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1 have fancied that f have found the sulphide of cal- cium in as large doses as viagra levitra price the stomach will bear with- out nausea, doses of one-half to one grain four times .1 day, to be of service in acute rheumatism and to hasten the convalescence. I am at present taking ob- servations on this point, but they are too few yet to warrant a conclusion. The great aim in adolescent primary heart affec- tions is viagra generic shipping to carry the patient along until the changes of middle life can develop, when the liability to acute articular rheumatism has ceased. It is significant how many cases of cardiac murmur viagra generic shipping we find nowadays in patients in middle life which have lasted for years without any inconvenience. Many a patient having mi- tral stenosis, viagra generic shipping which produced most serious symptoms at twenty, seems spontaneously to recover at about forty, apparently from the increase in the left ventricular cavity natural to that time of life, operating to dilate the previously narrowed auriculo-ventricular orifice. The first consideration to which I would advert in June 6, 1896] MEDICAL RECORD. 795 secondary disease of the heart is that unlike other viscera, such as the lungs, liver, kidneys, etc., which contain within themselves the chief conditions for their specific functions, the heart is but a part of the apparatus of the circulation. Not only, therefore, will disorders of the heart affect the circulation, but the converse is equally important, that disorders of the circulation will affect the heart. In the latter case our viagra generic shipping attention, instead of resting at the cardiac valves, should also include a consideration of the whole cir- cuit of the circulation. Thus, in primary disease of the heart its hypertrophy and dilatation are mainly due to disorder of its valves ; in secondary diseases the disorder of the valves is mainly due to antecedent hy- pertrophy and dilatation. Secondary affections of the heart, therefore, begin chiefly at the periphery of the circulation, so progres- sively embarrassing the flow of blood there that the central organ first increases in size and in strength to balance the increased work viagra generic shipping which it has to do. But as all hypertrophied muscles are more apt than nor- mal ones to undergo degeneration, so the main dan is the supervention of dilatation and. following upon that, increased weakening in its power of emptying itself. The chief indication, therefore, is now to keep up the strength of the walls of the heart and to let all concomitant valvular affections take care of them- selves. For this purpose I would divide our remedial measures into the constitutional and the symptomatic classes of agents. The first of the constitutional, and the most important and continuous in its operation, is the effect of fresh air. The oxygen of our respiration is nature's great source of muscular power, as is ex- emplified throughout the whole animal kingdom that muscular strength is directly proportioned to the ac- tivity of the respiratir.n. On the same principle, iron is the most effective among drugs, because iron is our respiratory food and has no other function in the body but as the carrier of oxygen to enable us to breathe. viagra levitra price The recognition of this fact in modern therapeutics has led to the recommendation of moun- tain climbing as viagra levitra price a cure for failing heart power, and when resorted to in the right cases viagra generic shipping and in proper measure it undoubtedly is a great advance over the old views which confounded secondary with primary dis- orders and hence advised viagra levitra price that every patient with heart disease should be very careful about muscular exercise. Next to as continuous breathing of the open air as possible, I would rank properly applied massage, especially that form in which the patient exerts a care- fully regulated resistance to the flexion and extension of his muscles by the operator. I have seen many cases of most striking improvement, especially in se- nile hearts, by the addition of this procedure to other measures of treatment, for it must be remembered that the movements of the aged in walking are not only slow but very limited in their range, and not at all calculated to react as favorably upon the heart as the viagra generic shipping above-mentioned exercise, given when they are recum- bent, seems to do. The improvement in breathing after some weeks of this massage is too unmistakable to be doubted. Of course, the seat and nature of the peripheral ob- viagra generic shipping struction which reacts upon the heart will modify the symptomatic medication. Dilatation of the right side of the heart with resultant dropsy, due to chronic bronchitis, is one of the most curable of heart affec- tions, if only you can cure the bronchitis viagra generic shipping first. The trouble is that a vicious circle of interacting influ- ences is set up in these cases whenever the heart be- comes involved, the bronchitis becoming worse when cardiac congestion of the lungs supervenes; and this in turn increases the heart weakness. In such cases, again, hours spent in a dry equable air help the weakened bronchial muscles and the weakened right ventricle as well. Among medicines the tinctureof the chloride of iron with strychnine does more good to the cough than any cough mixture. It is in these cardiac cases also that arsenic and the potassium io- dide so often do good, but these drugs are also useful in the treatment of chronic bronchitis itself. The most common as viagra generic shipping well as viagra generic shipping most serious of second- ary heart diseases, however, are, of course, those de- pendent upon general arterial disease. It has been rather graphically said that a man is as old as his ar- teries, and increasing experience with the causes of decline and death in our patients viagra levitra price after middle life will lead, we think, most physicians to agree with this