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very act of opening the month giving rise in some cases to retching and even vomiting. Indeed, a considerable num- ber of cases kamagra in uk of so-called hyperesthesia aud parsesthesia of the larynx and pharynx are traceable to some vaso-motor disturbance or sympathetic nerve irritation. The changes in the vascularity of buy kamagra jelly the mucous membrane often take place with great rapidity, the vessel dilatation being quickly re- placed by a condition approaching pallor, while the latter as quickly gives place to the laryngeal or pharyngeal blush. In eases in which the neurotic feature is especially well marked, the alternate dilatation and contraction of the ves- sels can be most conveniently studied. The suffusion and swelling may be diffuse and order kamagra uniformly distributed over the structures, or it may be more pronounced over certain areas, presenting a certain anatomical resemblance to a cutaneous eruption. The secretion of colorless watery fluid is not so constant nor so abundant as in analogous conditions of the nasal kamagra paypal passages, nor is the swelling of the mucous surfaces so con- spicuous. The reflex phenomena symptomatic of this class of pharyngo-laryngeal neurosis need not detain us at pres- ent. Suffice it to say that they are sufficiently numerous, and consist chiefly of various sensory and motor disturb- ances in the path of the nerves that radiate from the pha- ryngeal plexus, and in spasmodic contraction of the pharyngo- laryngeal muscles. In one ease the spasm of the pharyngeal and palatal muscles was so greaf that it materially hindered the passage of kamagra on line air through the nares and laryngeal vestibule, causing the patient to start suddenly from Ins sleep with what might be termed a veritable naso-pharyngeal asthma. In whatever portion of the respiratory trait these vaso- motor neuroses air situated, the general principles of treat- ment are in each and every evenl essentially the same. When, some time ago,* I formulated the view a rding to which the so-called nasal or respiratory retiex neuroses, the group of phenomena known as "hay-fever," "asthma," and other reflex conditions found in connection with nasal disease, mav be classed as symptoms which, owing their origin to a common cause, form part and parcel of a single kamagra quick pathological process, I did so not merely upon theoretical grounds, but based my conclusions upon the results of clinical experience — upon the observation that the treatment of one of these neuroses was essentially the treatment for all, and whether we had to deal with paroxysmal COUgh, •"Maryland Med. Journal," April 11, 1885. asthma, buy kamagra or with the ensemble of those phenomena known as "hay-fever," "rose cold," etc., the therapeutic indications are identical. With these brief prefatory remarks, let us turn to the kamagra now most typical and interesting of these affections, in wdiich the nasal passages and adjacent organs are the most con- spicuous seats of the vascular disturbances, and which we may designate coryza vaso-motoria periodica. The chief indications in the treatment of this affection are: (1) To remove any existing local respiratory disease or irritation ; (2) to uk kamagra so alter the nutrition of the nerve-cen- ters that they may not respond kamagra online uk so easily to reflex-producing impressions; (3) to search carefully for any pathological condition, systemic or local, buy kamagra in uk which may be regarded a- a source of direct or kamagra fast indirect irritation of the nervous or res- piratory apparatus, and adopt appropriate measures for its relief. Failing in the above measures, (4) the partial or complete destruction of the vessels or sinuses over the area or areas in which the vascular disturbance is most marked. I have dilated at length, elsewhere, upon the manner in which these indications should be carried out, and shall, therefore, on this occasion, only offer a few supplementary suggestions. The first lesson to be learned in the treatment of this affection is that it is a chronic neurosis, and, as such, re- quires chronic treatment. It should be remembered that the peculiar condition of the sympathetic is. like epilepsy, with the patient by day ami by night, in winter and sum- mer, readv at any moment, under favorable conditions, to give expression to its kamagra kamagra co uk presence by a paroxysm. Any treat- ment, therefore, undertaken a short while before the ex- pected attack or during its course, is almost wholly pallia- tive, and can kamagra online rarely, if ever, accomplish any permanent good. And thus the innumerable remedies (such as chloral, belladonna, opium, stramonium, etc.) which have been used from time to time can accomplish no lasting good, and in many cases either lose their beneficial effects altogether, ori in the end, by their constant physiological effects upon the nerve-centers, maj tend even to aggravate the predisposi- tion to the affection. In this eategorj I would place co- caine. As I pointed out some time ago,* and also at the last meeting of this association,] the long-continued kamagra jelly online use of this drug in the nose and throat begets an increased irrita- bility of these structures, due. probably, to the repeated contraction and consequent fatigue of the contra. -tile ele- ment- in the smaller n K and erectile tissues, which ter- minates in some cases in a subparalvtic condition of these structures, ami subsequent puffiness of the membrane. As the habitual use of carthartics eventuates, sooner or later, in constipation, so the prolonged use of cocaine will result, in a certain proportion of cases, in a byperBBSthetic condi- tion of the mucous membrane. In the case of the erectile * Discussion on Cocaine, May kamagra oral gel 18, 1885. "Trans, of the Med.-chir. Fac. of Maryland," lss:,, .,. 189. I Discussion, June 26, 1886. " Trans, of the Am. Laryngol. a issft, p. lli». I may mid thai since then Beverley Robinson ("Med. I;.-,, ml." kamagra cheap Oi i. 17. 1885), Ingala ("Journal of the Am Me I Lssoc," Feb. •jo, lsSii), ami purchase kamagra others, kamagra to buy have recorded similar observations. 236 MACKENZIE: RESPIRATORY VASO-MOTOR NEUROSES.

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