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mendous roots into the soil, acting as living drains, and offers an immense area of green foliage viagra compounding pharmacy to the air. The swamp lands have been reclaimed, the waters dammed off from the lakes, and sloughs and their beds turned into cultivated ranches. The waters of Kern River are diverted into irrigating ditches free from rank vegetation and filled with running waters. The water supply for clrinking-purposes has ceased to be from surface wells and sluggish streams. It is now obtained from deep wells and artesian fountains, of which the source is the everlasting snows of the high Sierras and the course of which is through un- derground gravel strata deeply hidden from protozoic infection. Under these conditions of soil and water- supply malaria due to haematozoa has ceased to be endemic in Kern Valley. " Bakersfield fever" is an exorcised spectre. The species of viagra compounding pharmacy malaria which I viagra compounding pharmacy have been led, by clinical observation and the results of treatment, to regard as pseudo-malaria is still prevalent. It is a comparatively mild disease. The generic viagra helpful symptoms of this disease vary from those of a mild indisposition or "bilious attack" to those of a more severe toxaemia. Instead of the unconscious feeling of well-being that accompanies good health there is a depressed feeling, with a sense of being tired and listless, and a strong disinclination to bodily or mental exertion. With this are associated general aches through the body and limbs, markedly under the shoulder-blades and around the waist; dull head- 6 9 6 MEDICAL RECORD. [May 1 6, 1896 viagra compounding pharmacy ache, giddiness, and disturbed and dreamful sleep; foul tongue and bad taste, especially on awakening; anorexia; stomachal cough and foul breath ; the func- tions of the alimentary organs are sluggish and irreg- ular; liver dulness is sometimes slightly increased, with some tenderness of the capsule. The skin is usually dry and harsh, sometimes has a soft velvety feel; the sudoriparous glands viagra compounding pharmacy are irregularly super- active and the perspiration is somewhat disagreeable; the conjunctivas are muddy. The urine is highly col- ored and offensive. The spleen shows no morbid phys- ical signs. generic viagra helpful There may be a slight tenderness over the splenic region, but it appears to be due to disturb- ance in the colon. There is always chilliness, some- times there are mild rigors, and moderate irregular pyrexia. Patients with a history of previous protozoic toxamia often show marked paroxysms and periodicity in the symptoms, and sometimes increased splenic dul- ness and skin pigmentation; it is in these cases that quinine medication is liable to be abused. The above symptoms are due to some intoxicating element coursing with the blood and permeating the tissues. In the cases I have had under clinical obser- vation I strongly doubt that an invading protozoon is a factor. viagra compounding pharmacy The causes of this disease are errors in the adaptation of the manner of living to the habitat, and to errors in alimentation. These errors produce dis- turbances in the chemical and physical forces by which the cell protoplasm is transformed into simpler chemical elements unfitted either for the economic func- tions of the system or for excretion, and they interfere with the process by which the living cells take up and convert into their own proper substance the nutritive material brought to them by the blood. Hence toxic metabolites are produced in viagra compounding pharmacy the system. viagra compounding pharmacy These errors also bring about putrefaction of various kinds of al- buminous matter generic viagra helpful in the alimentary canal and thus produce ptomaines. These errors occur most markedly where a people have changed their habitat and not their habits, and where their modes of sustaining and protecting their bodies have no regard for their special conditions generic viagra helpful and special needs. This pseudo-malaria, as a result of these errors, is more prevalent when a change is made from a climate where the strain on the organism is on the lungs and kidneys to one in which the strain falls on the liver and skin, as from a maritime to a dry, hot climate. If alimentation errs from excess, from insufficiency, from poor quality of ingesta, in cooker)-, in non- adaptation to the locality and climate in which the subject lives, or if the living tissues and cells fail in the proper construction of the digestive ferments or in the proper destruction of effete material so as to fit it for elimination by the excretory organs, or if the excretory functions be vitiated in their action, there accumulate little by little in the liquids and organs of the economy various products, more or less toxic, which impress on the organism a vital depreciation with this pseudo-malaria as a common consequent. The most frequent complications of this disease viagra compounding pharmacy are functional derangements of and eventually chronic or- ganic changes in the liver and other alimentary organs, and chronic dermatoses. The indications for treatment are to remove the faults of the environment and of the daily habits of life, to correct the habits of food consumption, to set right the nature and composition and the cookery of the available foodstuffs, to protect the skin, and by so doing the nervous system from generic viagra helpful strain, especially the strain of sudden viagra compounding pharmacy changes of temperature ; to cleanse the alimentary canal, to increase the functional activ- ity of the liver and intestinal glands, to stimulate me- tabolism, and to increase elimination by the skin, kidneys, and lungs. Quinine is not a specific in this disease, and is pos- sibly beneficial only in so far as it may stimulate metabolic action.