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over the front of the chest, and widely diffused, in cer- tain cases resembling the hruit de diable of exophthalmic goitre. The murmur is sometimes loudest at or near the apex; again, it is most pronounced over the pulmo- nary valve, at the left edge of the sternum; in a small proportion of cases a diastolic murmur coexists. At the same time violent and exaggerated pulsation of the ves- sels of the neck forms a striking feature of many cases. Accompanying these physical signs there is celexa manufacturer discount program usually a sense of weight or oppression buy celexa 40 mg in the chest, rapid, pant- ing respiration, and dyspnoea, the symptoms order celexa no prescription being in some eases most distressing and terminating in death in a few days (as in Case II above). The rapidity of heart action in these cases will aver- age about 130, but may show order celexa line a higher rate. In one buy celexa ex- treme case the pulse for three weeks ranged between 180 and 210, the patient suffering surprisingly little dyspnoea most of the order celexa online time, and finally making a com- plete recovery. In most of the cases there was moderate tachycardia, with murmurs and venous pulsation, without much dyspnoea. In the cases showing general anasarca the dyspnoea, anxiety, and mental distress were often most pronounced. Cj'anosis was occasional only. Some fourteen of the twenty-one fatal cases died directly from heart failure, at celexa price comparison times varying from three days to six weeks after the first symptoms of neuritis ap- peared. Many of the patients, in particular those suffering from heart irregularity, with dyspnoea and general ana- sarca, were blanched and pale, celexa discount card presenting an appearance of great anaemia, buy cheap celexa which, however,' order celexa online no prescription examination of the blood in about twenty cases failed to confirm. With Fleischl hffimometer no case showed a lower percentage than sixty, and the majority ranged from seventy-five to ninety, which buy celexa canada is fair average for supposedly healthy per- sons in this part of the world. The number of red cor- puscles, counted by Thoma-Zeiss instrument, was also not noticeably diminished. In cover-glass preparations, taken during the acvite stage, a leucocytosis was in discount celexa sev- eral cases shown, and in two instances there was a marked increase in the eosinophile cells, which increase subsided after a few days. A large number of both fresh and celexa prices us Chenzinsky-stained cover preparations were examined in acute and chronic stages, with celexa generic cost especial reference to the presence of the malarial or other plasmoditmi; such organisms, however, were not discovered in any in- stance. While some — a half score, say — of the cases were mild and of short duration, the disease, taken collectively, is the most serious, fatal, and distressing with which we have ever had to contend. Of the seventy-one patients attacked, twenty-one died, and all save ten order celexa without rx or twelve, which may be classed as mild, were unable to walk for from two order celexa canada to four months, and were for celexa cost without insurance weeks confined to bed with digestive and cardiac disorder. At the expira- tion of eight months there are, as above mentioned, still two patients unable to walk and with the danger of per- manent contraction and loss of motility in legs. In the order celexa fatal cases, one patient died of pulmonary tu- berculosis, one of pneumonia, generic celexa vs celexa two in the status epilep- ticus, fourteen directly from heart failure, and the re- Nov. 20, 1897.1 MACKENZIE: ATROPHIC ENDORRHTNITIS. 691 inaining three from a combination of causes. The com- jjlications hastened or insured a fatal termination in six or seven cases. (To be concluded.) ABSTRACT OF REMARKS ON ATROPHIC ENDOREIIINITIS.* M. D., By JOHN N. MACKENZIE, BALTIMORE. In order to confine this discussion within reasonable bounds, I shall address myself strictly to the pathological

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