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Nov. 27, 18!I7. MISCELLANY. 751 developed especially at maturity, without purchase prozac distinction buy generic prozac no prescription as to buy prozac online no prescription canada sex, under the influence of great emotion or from excessive mental and physical exertion. It was mani- fested by sudden attacks, vertigo, buzzing in the ears, and contractions of the neck and of the epigastrium. The heart beats were accelerated, and the number some- times reached prozac price without insurance two hundred and fifty and even three hundred pulsations. If the thoracic region was exam- ined at the time of an attack, an undulatory trembling would be perceived near the cardiac region, and auscul- tation would reveal a fcetal rhythm of the beats. The cardiac sounds were so accelerated that it was scarcely possible to distinguish the ditTerent periods. Some- times, however, a systolic prozac purchase uk souitie coiUd be perceived, which disappeared after the attack. The pulse was small and the face pale. In addition to the vertigo, there were buy prozac online no prescription delirivim, insomnia, and buy prozac uk oliguria, but there was no fever. Mydriasis or meiosis of the eyes was observed. It was not possible, said Dr. Silva, to determine the certain cause of these attacks, which manifested them- selves without any apparent cause and lasted from a few minutes to several hours. They became grave when they exceeded the latter duration and terminated then in death during an asystolic attack. More frequently prozac cost per pill the attack was terminated suddenly at the end of a few hours by polyuria and profuse sweating, when buy prozac online no prescription needed the pa- tient recovered. Attacks of tachycardia might follow each other at intervals of a few days, or there might be very long generic prozac price respites. The diagnosis, said Dr. Silva, was established by the abruptness of the paroxysms, which were not accom- panied by sounds of organic lesions of the heart. This abruptness of the symptoms, which buy prozac canada broke out and dis- appeared suddenly without leaving behind them any alteration in the general health, was also a guide to the clinician in distinguishing tachycardia from true endo- carditis; and in angina pectoris arrhythmia, which was generally prozac price ireland absent in tachycardia, was present. Regarding the pathogeny of this affection. Dr. Silva said that many theories had been advanced. Accord- ing discount prozac to certain authors, it prozac price per pill was an excitation of the great sympathetic; according to others, it was, on the con- trary, an ephemeral paralysis of the pneumogastric nerve which caused the attack. Debove and Coiirtois-Suffit thought it was a bulbar neurosis; Friintzel thought it was an undiscovered lesion of the myocardium. The speaker thought that the beginning of the attack de- pended upon the pneumogastric nerve, and that later this attack was kept up by the poisons produced by the excessive work of the heart. Regarding bradycardia, or the slow pulse of Char- cot, the author continued, this syndrome was mani- fested especially in old persons. The patient was at- tacked suddenly with malaise, the face became pale, and he purchase generic prozac fell to the ground in a condition of trembling and profuse sweating. The pulse slackened and did not reach more than from seven to ten beats. Soon the patient recovered consciousness himself, prozac cost uk and all the alarming symptoms disappeared at the end of a few minutes. The attacks might break out without any apparent cause or after emotion, anger, etc. The pa- tient might succumb after generic prozac no prescription the first attack. More fre- quently the attacks occurred every two weeks or every month; in the interval the patient, who might live many years, was very well. Dr. Silva stated that the diagnosis of bradycardia was very easy and the prognosis very grave. Charcot and Caracretti had thought it was a circula- tory or functional anatomical lesion of innervation, but Dr. Silva thought, on the contrary, that bradycardia de- pended sometimes upon a lesion of the centre of the ])ueumogastric nerve, sometimes upon arteriosclerosis, and at other times upon a lesion of the myocardium. The two affections, he thought, should be treated in the same way — that is, with hydrotherap)', electricity, thoracic massage, and climatic treatment. Gastric Secretion during Fasting. — The Presse mcdi- cale for November prozac discount coupons Gth publishes a report of a recent meeting of the Society of Russian Physicians of St. Petersburg at which Dr. Paoloff stated, referring to an experiment practised upon a dog, that other experiments had shown that this arrest of the secretion depended especially on the dehydration of the organism, for it was sufficient to introduce into a dog's stomach or rec- tum some distilled water in order that the gastric secre- tion should be generic prozac as abundant as on the first day of the

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