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longer closes during systole. Thus a certain amount of regur- gitation takes place Order Bupropion Online until the ventricle has got rid Buy Cheap Bupropion of the excess of blood it contained. When more or less permanent dilata- tion has arisen from excessive internal pressure the same mechanism comes into play. We then see the symptoms of im- peded circulation in the veins, and we may often distinguish a systolic murmur in the tricuspid area. Wheu a Bupron Sr Tablets mitral murmur is present it may be difficult to decide whether a tricuspid mur- mur also exists; but the latter may often be differentiated by its having a Buy Bupron Sr point of maximum intensity near the Buy Bupropion Online sternum. Although increase of pressure in the pulmonary artery usu- ally takes effect on the tricuspid valve, in some cases its action is manifested on the pulmonary valves. Probably pulmonary regurgitation from this cause would be more frequent than it is were it not for the safety-valve action of the right ventricle. The author narrates a case in which two murmurs were heard in the pulmonary area — the one systolic, the other diastolic. The systolic murmur was loud, had the rough quality of a di- rect murmur, and was conducted toward the left clavicle ; the diastolic Order Bupropion murmur was soft, was heard best in the second left intercostal space close to the sternum, and was also audible in the third space and faintly in the firtt. There was no history of rheumatism. A second case given by the author seems to have been one of rheumatic endocarditis affecting the tricuspid valve. A systolic murmur was heard all over the priecordia, with the point of maximum' intensity in the tricuspid area. The murmur diminished in intensity in passing to the mitral area, and was not heard in the back. In the foregoing instances the murmurs pointed to organic disease on the right side of the heart, but generally murmurs in the pulmonary region are to be differently interpreted. Hsemic murmurs are always systolic, and their character is usually easily recognized. A diastolic murmur is sometimes heard in this situation, when the other conditions make it unlikely that pulmonary regurgitation is present. The author relates a case in point in which the diagnosis was doubtful, but the absence of a pulmonary .systolic murmur led him to exclude pulmo- nary regurgitation, since, according to Dr. Balfour, in all cases of pulmonary regurgitation the Purchase Bupropion Online murmur has been double. A systolic murnmr was heard at the aortic cartilage, and Dr. liradshaw finally concluded that the regurgitant murmur was also aortic in origin, though it is not easy to say why it was not heard in the usual situation. The Treatment of Aneurysm by Venesection.— In the Lancet of May 19th Dr. James T. R. Davison gives the details of three cases illustrating Cheap Bupropion the benefit of bleeding in the treatment of aneurysm. In all throe cases the symptoms were most urgent, and were promptly relieved by the abstraction of twenty-five to thirty ounces of blood from the arm. The first case was an aneurysm of the innominate artery and the ascending aorta with dilatation of the transverse arch. The i)ationt had frecpient attacks of dyspna>a, evidcnily duo to pressure upon the recurrent laryngeal. He had been under various foruis of treatment, including that with iodide of sodium, with oidy slight relief. When Dr. Davison w^as called to see him he found him nn(Minscioiis, with ditlicidty of breathing, his face Buy Bupropion cyanotic, and his pulse of liigli tension. The iiatient recovered consciousness after the bleeding, aiul has renuiined in good health up to the present time, a period of nine months. During this time he has taken iodide of sodiuni three weeks of each month, and applied a canlharides blister continually over the anoiirysiii. Oct. 6, 1«94.J REPORTS Oy THE PROGRESS OF IIEDICIXE. 445 In the second case the anenrysin also involved Bupropion Online the innom- inate artery and ascending aorta, with some Generic Bupropion dilatation of the transverse arch. The symptoms pointed to compression of the innominate veins, especially the right. The oesophagus was .il-i :ftTe<-ted. The efTeets of the bleeding were again very in Ilk. 1. Under the use of iodide of potassium the patient coiiliiiiies free from urgent symptoms, though the right exter- nal jugular vein is full and the superficial veins of the chest are dilated. The third case appeared to he one of aneurysm of the as- cending and transverse aorta. The symptoms were coldness of the right arm, prsecordial pain, pain and difficulty in swallow- ing liquids, and hoarseness of voice. An attack of sneezing was followed by inability to swallow solids and an Purchase Bupropion increa.-'e of pain. Venesection was performed, and immediately the dilii- cnlty of swallowing and the pain disappeared. A similar at- tack a year later was again relieved by the same measure, though not 80 promptly. The iodide of potassium was given in this case also. In the treatment of aneurysm there are three indications to be kept in view: These are the contraction of the aneurysm, the hypertrojihy of its walls, and lastly the deposition of tibrin within its cavity. The first indication can be met by a copious depletion, together with absolute rest for several months and the ingestion of bat a limited amount of liquids. The second indication can be carried out by the internal administration of moderate doses of iodide of potassium. The third indication requires a diet which, without being so rich as to stimulate the

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