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Cardiac examination showed Price Viagra In India marked dilatation with loud systolic murmurs at the base and apex. This cardiac con- dition — with remission and exacerbations — lasted three months ; coincident with the gradual improvement in the neuritis, the dilatation disappeared and as the only evi- dence of the former lesion, there was present a slight impure first sound at the apex. Case VIII. S. H., male, age forty-four years, heavy tobacco smoker since youth, no alcoholic, rheumatic, or luetic history; no alcoholism, no arteriosclerosis. One Price Viagra In India year ago while running for a car. he suddenly fainted and remained unconscious for over an hour. The patient was not seen until some weeks after he had recovered from this attack of acute cardiac dilatation (?). Since then, there had been frequent attacks of true angina pectoris, sotne of them severe, many brought on by even mild ex- ertion (e. g., rapid walking across the room). Examina- tion showed a slight increase of heart area and Price Viagra In India a faint blowing murmur at the apex. In the anginal attacks the only additional physical sign was slight acceleration of the pulse (16. 17). ."Xt the present time after several 785 CORRESPONDENCE. months' treatment (particularly rest in bed at first, total abstinence from tobacco, and carefully graded exercise) his anginal attacks have disappeared and he is able to walk about with practically no discomfort. The cardiac area is normal and only occasionally is there heard a faint blowing murmur accompanying the first mitral sound. These few cases are cited because they strikingly illustrate the point the writer wishes to make— - how little, besides the alteration in the first systolic sound, remains after these severe attacks of acute dilatation. In even,- instance the patient was Price Viagra In India quite ill during acute attacks of what might be called typical heart failure, and yet, after a longer or shorter time, sometimes only after a few hours, at other times, after months, the heart functionally re- turned to the normal and regained its "tone :" all evidences of severe dilatation and heart weakness had vanished, dyspnoea, oedema, bronchitis, and loud murmurs had disappeared, the patients went about their usual work (in many instances hard manual labor), and only very careful and perhaps repeated examination showed any physical abnormity in heart action or heart sounds. Indeed, if unac- quainted with the direct evidences of severe and sometimes dangerous failure of compensation oc- curring in these attacks, it would be difficult to be- lieve that the apparently normally acting, steady heart could assume such alarming irregularity and give rise, by its dilatation, to loud mitral murmurs and severe evidences of decompensation. It is of course not tn be miplied that all hearts with alterations of the first apical sounds have been the seats of acute severe dilatation. Price Viagra In India In myocarditis, as in most other organic diseases, there are slow, in- sidious forms in which there may never be an acute attack of heart failure. Patients with the impure mitral sounds pre- viously described will bear close watching, how- ever, because evidences of acute dilatation may sud- denly and unexpectedly supervene. These Price Viagra In India attacks are usually caused by overindulgence in alcohol or tobacco, by overexertion, etc. Patients should be warned against special excesses and indulgences which are apt to bring on attacks. The physician should particularly remember that though patients with the apparently slight physical imperfection de- scribed may go along for years or perhaps to the end of their lives without symptoms referable to their hearts, there is always the possibility that this same heart, apparently so near the normal, may quite suddenly "give out" and present all the dan- gerous manifestations and characteristics of severe acute dilatation and consequent decompensation. 1275 M.ADisoN Avenue. References. 1. Calbeck. Lancet, 1904, p. 990. 2. Mackenzie. Diseases of the Heart. 3. Gossage. Medical Price Viagra In India Chirurgical Transactions, xc, 2. 4. Gossage. Proceedings of the Royal Society of Med- icine, 190&. 5. Allbutt. System of Medicine, 1909. 6. Senator. Fortschritte der Medi:in, xix, Price Viagra In India 13, 1901. 7. Porter. American Journal of Physiology, xv, 1905. 8. Stokes. Diseases of the Heart, 1855. 9. Eisner. Medical News, September 5, 1896. 10. Rog and Adami. British Medical Journal, December. 1888. 11. Bauer. Festschrift der Mi'mchencr niedisinischcii Facultdt fiir Pcltenkofer, 1893. 12. Xothnagel. Diseases of the Heart. American Edi- tion, p. 497. 13. Garter. Medical Nezvs, January 11, 1902. 14. Herz. Deutsche Price Viagra In India niedidnische Wochenschrift. 1900. Nos. 8 and 9. 15. Camac. Johns Hopkins Hospital Bulletin, Februarv. 1904. 16. Musser. Medical News, January 11, 1902. 17. Musser. American Journal of the Medical Sciences. September, 1897. iS. Steell. Medical Chronicle. 1893. Price Viagra In India Corrfspoutittta.