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Atropine acts in a similar way by relaxing mus- cular spasms, and can be given alone or in combina- tion with morphine. It influences the inflammatory process by first contracting and then dilating the arterioles, relieving congestion. It can be given to dryness of viagra video demonstration mouth and throat and dilatation of the pupils. Opium and belladonna suppositories occa- sionally stop the pain. Chloroform inhalations are ■dangerous and have been entirely abandoned by most practitioners. Pyramidon, antipyrin, and other coal-tar prepa- rations do not stop the pain of severe paroxysms "but often give satisfactory results in milder at- tacks. The salicylates in large doses are occasion- ally useful. Of the physiological measures of treat- ment rest in the recumbent posture is of paramount importance. The excruciating pain forces the pa- tient to go to bed, and this meets the first and most necessary condition to relieve muscular spasms. Though not sufficient to stop the pain, it favors the action of other measures. Mental rest is almost of equal importance, excitement and emotion being often the cause of a paroxysm. A well-ventilated, half-darkened room and a cheerful and quiet nurse will accomplish much. Rest, physical and mental, is the most important remedy to influence beneficially the circulation. Congestions are relieved and the blood flows with ease and in abundance to diseased structures where the current is slowed and retained in the inflammed area by injured vessels. The next in importance to assist the action of drugs and of rest is heat. It may be administered as a full hot bath, as a sitz bath, in the form of poultices and cataplasms, or as electric thermophore. If heat is applied, dilatation of vessels and red- dening of the skin occur at once and gi-adually be- come more intense. The application of great heat will cause immediate paling followed by reddening, and this persists for some time after the application has been removed. Cold acts in a similar way, viagra video demonstration and an ice-bag may be used when heat is not well borne. The direct effect of cold upon the vasomotor nerves produces a narrowing of the vessels and muscular contraction. after taking viagra This is followed by dilatation of the vessels and reddening of the skin, which becomes finally cya- notic when the application is not removed. With either method we stop pain by paralysing the sensory nerves and we produce an active hypere- mia by influencing the vasomotor apparatus. Electricity is recommended and occasionally useful. It stops viagra video demonstration pain and causes an active hypere- mia. Massage, when skilfully given, will produce hyperemia, ease pain, and favor the expulsion of the stone or stones. It will prove of advantage only in the hands of a physician who is thoroughly fa- miliar with the method. Unskilful after taking viagra application may do great harm and cause rupture of the gall-bladder. The patient has to after taking viagra be carefully watched during the paroxysms, and especially the aged need analoptica like coffee, tea, strychnine and alcohol in some form. Death has after taking viagra been produced by shock during a parox- ysm. A morphine and atropine injection relieves the cramp and will best prevent shock. The treatment of gallstone disease is indicated by its etiology, pathology, and course. The presence of an inherited predisposition and the facts that it is only exceptionally found in childhood, rarely in the young, that it becomes more frequent with ad- vancing years and its great predominance in wom- en, after taking viagra allow of but one explanation — a poor abdominal circulation. The inherited predisposition is after taking viagra en- teroptosis with its pendulous abdomen and relaxed abdomnnal walls or rigid recti and diastasis; the greater frequency increasing after taking viagra with years is due to the adoption of an indoor life and late hours, with usually a more generous diet to burden the circula- tion ; the greater frequency in women is due to an indoor life as well as to the relaxation of the ab- dominal muscles after childbirth and to lacing, which interferes with diaphragmatic breathing. A pure and free flowing bile prevents the formation of stones and dissolves them after they have viagra video demonstration been formed — this is the only solvent of biliary calculi so far found. Freriches after taking viagra and others found calculi small and crumbling after treatment. I can confirm this ob- servation. Mr. T., 52 years of age, a civil engineer. He gives a history of renal colics during which he passed gravel and calculi the size of a small pea. He was to be oper- ated upon for stone in left kidney, when the pains stopped suddenly after taking viagra after he had passed some blood and mucus. He has not had symptoms of gravel or renal viagra video demonstration calculi for 7 years. Early in 1912 he had his first typical gallstone colic, followed by five others up to February, 1913. At that time he called on me. He was deeply jaundiced and had chills and fever. Under treatment all symptoms passed, but were followed by another attack a few months later. Dr. Fossier, who treated him in my absence advised an operation. A gall-bladder with thickened walls was removed which contained two very friable small stones, the size of a pea, breaking readily on touch. Mrs. P., 43 years of age, mother of eight children. Patient had a typical gallstone attack nine years ago, followed by three others four years later. Then she was in perfect health till April, 1913, after taking viagra when she was seized with another colic. I saw her during this attack. She was deeply jaundiced and had fever and chills. All symptoms passed and she then returned to her 522 MEDICAL RECORD.