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MEDICAL RECORD. [Oct. 9, 1915 The above are part of a series of ten cases can you take viagra through customs that have come under my care since I began to study the relation can u take viagra through customs of endameba to the persistent discharge from the accessory sinuses in spite of excellent sur- gical treatment rush limbaugh viagra and excellent resultant drainage. Six cases cleared up rapidly under emetine treat- ment and remain so at the present time. Two cases gave unsatisfactory results for reasons I am un- able to determine. Cases VIII rush limbaugh viagra and XII can you take viagra through customs cannot be classified yet. The following cases all had typical recurrent at- tacks of abortive coryza and general malaise that suggest endamebic infection of nose, mouth, or ali- mentary tracts. Besides these specific symptoms all suffered from some general condition that was relieved by the effort to clear up the nasal condi- tions. Case XIII. — Female, age 21; slender, not robust. Referred to me latter part of 1914 for acute mas- toiditis. Simple mastoid operation, followed by un- eventful recovery. Referred to me again six weeks ago for a so-called neuralgia of upper and lower max- illa on can you take viagra through customs both sides. The paroxysms of pain were so severe that sleep was impossible without an opiate. The efforts of her dentist and physician were without effect. The attack had lasted two weeks when I first saw her. Intranasal examination and transillumina- tion gave negative findings. The teeth had no rush limbaugh viagra cavities. One can you take viagra through customs lower and three upper teeth had small pus pockets under the gums. Smears were strongly positive. En- damebffi were the only etiological factor that could be found. The gums were perfectly normal except for these small pockets. It did not seem possible that the severe pain could be rush limbaugh viagra caused by this condition. For want of a better trail to follow, emetine injections were given and the paroxysms of pain at once began to lessen and to recur at longer intervals. Within a week the pain had entirely stopped and remained so. Case XIV. — Male, age 67; Englishman. Frequent attacks of abortive or paroxysmal coryza, very nervous, depressed, apprehensive, heart and sternal constric- tion and general toxemia. Had a blood pressure of 217, and a mouth full of suppurating roots. Treatment to reduce blood pressure and stimulate renal excre- tion failed to clear up the chief sjTnptoms. Nasal and mouth smears were strongly positive. Emetine treat- ment was added to his general treatment. The re- sult was that the depression, the toxemia, and sternal and precordial sensation of constriction were emphatic- ally relieved as well as the nasal condition. Case XV. — Male, age 57. Two severe attacks of heart block, one a year and a half ago and the other about a year ago. Had specific nasal rush limbaugh viagra and general symptoms of endamebic infection. Consulted me for tendency to recurrent abortive colds in head. Nasal examination showed left posterior exostosis without much pressure, and a superficially irritated mucous membrane. The mouth showed an rush limbaugh viagra advanced pyorrhea alveolaris. Pus pockets were frequent. can you take viagra through customs Two of the roots of one molar were free in the mouth. Three other teeth were very movable. He had also had severe precordial distress and digestive disturbance al- most constantly since his last attack of heart block. Nose and can you take viagra through customs mouth smears were positive. Under emetine and dental surgery the tendency to colds in the head, precordial distress and fear can you take viagra through customs to eat disappeared. Eight other cases of which the above are typical have come under my observation where persistent general conditions have cleared up under the eme- tine treatment given for relief of nasal conditions. The exact relation of endamebic invasion of the nose, mouth, or alimentary tract to local and general symptoms is difficult to determine. That there is an etiological relation I am positive. Are the symp- toms due to the toxemia from the bacteria that feed upon the material eroded by the endamebse or to an anaphylaxis from the endamebic excreta? If the symptoms were due to bacteria, emetine would not clear them up so rush limbaugh viagra rapidly. The fact that there is such a radical and rapid relief of the symptoms would indicate the excreta of the endamebae are the cause rather than the proteins of dead endame- bae. Otherwise, the rapid destruction of the enda- mebas by emetine would intensify rather than im- mediately relieve the symptoms. If the symptoms were due to endamebic excreta they would be ana- phylactic rather than toxic. The nasal symptoms of abortive coryza simulate the anaphylactic symptoms of pollinosis, and the accompanying physical depression and lack of feel- ing "fit" are distinctly anaphylactic. The sternal constriction and precordial distress as seen in sev- eral cases are frequently seen in severe anaphy- laxis. In pyorrhea alveolaris the endamebse erode off the blood-vessels, the lymphatic spaces, and, when the disease progresses far enough, the bony edge of the alveolar process. This opens up direct com- munication with rush limbaugh viagra the lymphatic and vascular circula- tion as well as the bone channels. A tooth rests on an elastic cushion at the bottom of its socket. A pressure of 200 to 400 pounds is exerted on the molars during mastication. This forces on- ward the fluids in the lymphatics and vessels in the cushion. With the release of the pressure the vessels fill again, and the same process takes place. By this means bacteria could be forced into the lymphatic or vascular circulation. The endamebic excreta could be absorbed in the same way and cause anaphylactic symptoms as easily as the proteins of pollen are absorbed through the mucous membrane


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