lectures, Kraepelin" describes three typical cases of puerperal insanity, in one of which there was a history of apoplexy cipro 250 three years cipro order previous to pregnancy, and in another there were signs of an enlarged heart with an apical presystolic murmur. Yet he passes these data by without any further comment. Cardiac disturbances of any kind might be oftener discovered in cases of puerperal insanity if more attention were paid to the condition of the heart in obstetric practice, and thus, perhaps, indirectly contribute to the study of mental mani- festations in relation to cardiac disease. THE OPHTHALMOSCOPIC EXAMINA- TION FOR KIDNEY DISEASE.* By EDWARD JACKSON, A. M., M. D., OPHTHALMOLOGIST TO THE ARAPAHOE COUNTY HOSPITAL, DENVER, COLORADO. In cases of renal disease the ophthalmoscopic examination follows closely in importance the clinical and microscopical examinations of the urine. Noticeable changes are found in fifty per cent, of such cases ; and distinct albuminuric retinitis occurs in not cipro hc less than ten per cent. In these latter cases the ophthalmoscopic appear- ances are easily recognized, are as pathognomonic of the general disease buy cipro as any set of symptoms known in medicine, and have the most definite prog- nostic significance. Of the men showing this symptom in Haab's Clinic, all died within two j'ears. Belt, in 419 collected cases, found that seventy-two per cent, were dead at price of cipro the end of the first year, and ninety per cent, at the end of the second year. A symptom of such frequency and such significance is worth looking for, and it should be looked for repeatedly, for some of its most characteristic appearances are transient. To look for it thoroughly requires cost of cipro the use of a mydriatic. The patient usually presents a small senile pupil. The most characteristic changes are apt to be in or near the macula, a region hard to examine thoroughly without the use of a cipro cheap my- driatic, even in young eyes. If the patient is in purchase cipro bed, the cipro 250 mg difficulty is still further increased, and also the need for buying cipro online the mj'driatic. But these pa- "Einfiihrung in cipro cost die psycltiatrische Klinik. Leipsic, 1901, p. cipro 500mg 135. •Read before the Colorado State Medical Society, June 19, 1901. tients are suffering a progressive loss of vision. If you put atropine in the eye, it takes two weeks to get over it. The atropine impairs the sight, and by two weeks the progress of the disease will

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