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Personal. — Dr. Charles B. Penrose has been made the head of the Philadelphia Municipal Court's new de- partment of diagnosis which has been formed from the court's various medical agencies. Associated with him are Dr. D. J. McCarthy, Dr. Charles S. Potts, Dr. S. W. D. Ludlum. Dr. John C. Da Costa. Jr., Dr. Thomas A. Shal- low, and Dr. J. M. Baldy. Colonel Herbert proventil inhaler coupon Alexander Bruce, Consulting Surgeon of the British Army in France, Who was recently in proair proventil the United States as a member of the special British medical mission, has been cited by Field Marshal Haig for bravery in the field. Dr. .Seth Lake Strong, who was graduated from the Harvard Medical School in 1913, has been appointed lec- turer in surgery at the Royal Medical College at Bangkok, Siani, and will also act as surgeon to the Siravaj Hospital there. Dr. Samuel T. proventil nebulizer Darling, a member of the International Health Board, has been appointed professor of hygiene and director of laboratories in the School of Medicine and Surgery, Sao Paulo, Brazil. Modern Treatment and Preventive Medicine A Compendium of Therapeutics and Prophylaxis, Original and Adapted VICIOUS CIRCLES IN RESPIRATORY DIS- ORDERS AND THEIR TREATMENT. By Louis proventil cost T. de M. Sajous, B. buy proventil online S., M. D., Philadelphia. PULMONARY TUBERCULOSIS. {Continued from page 432.) An important part is played by nervous influences in the rapidity of progress of pulmonary tubercu- losis. Poisoning of the nerve centres through ab- sorption of toxic material from the involved tissues accounts for order proventil a variety of attendant disturbances, both physical and mental. The early loss of gen- eral muscular tonicity and strength is ascribed by Lawrason Brown, 1913, to toxic action on the nervous system. Sweats in early tuberculosis are attributed in general to intoxication of the sweat, heat, and vasomotor centres by the tuberculous poison, though later the sweat glands, it is stated, proventil albuterol may themselves be directly excited. Toxic changes in the nervous control of the heart are responsible, in part, for the marked instability of the pulse and tendency to tachycardia coupon for proventil in this disease proventil coupon ; disturb- ances of the alimentary tract may at times arise upon a nervous basis. Excessive irritability of periph- eral neurons may be manifested in exaggeration proventil price of certain reflexes, and tremor may occur. Neuras- thenic manifestations, unusually common in tuber- culosis and at times so pronounced as to distract attention from the earlier local changes, are thought due to intoxication of the higher centres. The psychic disturbances vary in their nature and degree. While unwarranted hopes of recovery are frequent in the minds proventil hfa coupon of advanced cases, many pa- tients develop a nervous pessimism or melancholia which, occurring sometimes relatively early, is of greater practical significance in its harmful in- fluence than is the opposite condition — spes phthis- ica, — where present as a helpful factor in cases al- ready far advanced. In all of tlie above nervous disturbances there lurks the possibility, if not the probability, of a vicious circle. Reduction of muscular proventil mdi tone, exces- sive sweating, tachycardia, disordered digestion, and nervous depression — each of ventolin proventil these, if suffi- ciently marked, will tend to disturb and weaken one or more functions upon the maintenance of which at a normal level the maximum defensive eft'ort against the invading infection must depend. Where, as a result of such functional impairment, the defensive process does suffer, progress of the disease is likely buy proventil to be more rapid, with proventil hfa inhaler extension of tissue involvement, increased liberation of toxic material, and consequently, enhanced toxic effects upon nerve centres, thus completing the vicious circle. A pessimistic mental attitude, where pre- sent, seems to exert a particularly harmful influence by precludmg a firm determination to recover on the part of the patient. The marked significance, from the prognostic standpoint, of a proper psychic state in this disease has been widely commented upon and is indirectly confirmed by the striking benefit often noted from new therapeutic measures, in- dependently of their actual organic proventil inhaler value as shown by subsequent events. To whatever extent mental depression is here the result of proventil inhalers toxic proventil 90 mcg eft'ects on nervous tissue, by so much will its harmful influence proventil coupons be likely to operate in the form of a vicious circle, mental depression weakening resistance to the dis- ease, and this in turn, resulting in increased toxic action on the centres. The mental condition, ac-

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