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Related post: peptic ailments ? Do mental causes enter into the etiol-
ogy? Has there been over-excitation of the sexual system?
Is tobacco used immoderately ? Canvassing fully and fairly
the facts embraced in the answers to these two classes of ques-
tions, the prognosis is to be based, on the one hand, on the
evidence of Penegra Tablet an inadequateness in the amount of organic dis-
ease to account for the symptoms, and, on the other hand, on
the adequateness of existing causes to explain the disorder, in-
dependently of the lesions which exist.
The difference in the tolerance of chronic affections of the Penegra 100
heart is to be considered with reference to the prognosis.
What is trup of Buy Penegra most chronic diseases, namely, that the same
lesions are tolerated very differently in different cases, is espe-
cially exemplified by the structural affections of the heart. It
is truly astonishing how well borne, in some cases, are cardiac
lesions of unusual magnitude. A case which recently came
under my observation afforded a striking illustration of this
fact. The patient, a man of middle age, was suffering greatly
from dyspnoea in paroxysms, together with loss of appetite and
general prostration, and the case ended fatally within a few
weeks after the occurrence of the symptoms just named. I
saw the patient a few days before his death, and found the
heart enormously enlarged. The apex-beat was in the eighth
intercostal space several inches without the linea mammalis ;
and the dulness on percussion over the praecordia was propor-
tionately increased both in area and degree. Here was truly
a cor hovinum. There were present murmurs, indicating both
aortic and mitral lesions. There had occurred an attack of
acute articular rheumatism fifteen years ago. Now, prior to a
few weeks before Penegra Tablets death, this patient had seemed to be in ex-
cellent health, and he declared that he was so. He was a man
of very active, habits, engaged Penegra For Women in a business (that of a wool-
merchant in the country) which required much Penegra Express travelling.
He had had, on one occasion, an attack of hemiplegia, of very
DISEASES OF THE HEART. 273 Penegra 100 Mg
brief duration, -which was j)robably attributable to embolism.
AVith this exception, he had not for many years been a patient,
considering himself a healthy man. He was a man of Penegra 50mg tem-
perate Order Penegra habits, but a good liyer as regards diet, eating yery
heartily, and digesting his abundant meals without difficulty ;
jet, it is certain that for seyeral years there must haye been
very great enlargement of the heart, resulting from the yalyular
lesions. For some time before the occurrence of grave symp-
toms referrible to Penegra 50 Mg the heart, he had had an unusual amount of
mental and physical work, accompanied with much excite-
ment ; nervous asthenia and impaired appetite ensued, and,
under these circumstances, he began to suffer from dyspnoea.
He was compelled to keep the bed ; he became despondent ;
the existence of disease of the heart was forced upon his at-
tention, and he failed rapidly. The liistory of this case
represents what I have repeatedly been led to observe in other
cases, to wit, the tolerance of disease of the heart, while it was
advancing, more or less slowly, until it had attained to a great
amount, the person affected, in the mean time, not consider-
ing himself an invalid, taking no remedies, living freely, and
engaged in pursuits involving activity of mind, or of body, or
of both. The case also represents a fact which I have repeat-
edly observed, namely, that from the time when persons with
disease of the heart become patients, that is, when they be-
come impressed with a knowledge of the existence of the
disease, and are obliged to give up their usual pursuits and
habits, they are apt to fail rapidly. It is a facilis descensus
from that time. The latter fact, as well as the remarkable
tolerance of the disease under the circumstances stated, teaches
an instructive practical lesson. Penegra Online
In speaking now of the tolerance of cardiac lesions, I do
not, of course, have Penegra 50 any reference to those which have already
been referred to as innocuous. I refer to lesions which are
more or less serious, that is, involving either obstruction to
the Penegra Tablets India free passage of blood through the orifices of the heart, or
regurgitation, or both these immediate effects combined, to-
gether with enlargement by hypertrophy or dilatation sep-
arately or in combination.
All clinical observers who have seen much of diseases ot
18
274 PEOGKOSIS IN CHROKIC
the heart must have been struck with the fact tliat the incon-
venience and suffering attendant on lesions the same in char-
acter and extent, differ widely in different cases.
What are the circumstances on which this variation as re-
gards tolerance depends ? Tliis question not only has a bearing
on the prognosis, but it is of great importance in relation to
management. Buy Penegra Online I will devote to it a few remarks.
In general terms, chronic diseases of the heart, as of other
organs, are tolerated in proportion as the functions of the body,
exclusive of the part diseased, are healthfully performed. The
internal conditions of general health and constitutional strength
relate especially to the series of functions which begin with
ingestion and end with nutrition. Other things being "eqnal,
the toleration is best and longest when, ^rst of all, the ingesta

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