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\"IC10US CIRCLES IN RESPIRATORY DIS- ORDERS AND THEIR TREATMENT. By Louis T. de M. Sajous, B.S., M.D., Philadelphia. {Continued from page jS8) PULMONARY TUBERCULOSIS. The vicious circles established in hemoptysis of tuberculous origin have already been referred to under a separate heading. In addition to these there Eskalith Cr are a number of others that may arise in tuber- culosis — some of great importance, as they may exert a marked general influence on the course of the disease. Certain facts relative to the incidence of tuberculosis may be mentioned. Poverty and its results, viz., overcrowded living quarters, an insuf- ficient diet, ignorance and tilth, are well known as factors favoring an increased incidence of the dis- ease ; on the other hand tuberculosis as a cause of poverty was Lithium Carbonate Buy shown by Kingsbury, 1912, to have led to an appeal for charitable assistance in no Lithium Eskalith less than thirty-four per cent, of a series of 1,600 families in New York city. These facts definitely suggest a vicious circle, poverty favoring tuberculosis while tuberculosis, in turn, promotes poverty. Again, overstrain, as Baldwin, 1913, specifically stated, may inhibit the mechanism of protection against tuber- culosis and not only lead to spreading of an Eskalith Cr 450 old tuberculous infection but render possible a fresh in- fection. Such augmented or new Eskalith 450 Mg infection, we may add, increases the susceptibility of the individual to overstrain under continued labor, thus Lithium Carbonate Online complet- ing another Buy Lithium Carbonate vicious circle which tends to aggravate the disease and, incidentally, may combine with the preceding circle by reducing or interrupting the in- come derived from the subject's daily occui)ation. A third probable factor to be borne in mind is the influence of an unstable or defective nervous sys- tem. Individuals with a delicate nervous Buy Eskalith makeup are known to fall readily a prey to the disease, and Generic Lithium Carbonate the defective nutrition resulting from nervous or mental disorders has been thought to open the door to tuberculous infection. In the developed disease nervous disturbances may take part in an actual vicious circle. The prejudicial influence of the several factors just referred to on the incidence and progress of tuberculosis is confirmed by the equally marked favorable influence of opjxjsite conditions, which prevent or interrupt the vicious circles. Good food and an ample diet reduce the incidence of tuber- culosis and oppose its progress when established. Fresh air, whether inhaled in the course of the daily work or employed as a curative measure, again greatly promotes resistance. Muscular exercise, where engaged in under conditions Buy Lithium Carbonate Online such that it will not overstrain but actually strengthen the body tis- sues by promoting cell nutrition, serves a useful purpose, but where pushed to the degree of exces- sive fatigue, or where any exercise adds to the already morbid cell consumption, as in the well established disease, must be replaced by rest, which effectually interrupts the vicious circle. In fully developed, open tuberculosis several important vicious circles relating to the disposal of the infected material coughed up may become estab- lished. Essentially these are all manifestations of failure Order Lithium Carbonate Online of the natural process of protection by elimi- nation, the primary object of which is to get Eskalith Er rid of loosened tissue, bacteria, and secretions through the respiratory channels without infecting the latter. A salient example of failure of this process of pro- tective elimination is met with where a cavity emp- ties its contents into a bronchus. The importance of this particular incident in the course of tubercu- losis Purchase Lithium Carbonate is clear when we confront two statements of MacCallum, 1913, viz., that "one can at autopsy al- most invariably pass a jirobe from any tuberculous cavity directly into a bronchus," and that emptying of the cavity contents into a bronchus "is usually the first step in the wide involvement of the lung in the tuberculous process." The violent respiratory movements and cough induced by the material lying in the bronchus, acting in conjunction with gravity, lead rapidly, according to MacCallum, to a distri- bution of the tubercle bacilli in bronchi previously not infected, with corresponding enlargement of the diseased area. This, in turn, not only tends to weaken the resisting powers of the body against fur- ther progress of the disease, but gives opportunity for the formation of new cavities, from which fur- ther rapid extension is likely to occur, a vicious cir- cle being thus completed and the prognosis as to duration of life rendered more unfavorable. Mani- festly no direct measure for overcoming this vicious circle is at our disposal, except in so far as reduc- tion of coughing to a necessary minimum may be helpful in this direction. The main treatment of this circle may be said to be prophylactic, all pos- sible efforts being made to detect and check the dis- ease before cavity formation has occurred.

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