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a hypersensitiveness to the pollen of certain bloom- ing plants. These irritating substances gaining access to the respiratory tract are considered the cause of the well-known and distressing clinical symptoms, whilst vaccination with pollen extract seems to attenuate or to prevent the occurrence of the clinical manifestations. The therapeutic results with pollen vaccination are doubtless a great achieve- ment in the relief and removal of the abnormal clinical signs. From the clinical standpoint, cases of hayfever offer much interest, since closer exam- ination reveals certain clinical particularities which deserve our attention, as shown in the following cases : Case I. — Mr. W. B., age 36, teacher, negatve family history and past history. Hayfever attacks date back for the past 18 years, which manifestations are of ex- treme violence, attended by burning, tickling sensations in viagra online vancouver the viagra prescription boots nostrils, eyes, throat, violent sneezing, serous discharge from the mucosa? of the respiratory tract, with distressing attacks of asthma — particularly in the evening. The exciting causes of such manifestations are the following: Blooming lilac, different gramineae, roses, dusty, heavy, damp atmosphere. Patient before coming to me had tried all kinds of treatments for nose and throat and various drugs without viagra online vancouver any success what- soever. The results of the physical examination are the fol- lowing: Patient short built, well nourished, eyes in- jected, viagra prescription boots abundant mucous nasal discharge; emphysema- tous chest, moderate harsh breathing over right apex anteriorly; numerous sibilant rales over both upper lobes anteriorly and posteriorly. Heart, apex in left midclavicular line, fifth interspace; absolute cardiac dullness extending viagra prescription boots from fifth interspace to upper border of third rib, and slightly outside of the left sternal margin; relative cardiac dullness extends from fifth interspace towards the right and overlaps the right sternal border, reaching as far as the upper border of the second rib. Heart sounds: Over mitral area first sound roughened and distant but no murmur, second sound normal; tricuspid and pulmonary sounds weak, not accentuated; second aortic sound weak. Blood- pressure — auscultatory method — Tycos — 112 systolic, 78 diastolic; 34 pulse pressure. Abdomen prominent, nothing particular. Knee-jerks accentuated. Marked dermography of the skin. Treatment and clinical remarks: Subcutaneous in- jection of pituitrin, 1 c.c; Adrenalin chloride solution 1/1000, 0.5 c.c, given on June 6, 1914. Patient reported two days later, felt very well after the injection ; came down town in motor car; experienced slight tickling in the nose, dryness, and some watery feeling, viagra online vancouver but had no sneezing or any further unpleasant manifestations. Since this was my first hayfever case, as a precaution *Paper presented at the XVIIIth Annual Meeting of the American Therapeutic Society, New York, June 1-2. 1917. July viagra prescription boots 7, 1917 J MEDICAL RECORD. 11 the patient was given one dram t.i.d. of the following prescription: Ammon. iodide, 5j ss; ammon. bromide, 5ii; tincture lobelia, ,ij ; syrup of tolu, fi. 5ij ; pepper- mint water, q. s. ad. fl. 3*1 J - Alcohol rub for the skin every viagra prescription boots morning. June 11. Notwithstanding the hot and close weather and blooming grass, which factors always caused a severe hayfever attack, the patient experienced only a slight tickling sensation in the nose, which lasted for about 5 minutes instead of several hours as in former times. No attacks of sneezing whatsoever. Pulse 81. Blood pressure: Systolic 108, diastolic 70; pulse pressuie 38. Patient received another injection of pituitrin and adrenalin in the dose mentioned above. Reported at office 3 days later that he had been feeling fine for two viagra online vancouver days after the injection. Slight sneezing and burning sensation was noticed during an exceed- ingly damp, moist viagra prescription boots and rainy day, but no discharge viagra online vancouver from nose, and no dyspnea. The injection was re- peated without any internal medication, which was dis- continued. The fourth and fifth injections were viagra online vancouver given on June 17 and viagra prescription boots 22. The weather conditions were the same unfavorable ones as mentioned all the time, but no single attack, no dryness, no sneezing and no dis- charge viagra prescription boots whatsoever was recorded by the patient when last seen on July 6, at which time the sixth pituitrin and adrenalin chloride injection was given. The pa- viagra online vancouver tient was advised to report at the slightest indication of a viagra online vancouver hayfever attack but no such occurred, whilst all the previous years the severe attacks lasted for three months, with daily paroxysms. The patient kept well throughout the summer of 1914 and only repotted the next year on June 5, 1915, on account of a moderate dry sensation in his nose, with tickling, signs which were always infallible for a hay- fever attack. No sneezing spells nor dyspnea were noticed so far. As the only objective signs of interest the heart examination must be recorded, namely, dilata- tion of the right ventricle — threshold percussion — muffled first mitral sound, relatively small pulse pres- sure. The extent of the absolute cardiac dullness: apex sixth, interspace, slightly outside of midclavicular line, reaching to lower border of third rib and the middle of the sternum. Relative cardiac dullness extends from the sixth interspace towards the right, overlapping for one inch the right sternal border, reaching upward to the upper border of the third rib. The diameters are for the transverse diameter 5% inches, oblique di- ameter, 5% inches; height, 4*4 inches; the surface area of the relative cardiac triangle measuring 11.65 square inches. Heart sounds indistinct, muffled first mitral sound, second sound very distant, accentuation of both second aortic and pulmonic sounds; first tricuspid sound split, roughened, but no murmur. Pulse weak, irregu- lar, becomes faint during bulbous pressure, the rate 78; after pressure is relieved slows down to 66; Dlood-