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cerned; a knowledge not only of what alterations have occurred in shape, size, structure, or function of an organ or part, but of how they have been caused, and what is the ultimate Price Of Zofran history of tlTe agencies to which they are due. Where the heart is Zofran 8 Mg concerned error in prognosis may arise in connection with Zofran Iv either of these two factors; Zofran 8mg on the one hand, by mistake as to the ac- tual physical condition of the organ; on the other hand, owing to failure to realize what will be the result of the various forces which are rightly recognized as at work. In early life, the author thinks, the discovery of the lesion is usually easy, while with advancing years comes the time of degeneration, which in its gravest forms often can not 8 Mg Zofran with certainty be recognized. Youth, he says, is the period of acute Ondansetron Zofran inflammations, which are commonly discovered with ease by skilled observers, but no one can surely foretell Zofran Odt the future while acute endocarditis is running its course. Diagnosis is sim- ple, definite prognosis impossible. It is important to recognize, says Dr. Skerritt, wliat is the position of physical signs in heart disease and how far they can be relied upon as evidence of the Cost Of Zofran nature and extent of existing morbid changes and of their tendencies. It can not be denied, he says, that many of the errors in the prognosis of heart disease, and especially of valvular lesions, arise from too great a reliance upon the indications of the stethoscope. It will disclose the murmurs and therefore indicate to which of the various classes of valvular defect any case be- longs; but here its function ends; beyond this it does not Cost Zofran reveal what is in store for a patient. A true esti- mate of the Zofran Ondansetron gravity of a lesion can be gained only by a general survey of the case in the broadest possible light; to determine first what has been its effect upon the heart itself and then how far its influence has ex- tended beyond Zofran 4 this organ. If it is found that a mur- mur is present, no matter at which orifice, and that there is no change in that part of the heart upon which the strain first comes; if it is also known that this mur- mur has existed long enough for the effects of in- creased work to be manifested, then, says Dr. Skerritt, it follows that the lesion is trivial and stationary, and may remain so for an indefinite time. On the other hand, if hypertrophy or dilatation, or both, exist, their degree is a test of the actual interference with the heart in its Zofran Price work. Due weight should also be given to the character of the pulse, to such sjTnptoms as dysp- noea, palpitation, and sjTicope, and to any evidence of interference with Zofran Cost the pulmonary or systemic circulation or of the presence of associated disease. It is neces- sary not only thus to check the special physical signs of valvular disease, but also, sometimes, to estimate the value of symptoms by physical signs. The importance of history, the second factor in prognosis, the Zofran Buy author goes on to say, is never under- rated by the practical physician. By it are determined the origin of any morbid state, the "length of time that it has existed, and its tendency to development in one direction or in another, and an accurate appreciation of the information which it conveys is of the greatest value. Where valvular defect is due to acute endo- carditis it is important to know whether there is a lia- bility to a fresh onset of the malady in which it origi- nated. For instance, when endocarditis arises during the course of an acute specific disease such as scarlet fever, which usually makes one attack only, the pros- pect is better than in the case of acute rheumatism, in which recurrences, which are common, often light up fresh endocardial inflammation. Or the history shows that a murmur may be due, not to endocarditis, but to weakness of heart following acute illness or originating in anaemia, in which event there is a rea- sonable prospect of cure. Or the course is perhaps pre- ventable or more or less removable, as when avoidable muscular strain produces cardiac dilatation. Or it is a diathetic condition, such as gout, which can be kept in check, but not eradicated. Or the affection may originate in a Zofran Mg persistent and irremediable condition, as when dilatation and hypertrophy result from chronic Bright's disease or from the arterial degeneration of age. In every case a recognition of the cause of a car- diac lesion, and therefore of Zofran 4mg the degree to which it may be influenced or removed, enters into a rational prognosis. It is difficult to overestimate. Dr. Skerritt continues, the value of a knowledge of the length of time that a heart lesion has existed; it is of the greatest importance in prognosis. Endocarditis, for instance, must be esti- mated by the results which it produces — the damage which has been done to the heart in a given time is a test of what will Odt Zofran happen in the firture. Prognosis thus becomes a problem. If the heart is in a certain state at the end of a certain time, what, asks the author, will be its condition in six months, in a year, or in five, ten, or twenty years? The longer the interval that has elapsed since the acute inflammation the more certainly can this question be answered. Concei'uing the impor- tance of the history of a case. Dr. Skerritt relates the following, jvhich, he says, well illustrates it: The pa- tient said he had been suffering from aortic aneurysm. The existence of disease had been discovered by acci- dent and had not before been suspected, the patient feeling in his usual health. The heart was enormously enlarged and hypertrophied; the impulse was so forcible as to shake the chest-wall and could be Zofran 4 Mg i^lainly felt through Iv Zofran the clothes. The author says that although

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