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ago emphasized by Traube and Rokitansky. As to the relationship between this general toxemia and the adrenals, it was a fact that all but one (alcohol- ism, which had not been studied in this connection) of the morbid conditions known to provoke arterio- sclerosis had also been known to cause overactivity of the adrenals. He cited authorities in reference to these several conditions, and said that Tofranil Pm this evi- dence was further sustained by the fact that Coplin, in an examination of the adrenals of twenty-two cases of arteriosclerosis, found that seventeen were markedly altered, the exceptions being the seat of a tuberculous process in three instances and of a secondary neoplasm in one. Again, potassium iodide, our best remedy in arteriosclerosis, had been found to inhibit the secretory activity of the adre- nals. We were thus brought to attribute to Purchase Tofranil Online adrenal activity the production of clinical arteriosclerosis, a process similar to that caused by Josue when he in- jected adrenalin experimentally. Now, whether we injected adrenalin, or whether the adrenals were overactive, the effects produced on the vascular sys- tem per se were borne directly Buy Imipramine Online by the terminal arte- Tofranil Tablets ries. This appeared to furnish the key to the sit- uation, or, rather, the missing link of a chain of facts which clearly explained the pathogenesis of at least the familiar forms of arteriosclerosis Cheap Tofranil from be- ginning to end. Briefly, the pathogenic toxic agent, whatever it happened to be, caused more or less vio- lent overactivity of the adrenals (probably by excit- ing their centre), and thus increased their secretory activity sufficiently to reduce more or less the cal- ibre of the arterioles from which the vasa vasorum received their supply. Deficiently nourished through these, their nutrient vessels, the medial and intimal vascular tissues degenerated, forming the familiar sclerotic patches. Nature of the Cardiovascular Changes in Nephritis. — Dr. Alfred C. Crofton, of Chicago, said that in attempting to interpret the cardiovas- cular changes occurring together with nephritis, it was important to remember that, on the one hand, many cases of nephritis ran their whole course with- out the appearance of any cardiovascular manifesta- tions whatsoever, while, on the other, cases of nephritis sometimes occurred in which increased Order Tofranil blood tension made its appearance within forty- eight hours after the onset of the renal difficulty, and rapidly led to organic cardiac and arterial le- sions which proceeded throughout the Tofranil Cost course of the disease. Of the large number of cardiovascular disorders in which blood pressure Tofranil Price change either pre- ceded or accompanied nephritis one could logically distinguish three possibilities: 1. Buy Imipramine The cardiovascular changes preceded and caused the Buy Cheap Tofranil nephritis. This was the sequence of events in true Bright's disease, for in many of the cases of this we saw high tension long before nephritic symptoms appeared. A per- sistent increase in the arterial pressure ultimately led to degenerative changes, particularly in organs of the body supplied by end arteries, chiefly the kidneys, Buy Tofranil the retina, and the brain. 2. The car- diovascular changes Tofranil Mg developed Tofranil Online simultaneously with the nephritis. Here some agency must be operative which affected both the cardiovascular apparatus and the kidneys, and Tofranil 50 Mg to this category belonged chiefly the cardiorenal disorders seen in chronic lead poisoning and, above all, in the so called gouty dia- thesis. 3. The cardiovascular changes were mani- festly of renal origin, consecutive to the nephritis, and in all probability due to renal inadequacy with retention of urinary end products. It would conse- quently be seen how important it was from the standpoint of prognosis and treatment to attempt in each case of nephritis complicated with cardiovas- cular disorders an interpretation of the sequence of events. High Blood Pressure Arising from Nervous Strain in Diseases of the Nervous System. — Dr. Edwarh D. Fisher, of New Tofranil Uses York, in looking at the Generic Tofranil subject from his special standpoint, said he would emphasize the fact that many of those con- ditions already discussed were present and com- plicated the special disorders of the nervous system — in fact, might be the real cause of the trouble. He would call attention particularly to- diseases of the nervous system due to arterial disease, endarte- ritis, either of the atheromatous type, or that con- sequent upon syphilis, to cerebral compression as caused by new growths, increase of cerebrospinal fluid, etc, and to vascular changes due to direct poisons, such as uremia, diabetes, alcohol, etc. In the first group, endarteritis of a degenerative type, a rather general distribution of arterial disease was found ; so that, not only was the nervous system in- volved, showing cerebral and spinal symptoms, but interstitial nephritis and cardiac hypertrophy were also present. In patients under forty years, will) probably acute cardiac and kidney involvement, we had symptoms peculiar to disorders of the special organs, but no, or only slight, tendency to cerebral hemorrhage or epilepsy, as in older persons. In them the blood pressure might be temporarily high, but was not continuously so, and was more easily relieved or controlled, while in patients over forty years, there was a constant high blood pressure. 150 PROCEEDINGS OF SOCIETIES. [New York Medical Journal. subject also to marked Purchase Tofranil increase, which was the danger point, indicating the probability of a seizure, apoplectic or epileptic. The arterial condition Order Tofranil Online here marked out positively the difference between such Buy Tofranil Online epileptic seizures and so called idiopathic epilepsy, and also that due to a focal lesion. In eclampsia during pregnancy a great and often sudden rise in

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