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cording to Lawrason Brown, directly affects the weight in tuberculous cases. Interruption of the vicious circles just alluded to, however manifested, is most directly accomplished through provera cost reduction, or at least prevention of increase, of the amount of tuberculous poison exerting its harmful efifects upon the nerve centres. Such a result- is obtained more or less generic provera successfully by persistent application of the general hygienic buy cheap provera dietetic treatment of tuberculosis. In addition, however, it will doubt- less often be worth while to attack other segments of the circles by, e. g., the prevention of exhaustion from excessive sweating, in so far as possible ; pre- servation of the patient from influences which aug- ment further an already increased heart rate, and approjiriate treatment of distin-bances of the ali- mentary tract. States of mental depression may im- prove along with provera online a reduction of toxic absorption, but in any case, cheerful surroundings, encourage- ment by the physician and attendants, and a care- ful explanation of the aim of each measure in the treatment, with stress on the hopeful outlook af- forded by careful observance of hygienic rules, should prove helpful in overcoming pessimism and its prejudicial effects on the course of the disease. An important prophylactic precaution consists in careful avoidance of nervous excitement and luidue exercise, which increase the absorption of tuber- culous poison from the disease foci. buy provera Probably the most important of all the vicious circles that may aggravate pulmonary tuberculosis are those involving the alimentary tract, for proper cell nutrition has admittedly a order provera preeminent influence on recovery, and conversely, interference with diges- tion and assimilation reacts most unfavorably and rapidly on the morbid condition. According to Hays, a vicious circle may be initiated through the direct eft'ects of the tuberculous poison upon the alimentary canal, a deficiency in the digestive fer- ments being produced, with loss of appetite and conser|uent prevention of repair of the waste of the body, this, in turn, favoring extension of the disease and increased liberation of tuberculous poison, which completes the circle. E. E. Watson, igi8, explains the buy cheap medroxyprogesterone hyperacidity, hypermotility, and spas- tic constipation frequently met with in early tuber- culosis as being due to increased vagus tone through irritation of the vagus nerve endings in cheap provera the diseased lung parenchyma. In advanced cases, on the other 4/6 MODERh' TkEATMEXT AND PREVENTIVE MEDICINE. hand, toxemia may centrally excite the sympathetic system and cause decreased motility and secretion, with resulting symptoms such as coated tongue, hypoacidity, poor appetite, and provera mg atonic constipation. Again, as Watson sees it. lessened depth of inspira- tion and diaphragmatic excursion in advanced cases may cause retardation of blood flow through the abdominal organs ; combined with the usually weak- ened heart action, this results in actual passive con- gestion, impaired secretory fvmctions, and ac- celerated malnutrition and emaciation. A general visceroptosis from malnutrition of the abdominal muscles, loss of panniculus, and cough may here complicate matters. Lessened tone of the muscula- purchase provera ture at the cardiac oriiice has been thought to ac- count for the ease with which food in the stomach is vomited during cough in pulmonary tuberculosis ; malnutrition through insufficient retention of food because of emetic cough buy medroxyprogesterone online may appreciably reduce the general capacity of resistance and hasten the progress of the disease. In each of the above mentioned disturbances purchase medroxyprogesterone the elements necessary for the formation of a vicious circle are plainly evident. The opportunities offered the practitioner to impede the progress of the dis- ease and strengthen the patient's resisting purchase provera online power for the final decision against it are correspondingly numerous. In those vicious circles in which the tuberculous poison forms part of the circle, hygienic dietetic treatment will tend to arrest aggravation of the circle. Deficiency in the digestive ferments may provera tablets be artificially compensated. For hyperacidity and hypermotility, Watson reports gratifying re- sults from alkalies, atropine in doses of 1/200 to i/ioo grain one provera price half hour before meals, and the usual diet. The subsequent hypomotility and re- duced secretion he treats with nux vomica and a bitter tonic before meals, and hydrochloric acid and pepsin after meals. Intraabdominal circulatory stasis order provera online and heart weakness may be favorably affected by digitalis and the effects of visceroptosis by mechanical support. buy provera online Emetic cough forming part of a vicious circle is best treated by a rest in bed, hot water half an hour before meals, limitation of fluids order medroxyprogesterone at meals, buy medroxyprogesterone quiet after meals, and if indicated anesthetizing applications to the pharynx. To be carefully avoided, because they may sooner or later aggravate one or more vicious circles, are excessive

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