Buy Viagra Says | Viagra Pro Prescription | Best Pharmacy













































consolidation does not exclude phthisis. A bronchial tube may be the seat of a tuberculous deposit, which though small may cause harassing cough. Other Causes of Cough. Other causes of a chronic cough are pregnancy and abdominal tumors pressing upward on the lungs, laryngitis, tracheitis, cancer and syphilis of the lungs, and morbid growths of other parts of the respiratory passages. Not long ago I saw a patient whose cough of several months' duration was caused by enlarged glands at the base of the tongue. It should be a part of routine work to exam- ine the throat in all cases. By this means we deter- mine whether the throat is a factor in the production of the cough; for the throat is often a complication when not the primary cause. Chronic laryngitis is not infrequent, but most cases of chronic laryngitis are tuberculous and are secondary to phthisis. viagra pro prescription Tra- cheitis, tuberculous or non-tuberculous, is rare. I have mentioned the differential diagnosis of cancerous, syphilitic, and other growths in the lungs. In the throat they are not difficult of recognition. Pregnancy and abdominal tumors are easily diagnosed, and their presence must not be accepted without investigation as the cause of the cough. I have not space to dis- cuss coughs viagra pro prescription of a reflex origin from liver, uterus, or other organ. Such an origin is possible, but far from common, and such an opinion is never justified until every other source is excluded. Expectoration. I have said that the first appear- ance of expectoration varies greatly in different pa- tients. In some the entire first stage is passed with none at all. Usually there viagra pro prescription is more or less. If there is considerable viagra pro prescription pneumonic disturbance, the sputum will be of a viscid, gelatinous character. ( )ften it is a frothy mucus. This early sputum is not rarely streaked with blood. Microscopic Examination. Whenever sputum viagra pro prescription can be secured from a patient it should be submitted to a careful microscopic examination. And sputum can often be obtained from those who say they do not ex- pectorate. Only a few days since I secured a sample of sputum and demonstrated bacilli in the case of a patient whose doctor had excluded phthisis because there was no cough, by directing him to clear his throat and spit on a clean piece of white paper when he first awoke in the morning. A sputum examina- tion is of such importance in a doubtful case that the greatest pains should be taken to obtain it. The ba- cilli are often scant in the non-purulent sputum of early phthisis, and we cannot viagra pro prescription conclude positively that there is no tuberculosis after one negative examina- tion. But if after several attempts by one skilled in the procedure no bacilli are found, phthisis may be excluded. A buy viagra says good microscope costs considerable money, its successful use requires much skill and takes a good deal of time. For these reasons mi- croscopes will not very soon be as common as fever thermometers, though even more useful. But every practitioner can with little trouble collect a sample of sputum and send it to a microscopist. This should be done a hundred times where it is now done once. Haemoptysis. Next to a cough hamoptysis is the most frequent buy viagra says first warning of phthisis. Like the cough, it may come to one already in feeble health, yet frequently it occurs while the general condition is good. Not infrequently a case runs its viagra pro prescription course to a fatal end without haemoptysis ever having occurred. Families differ in this respect. In some families buy viagra says every case of phthisis will have frequent hemorrhages, while in others there is none. The bleeding of early phthisis is usually slight, not more than one or two ounces. Often it is a mere streak or spot of blood in the mucus. A single attack may consist of only one or two expectorations, or it may continue two or three days, the patient spitting some blood every few min- utes during the time. In some cases there is no cough preceding the hemorrhage and none follows. In others there buy viagra says is a dry persistent cough for some time before any blood is raised. Sometimes this viagra pro prescription cough is relieved by the bleeding, oftener it is not relieved, but continues its course as when no hemorrhage occurs. The color buy viagra says and appearance of the blood vary consid- erably; usually it is buy viagra says bright red and somewhat frothy; 83: MEDICAL RECORD. [June 13, 1896 if it is retained in the air passages any length of time it becomes darker and clotted. Thus we see that all forms and variations of hemorrhages occur in viagra pro prescription phthisis, and conversely any hemorrhage from the lungs or bron- chial tubes is viagra pro prescription a nearly certain indicator of tuberculosis. But there are other causes of haemoptysis as follows : 1. The neoplasmic growths before mentioned. None of these are so apt to bleed, even when present, as are tuberculous lesions. The sputa of cancer are of such a characteristic " prune-juice" appearance that they are easily recognized. Besides, cancer of lung is in most cases secondary. 2. A number of acute dis- eases, the most frequent of which is pneumonia. The history of these is sufficient for diagnosis. 3. Certain dyscrasiae, as purpura, scorbutus, etc. Again the his- tory is sufficient for diagnosis. 4. Organic heart dis- ease. The chief forms of heart disease which cause hemorrhage are mitral obstruction and insufficiency, obstruction of pulmonary valves, fatty degenerations, myocarditis any form of heart disease which leads to dilatation and enfeeblement of the right heart. As hemorrhage from heart disease does not occur until an advanced stage, with well-developed lesions, its recog- nition as a probable cause of haemoptysis is easy. And phthisis must not be excluded because of the dis- covery of heart lesions; for those very lesions which are said to most frequently cause hemoptysis are the