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In the evolution of these reflex phenomena two factors are conspicuously concerned : a depraved condition of the nerve-centers, and an abnormal excitability of certain por- tions of the naso-bronchial tract. The derangement of the nervous apparatus may be trans- mitted from father to son, or it may be acquired in a num- ber of different ways. Thus, for example, it may be the re- sult of prolonged irritation of the respiratory membrane (e. a., from nasal congestion and inflammation, polypi, etc., chronic affections of the larynx, pharynx, and bronchi), lead- ing to repeated and continuous vascular disturbances over certain areas (as, for example, the frequent engorgement of that portion Is Coreg A Beta Blocker of the nasal cavities covered by erectile tissue), with subsequent abnormal irritation of the nerve-centers. I do not bring this forward as a mere theoretical assumption, but as a fact of personal experience, having Coreg Cr 10 Mg been able to trace clinically the development of the Coreg Cr 80 Mg neurasthenic condi- tion from simple pathological irritation Order Coreg in the respiratory tract, and notably in the nasal passages. It thus comes to pass, after a time, that the constant ex- citation of the nerve-centers by the peripheral irritation so alters their reflex excitability that they respond more readily to reflex-producing impressions. When, therefore, an in- crease of peripheral irritation occurs, either from extraneous influences or internal causes, a corresponding Coreg Er excitation of the centers is produced which expresses itself ina paroxysm. We might draw a parallel here between this chain of events and the mechanism of the epileptic attack, or the exaltation of the spinal nervous system from abuse or disease of the generative apparatus. The exalted state of the centers may be conditioned in another series of cases, entirely independently of any local irritative process in the respiratory tract, by a constant wear and tear of Cheap Coreg the general nervous system from a multitude of causes — from the faulty nervous Coreg Cr 20 Mg constitution which Beard has termed neurasthenia. Such a condition, it is not diffi- cult to imagine, might produce in time a disordered state of the Coreg Cr 20 sympathetic and abnormal functional activity of the vaso-motor centers. In individuals affected with this form of neurasthenia, local organic irritation would be more likely to lead to re- Ilex phenomena referable to the region of the affected part, than in those whose nerve-centers had not been subject,,! to the same amount of functional strain. In the vaso-motor manifestations under review are found simply an application and illustration of this natural la«. Coreg 18.75 Mg Or. to put it in other words, Coreg 40 Mg tin' area in which the vaso-motor reflexes occur will depend, other things being Coreg 10 Mg equal, Coreg Cr 40 Mg on the seat of the local pathological process — on the localization i f the area pf pp. ripheral irritability. A polypus in the nose, for example, 232 MACKENZIE: RESPIRATORY VASO-MOTOR NEUROSES. [N. Y. Med. Jock., would excite in such a person symptoms referable to tbe respiratory system, while a similar growth in the rectum would elicit reflex disturbances referable to the lower bowel. Now, as there is no tract more subject to direct irritation from the external world than tbe respiratory, we should naturally look to it for manifestations of central vaso-motor disturbance, and herein lies the answer to the question which may be propounded : Coreg 80 Mg Why is it that these vaso-motor dis- turbances are so often encountered in the respiratory tract, and notably the nasal passages '. In still another class of cases the excessive irritability of the nerve-centers may find its predisposing cause in patho- logical states of the system as a whole, as, for example, cer- tain diathetic conditions; Coreg 2.125 Mg or it may be the result of reflected irritation from individual parts of the body. There are certain diseases that tend to abrogate the func- tional activity of the nerve-centers, and at the same time show a special proclivity to manifest themselves or leave traces of their existence in the respiratory tract. I might instance gout, rheumatism, certain fevers, syphilis, etc., and it is a clinical fact that the origin of the trouble may be traced to 8uch a source. You are familiar with the fact that vaso- motor coryza was, and is by some at present, supposed to be one of the protean manifestation- of gout, from the alleged frequency with which it is encountered in those of a Coreg Generic Name gouty diathesis. If what I have said above is accepted, how- ever, it is scarcely necessary to point out the inadequacy of this theory, and to lay stress upon the proposition that gout enters as a factor into the aetiology of the affection only in so far as Generic Coreg Cr it is one of a host of diathetic conditions which lead to weakness of the nerve-centers and inflammatory condi- tions of the respiratory tract. In connection with this portion of my subject I should like to call attention briefly to Coreg Cr 40 the occasional remarkable behavior of this group of respiratory neuroses under the in- fluence of certain acute diseases. I have observed the whole group of symptoms — coryza, asthma, sneezing, cough, etc. — completely disappear during an attack of acute rheumatism, while in another case a recurrence of the nasal affection and asthma took place during an attack of measles after a Coreg 20 Mg prolonged interregnum of immunity from these condi- tions. We now come to the discussion of the hyperaesthetic condition of the respiratory membrane. Is this factor con- stant, is it primary, is it Coreg Cr Generic the /onset origo of these affections, or is it fugitive and secondary? Is it the result of purely local disease, or is it the peripheral expression of more cen- tral nerve-irritation ? These questions have an important practical bearing on the treatment. It seems to me that the existing confusion in regard to these questions arises from failure to separate the hyperes- thesia naturally associated with the local pathological pro- cess and the excessive irritability principally met with dur- ing the paroxysms of this class of affection. According to my belief, the intense hyperesthesia characteristic of the paroxysm is, like the vasomotor phenomena (engorgement, swelling, etc.) which accompany it, a purely secondary phe- nomenon, and occurs only through the intervention of cen-

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