How Much Does Levitra Cost At Rite Aid | OVERNIGHT Delivery!







































furnishes suflScient evidence to establish the case. Another frequent cause of grave pulmonary congestion is chronic nepkritis. Here, too, the vascular nervous mechanism is at fiiult. The attacks may come on suddenly, and, after the most alarming symptoms have prevailed for a short time, they may as rapidly disappear. This course is peculiar to Bright's disease, and is itself an important diagnostic indi- cation of that How Much Does Levitra Cost At Rite Aid affection. In these cases the renal disease, or, to speak more-correctly, its associated nervous disorders, is the direct cause of the pulmonary congestion. In other in- stances the vascular apparatus is simply prepared for a catas- trophe, and exposure to cold or gastro-intestinal irritation is the determining factor. The gouty and rheumatic diatheses also act as predis- posing causes to pulmonary congestion, and should always be recognized and properly dealt with. In fact, a simple dyspeptic condition, an acute gastric catarrh, or the state vaguely known as biliousness, may be the underlying cause. Plethora is said to predispose to congestion and inflam- matory affections, but it may be rather the gouty or rheu- matic tendency so often associated with it which is respon- sible for the mischief. The diagnosis of pulmonary congestion is based upon symptoms and physical signs. The feeling of the patient is that of oppression or tightness in the chest, with dyspnoea, lano-uor, and malaise. These sensations are more or less pronounced in proportion to the gravity of the case. When the congestion is slight, there may be simply an uneasiness about the thorax, with perhaps an aching or dull pain, most frequently situated below the scapulae. The dyspnoea may only be apparent on exertion, and then the patient himself may not distinguish it from How Much Does Levitra Cost At Rite Aid his general feeling of distress. But the quick eye of the diagnostician will recognize it in the increased frequency of respiration which accompanies even so slight a movement as taking How Much Does Levitra Cost At Rite Aid off the under-garment. If more severe, the feeling of constriction or pressure be- comes distinct, and dyspnoea is complained of. In very ao-gravated cases, following upon alcoholism or excessive fatigue with exposure, the congestion is not limited to the lungs, but invades the other viscera, and the patient be- comes rapidly comatose and moribund. The objective signs of pulmonary congestion are increased frequency of respiration ; cough, dry at fiirst, afterward moist, if a stage of secretion is reached ; increased rapidity of pulse ; usually a slight elevation of temperature. The expectoration, when it occurs, will be simply that of the accompanying bron- chitis, unless the congestion be so considerable, or the How Much Does Levitra Cost At Rite Aid con- dition of the patient such — as in Bright's disease, hydreeraia. or chronic alcoholism — as to give rise to oedema. WTien this occurs there will be more or less blood in the sputa. The characteristic sputum of oedema is a bloody serum. When oedema occurs with a moderate amount of congestion, the blood is scanty ; but when the engorgement of the lungs is very great, as it is in the early stages of the pneu- monia of drunkards and other asthenic subjects, it may give quite a dark red. The prune-juice expectoration of asthenic pneumonia is indicative of great venous engorgement, with some oedema. On examining the chest, if the disease be of moderate severity, the percussion note anteriorly will be either un- altered or more than normally resonant, while the respira- tory murmur retains its vesicular quality, but is rather louder than usual. Posteriorly and below the How Much Does Levitra Cost At Rite Aid middle of the scapula the resonance elicited by percussion is dimin- ished, usually to an unequal degree, upon the two sides, while the respiratory murmur is much less distinct than normal. Deep breathing almost always produces some small mucous rales. To recognize these signs of moderate congestion, the obser.ver must have had some training, and particularly must be familiar with the differences which exist between normal chests. The congestive stage of acute croupous pneumonia is not always to be distinguished, but it is usually character- ized by a chill, higher temperature, more rapid and forcible pulse, and greater flushing of the face. Besides, unless a double pneumonia is about to intervene, the percussion dullness and suppressed respiratory sounds are limited to one side. If the case is severe, there will be an exaggeration of all the symptoms mentioned, except that the temperature is not high, and the pulse is weak and rapid. In very adynamic cases subnormal temperatures are found. The dyspnoea becomes so intense that the patient is cyanotic, the cough is feeble and ineffectual, and the small and few mucous rales which were heard at first at the bases of the lungs are become more numerous and loud, showing that the general bron- chial system is filling up with mucus. During the agony the surface becomes pale, cool, and damp, the nose and lips are cold, and loud tracheal rales proclaim the approach of death. In some of the most severe and rapidly developing cases, such as have been described by How Much Does Levitra Cost At Rite Aid Dr. Leuf in his paper on pulmonary congestion in a recent number of the " Ameri- can Journal of the Medical Sciences," the fatal event is so soon reached that there is no time for the development of the ordinary symptoms. It would appear that the capillaries dilate to their fullest extent, and the blood flow-ing in so completely obstructs the air-passages that the patient dies immediately from asphyxia. The prognosis in pulmonary congestion will depend upon the individual affected, the nature of the cause, and the eom- plications. As to the individual affected, if he be old or enfeebled from any previous disease or dissipation, if he be of an originally feeble constitution, or if that variety of plethora known as excreraentitious prevail, the outlook is serious. The gravest cases are those which occur in drunk- ards or debauchees and in those who are fat, flabby, watery, and usually plethoric. The latter class owe their peculiar July 24, 1886.1 WE8TBR00K: DIAGNOSIS AND TREATMENT OF DISEASES OF THE CHEST. 8T condition to a want of vascular tone, consequent upon long- continued disturbances of nutrition. Their respiratory pow- er is slight in proportion to their weight, and the circula- tion is feeble and inefficient. The subjects of Bright's dis- ease are always liable to oedema of the lungs, and this may. be at any time precipitated by the congestion which follows a cold, fatigue, injury, or acute indigestion. The gouty and rheumatic diatheses are not so dangerous, because more amenable to treatment. A congestion of the bases of the lungs often accompanies acute articular rheumatism. It is How Much Does Levitra Cost At Rite Aid not usually a ver}' dangerous complication if the primary dis- ease can be controlled. The treatment of this condition will vary in accordance