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part may be modified by irritation in another, but they are so familiar that they will immediately suggest themselves to the reader. There are, then, as I conceive, four conditions in which counter-irritation may act to relieve pain, or abate inflamma- tion : 1. When there is a direct vascular connection between the 4 irritated surface and the diseased part. In this case, counter- irritation acts by Buy Lithium Carbonate Online opening a larger passage for the blood through the sound tissue, and thus diverting the circulation in part from that which is diseased. An example Lithium Eskalith of this is afforded by the application of blisters to the neighborhood of inflamed joints. 2. When a large surface is exposed to the irritating agent, in wliich case the entire circulation of the body, including that of the diseased part, may be modified. An example of this may be found in the use of hot foot-baths, to relieve conges- tions of the Lithium Carbonate Online thoracic or abdominal organs, or of hot applica- tions to the chest and abdomen to relieve wakefulness. 3. When the irritation is transferred to a distance by re- flex action, and there simulates the first condition. As an ex- ample of this, may be cited the employment of blisters to the breast, to act upon the lungs, there being no direct communi- cation between the vessels of the skin and those of the dis- eased organs. 4. When pain is the result of a mech^inical cause, which cause may be removed by exciting Eskalith Cr muscular action through the reflex function ; as when, in flatulent colic, the muscular coat of the intestines is brought into action Order Lithium Carbonate Online by irritation ap- plied to the abdomen, and expulsion of the flatus results. Of course, two or more of these conditions may coexist, and. probably Lithium Carbonate Buy in most cases such is actually the fact, and the result is thus rendered more or less complex. There is a secondarj'^ consequence of the dilatation of the vessels which I have described, which may be mentioned, though its practical importance is probably not great, except in rare instances. I refer to the fact that, when the capillaries of a part are widely dilated, the blood, being in excess of the physiological demand, does not acquire the full venous charac- CIRCCTLATION OF THE BLOOD. 347 ter, but preserves to a greater or less extent the properties of arterial blood, even after it reaches Purchase Lithium Carbonate the veins, as in Bernard's experiment already referred to. It is conceivable that some of the relief afforded in cases of Buy Lithium Carbonate dyspnoea by envelopino; the chest in Eskalith Cr 450 a sinapism may be OAving to this cause, the blood reaching the lungs in a condition to require less than the usual amount of oxygen. If the views which I have advanced respecting the effect of counter-irritation upon the circulation be correct, it follows that the aim should be so to manage the irritation as to cause the greatest possible flow .of blood tlirough the part. Yie should, therefore, Buy Eskalith stop short of inducing inflammation, as this tends rather to impede or arrest the capillary circulation than to promote it. More effect w^ill be produced by irritating a large surface to a moderate degree, than by exciting an in- tense action within narrow limits. This is illustrated in the advantage which is derived from " flying blisters " in subacute inflammation of the joints or in sciatica. These blisters are applied for a short time only, so as not to produce complete vesication, and are repeated at short intervals. They are found to be much more eflicacious than when the full action of a blister is produced. It is not intended by Eskalith 450 Mg this suggestion to ignore the effect which may result from the evacuation of serum by means of vesicants, or of the drain which may be established by main- taining suppuration from a blistered surface. This comes under the head of depletion rather than of counter-irritation, the latter being merely incidental to the former. In examining the capillary system, we shall find that the skin on the one hand, and the mucous membranes and tlio solid internal organs on the other, are very richly supplied with these vessels, while the muscular and cellular tissues have much fewer in proportion. Excluding the latter, w^e may, for the sake of convenience, speak of the cutaneous system and the visceral system of capillaries. These two systems, com- prising so great a proportion of all the capillaries in the body, stand in a certain antagonism to each other. The health of the body requires that neither of these should re- ceive for any considerable time an undue proportion of blood. 348 ciRCULATioisr or the blood. Such a condition involves a double departure from tlie normal state, as the excess in one system necessitates Generic Lithium Carbonate a corresponding deficiency in the other. Let us suppose, then, that the cuta- neous capillaries are by any means increased in diameter to a considerable degree, as they may be, for instance, by the hot bath : we shall find as a result that, the resistance to the flow Eskalith Er of the blood through them being diminished, a much larger proportion will seek that channel to reach the venous system than will pass through the capillaries in other portions of the body. As a consequence, the remainder of the body will be left with an insufficient supply. We may sometimes observe

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