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he was of opinion that the physical signs did not Jus- tify the diagnosis of aneurysm, yet they were not such as altogether to negative its existence. But he zoloft 100 mg street value was much struck with the point already mentioned — that the trouble had been discovered by accident and not from symptoms does zoloft have street value complained of by the patient, who was exceptionally intelligent and observant and had led an active life. It appeared to him generic zoloft online pharmacy no prescription that a lesion accom- panied by cardiac action differing so decidedly from the normal, if of zoloft online order recent origin, could not arise without attracting the attention of the patient; and on careful inqriiry it came out that the strong beating of his heart had been noted in his early adult life; and, further, that when he was a little child his father once came into the nursery when the hoy was undressed and observed something which led him to zoloft street value bring the family medical adviser, who examined the chest. Dr. Skerritt there- Dec. 4, 1811V. I MISCELLANY. r87 fore concluded that the patient had grown iij) with the lesion that existed, so that to him it gave no abnormal sign. It followed that aneurysm, which would be a recent development, zoloft price comparison did not exist. The prognosis at- taching to the latter being thus set aside, the question arose as to what the future had in store. It was argued that, if compensation was so eomjilete that the heart, zoloft 300 mg daily although thus enormously enlarged, had been able through all these years to do its work in such a way that zoloft 300 mg per day an i took 300 mg of zoloft active' man had no suspicion that it was not normal, there was no reason why it should not long remain equall}' efficient. As a matter of interest, and as showing how inconclusive were the physical signs, tlie author states that, as opinions so divergent were given upon a subject of such importance, the patient was examined in London by two eminent authorities, one of whom came to the conclusion that aneurysm ex- isted, while the other agreed with him in his view of the case. The patient, after hearing either diagnosis fully argued by its supporter, made up his mind that the balance of evidence was against the existence of anemTsm, zoloft 300 mg a day and laid his plan of life accordingly. This was nearly eight years ago. Dr. Skerritt has examined him at intervals since and been unable to detect any signs of advancing disease; he is not conscious of street value zoloft 100mg any trouble; he leads a busy and fairly active life and looks the picture cheap zoloft no prescription of health. Dr. Skerritt remarks that he has gone fully into this buy generic zoloft online ease because it is a forcible illustra- tion of the value of a knowledge of the past as a guide to the present and does zoloft come 150 mg tablets the future. A most important de- cision turned upon the history, and the result iias proved that reliance was rightly placed upon its in- dications. The knowledge of the course which is usually run by a given form of heart disease often can not be aj)- plied, says the author, with sufficient accitracy to be of much value. A lesion that in one instance may end generic zoloft online fatally in a few months may in another be compatible with long life and practically good health. The rela- tive gravity of valvular derangements is variously esti- mated by different authorities. Walshe, says the au- tlior, places them as follows: Tricuspid regurgitation, mitral regurgitation, aortic regurgitation, pulmonary constriction, and aoritic generic zoloft sale constriction, tricuspid constric- tion and pulmonary regurgitation being too little known to be placed in the list. The worst results fol- low those lesions which directly obstruct the circula- tion behind them. Of all valvular lesions aortic ob- struction is the most favorable, the left ventricle fre- quently undergoing hypertrophy sufficient to overcome the obstacle at the orifice of the aorta. The prognosis of chronic valvular disease resulting from a non-recurrent specific fever, the buy generic zoloft online no prescription author contin- ues, is more favorable than the prognosis of that origi- nating in zoloft online pharmacy no prescription acute rheumatism, as further attacks of the latter may occur, bringing with them fresh risk to the heart. But the prospect is better when the valvular change is due to the endocarditis of rheumatic fever than if if results from inflammation that is chronic from the first, for, while the former buy zoloft online canada may remain quies- cent, unless the valve is attacked afresh during a re- currence of the fever, the latter is commonly due to some persistent cavtse leading to progressive inflamma- tion with its increasing valvular deformity. Concerning the chronic degenerative changes in the heart wall, says Dr. Skerritt, when fatty degeneration is once established it tends to increase, owing to the persistence of its cause. In like manner no prolonged consideration can be devoted to the prognosis of hyper- trophy and dilatation. As their cause is usually per- sistent, and often progressive, the secondary cardiac enlargement is correspondingly permanent and tends to increase. The greater the hypertrophy in proportion to dilatation the better will the extra work be done and

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