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Dr. Robert N. Willson in this paper said that to those who knew the heart simply as a muscular pump, the function of which was to supply the various parts of the body with blood, the term cardiovascular poison would mean little more than a drug which caused the heart to misbehave or to functionate badly. It was no very recent discovery that if any human organ was overrich in its nervous supply, the heart was that one. An exceedingly important item perdorimi i viagrave of knowledge was that one of the main nervous distributions in the heart was subendocardial. Highly important was also an appre- ciation of the probability that the cardiac nervous structures entered in greater or less degree into the inception and the discharge of each and all of the main functions perdorimi i viagrave of the heart. Three groups of cardio- vascular poisons briefly discussed were (1) decomposi- tion of food products. These Dr. Willson believed perdorimi i viagrave con- stituted the causal factor in arterial changes and the hypertension contributing so actively to the cardiac disease of later years; (2) microorganismal influences which make their attack from without, viagra 50 mg precio such as syphilis, tuberculosis, rheumatism, so-called, and diphtheria. Frequently children of luetic or tuberculous parentage were found to be the subjects of myocardial or valvular defects. The tubercle bacillus and its toxin also fur- nished an invariably diseased heart. Much uncertainty attached to the acute rheumatic infection even viagra 50 mg precio with respect to its etiology. In diphtheria was experienced nearly 100 per cent, of instances of myocardial involve- ment. The third class of cardiovascular poisons was that of tobacco and alcohol. Histories of two patients were cited illustrative of tobacco poisoning. It was the author's confident belief that between tobacco and the various forms of food toxemia could be divided the responsibility of the vast amount of arteriosclerosis not attributable to syphilis and old age. Alcohol was said to be almost the twin of tobacco in perdorimi i viagrave its anesthetic and narcotic eflfect. Its lack of value as a food had been demonstrated beyond all peradventure and this lack had been accepted as a working principle in all of the foremost laboratories. It was viagra 50 mg precio known that in small doses and in large alcohol in viagra 50 mg precio continued perdorimi i viagrave use soon depressed and then paralyzed the vasomotor nerves. While it was not known that alcohol produced arteriosclerosis it was known that tobacco did, and that the use of alcohol practically implied the craving for tobacco. Other ex- viagra 50 mg precio cesses in food and venery the author said were closely associated with alcoholism and the tobacco habit that tended equally toward sclerotic vessels and myocardial disease. It was impossible, therefore, either to indict alcohol upon the score viagra 50 mg precio of directly producing arterio- sclerosis, or to relieve it completely of either a direct contributory or an indirect i-esponsibility for much of the rapidly increasing cardiovascular disease. Dr. Willson viagra 50 mg precio regarded it as only fair to e.xonerate the drug alcohol from contribution to the sclerotic total when used by the physician in therapeutic dosage — if there were any such thing. There was abundance of reliable evidence to show that the administration of alcohol lowered the vital resistance to bacterial infections by diminishing the power of the human economy to marshall its phagocytes at will and to manufacture the antitoxins requisite to combat the infections working mainly as toxemias. The only conceivable occasion upon viagra 50 mg precio which the drug could assist in a grave toxemia was said to be in such an infection as typhoid fever occurring in a strong, robust individual of high antitoxic resisting power in whom there was a too wholesale destruction of bacteria in the tissues with danger that the patient might poison himself to death through the very process that usually worked the cure. In the vast majority of typhoid patients, however, this danger was not present. There were few physicians, he believed, approximating forty years of age or over who felt that a place remained for alcohol in the pharmacopeia of perdorimi i viagrave the well read and conscientious physician, e.xcept as an emer- gency stimulant, and then only in minimal dosage which did not mean a half ounce or an ounce at intervals of a few hours. The physiological effect of alcohol was said to be better comprehended by the lay public than by the average medical man, judging by the perdorimi i viagrave tide sweeping over the country. With the recent action of 700 physi- cians of Pennsylvania standing for the right of a community to determine by vote whether its citizens should exchange health for avoidable cardiovascular disease, he felt the next advance to be the ranging of perdorimi i viagrave the national medical body on the side of the disuse of a drug now recognized, in any dosage, to viagra 50 mg precio be a cardio- vascular nerve and muscle poison, a tissue destroyer and an economic harm. Mention was made of the several forms of clinical and laboratory evidence for and against the use of alcohol in medicine. Three series of experiments were mentioned confirming Dixon's con- clusion that the first action of alcohol was a stimulation of the heart. For every statement made ample clinical and laboratory evidence was given of investigators known and trusted as such by the entire medical world. While a study of the cardiovascular poisons was in- viagra 50 mg precio complete without the consideration of an excessive pro- duction of the internal secretions the author limited himself to a discussion of the three groups nearest to the citizen and the general practitioner. Dr. H. A. Hare had sometimes regretted that in meet- ings of American associations the custom of English medical societies of attacking each other vigorously was not carried out. While not his intention in anything he might say to give offence he observed that under the title of a paper on heart disease Dr. Willson had really read an attack upon alcohol as a drug. The first mis- take in the paper, if he might be pardoned for saying so, he said, was that of making sweeping statements without the slightest justification for many of them, and some of which were in direct controversion to known laws of physiology and pathology. To state, for example, that in the early stage of the influence of alcohol the drug stimulated the perdorimi i viagrave circulation by stimu- lating the vagus showed an entire ignorance of what every second year student in medicine knew — that the function of the vagus was inhibitory and that in its action it decreased functional activity of the heart rather than increased it. Further, when the statement was made that alcohol produced arteriosclerosis and arterial spasm, and in the same breath the assertion was made absolutely that alcohol depressed the entire vasomotor apparatus, it was difficult to agree with the