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was normal in quantity, and clomipramine 50 mg he experienced no pain or difficulty in voiding it. The blood was always thoroughly mingled with the urine, was as profuse at the commencement as at the end of the flow, and never occurred indejjendent of micturition. Dur- ing the anafranil online four or five days which an attack would last the amount of blood lost each day was about equal in quantity. Occasion- ally during the day he would pass urine which was clear, but these specimens may have contained blood-corpuscles. Physical examination gave negative results. Although the urine was repeatedly examined, no albumin was found in it. There was no cy.stitis or urethritis. Microscopical examina- tion of anafranil for ocd the urine revealed no abnormities except the presence of blood-corpuscles, a few uric-acid crystals, and bladder cells. The sound failed to show the presence of stone or villous tumor of the bladder, which were suspected. In September last he had an unusually severe haemorrhage. He became cheap anafranil some- what anaemic and emaciated. The amount of blood he was losing caused extreme weakness. Gallic acid, in fifteen-grain doses, controlled the haemorrhage. Ordered the order anafranil gallic iicid to be taken a few days before each expected return, and continued through the usual clomipramine 20mg period of haemorrhage. Since that time two months have elapsed, and the hfemorrhage has not returned. During this last attack I was called to see him one night (December 19th), and found him suffering from some clomipramine hydrochloride prodromal apoplectic phenomena: a full and bounding pulse, Lead.iche, dizziness, and numbness of the left arm and shoulder. His tem- perature was normal. Said he had had the same trouble be- fore. These symptoms soon passed away. The diagnosis of this case must be reached chiefly by exclusion. A careful consideration of the symptoms would point anafranil buy to the kidneys as the probable source of the haemor- rhage. Accepting clomipramine tablets the hypothesis that the haemorrhage was of renal origin, we must exclude the lesions occurring in those organs which could anafranil 150 mg give rise to this condition, such as car- cinoma, Bright's disease, abscess, etc., when we consider the anafranil buy online fact that the microscope failed to show any evidence of renal disease, that at no time was there any albumin pres- clomipramine hydrochloride tablets April G, 1889. LEADING AUTIVLES. \m ent, and that the urine was passed in normal (juantities. In cancer of tlic kidney the h}einical si^- nificaTice. CJases mentioned by Ashhurst, Roberts, Beale, and others, show that any sudden muscular straiii, a fall, or a jar, will often rupture a small renal blood-vessel, usually a ca[)illary in the Mal{)igliian tufts, and be clomipramine 50mg followed by attacks of haimaturia which may return at intervals. In this case the absence of blood-casts in the urine would show that the hicmorrhage came from purchase anafranil the pelvis of the kidney, if indeed it was of renal origin. At my visit to anafranil 150 the patient on the night of December 19th 1 examined his heart and found a slight accentuation of the aortic second sound, indicating the presence of arte- rial degeneration. This, with the (x^currencc on several oc- casions of apoplectic symptoms, seems to have some signifi- cance. It appears to me like a (^asc of essential hasmorrhage, due to a general condition of the vascular system and spe- cially localizing itself in the kidneys, just the same anafranil 50 mg as the loss of blood coincident with ovulation is essential, relieving the vascular turgescence of the generative organs present at that period. That this discharge relieves a state of vascular tension is shown by those peculiar cases of vicarious men- struation where a more or less regular escape of blood takes place from parts ocd anafranil other than the uterus, and it does not seem impossible that the luemorrhage which took j)lace from this man's kidneys relieved the clomipramine anafranil tension of anafranil price a vascular system overburdened by fibroid (diangcs, thus preventing the apo- plectic seizures which might otherwise have occurred. Still, should this be the case, it does not explain the regular re- turn of the discdiarge, which makes the case of such peculiar interest. 114 Wkst 104th Stkkkt.

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