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Related post: sixpence, resembling a cicatrix," evidently a patch of
fibroid myocarditis. Cheapest Tenormin In another Tenormin Atenolol case (which seems
really to have been one of angina sine dolore) the pa-
tient, who had a difficulty or incapacity to walk up a
moderate ascent, died in a sudden transport of anger.
John Hunter, who made the dissection, found '* the two
coronary arteries, from their origin to many of their
ramifications upon the heart, were become one piece of
bone." * Tenormin Online The older reports, which corroborated the
opinion of Jenner, are to be found Tenormin Buy in Parry's mono-
graph; while the full statistics on the question have
been collected with great pains by Huchard. In a sup-
plementary chapter to his work you will find a summary
of 145 autopsies in cases of angina, gathered from the
literature. In 17 cases there was mention only of a
lesion of the coronaries without further specification;
of 128 there were 68 with lesions of both coronary ar-
teries, 37 of the left vessel, 15 of the right, and in 12
the seat of the lesion was not stated. In the 128 cases
obliteration or stenosis of the vessels had occurred, and
of these in 121 there was atheromatous narrowing or
thrombosis, in 5 embolism, and in 2 compression. Fatal
cases are on record in which the coronary arteries have
been found normal; most of these are instances of ad-
herent pericardium or valvular disease. There are also
fatal cases of tobacco and post-febrile angina in which
the anatomical condition is stated to have been negative.
Nothing is easier than to overlook myocardial changes,
particularly in the older methods of examination, and a
heart may present extensive fibroid disease with oblitera-
tion Cheap Tenormin of arteries, which to the Buy Tenormin untrained eye looks
* Medical Observations and Inquiries, vol. v, 1774.
healthy, or which may not show any coarse lesions of the
aorta, or of the main branches of the coronary vessels.
Or again, with Krehl's method of serial section a heart
apparently normal may show extensive myocarditis, with
changes in the smaller arteries. Spasm of the coronary
arteries has been invoked to explain the sudden death in
these eases, but it is much more Atenolol Tenormin likely that changes of
a serious nature were overlooked Tenormin 25 Mg (as from personal ex-
perience I know they often are) in the ordinary methods
of examination. Ischamiia, a condition Buy Tenormin Online in which the
heart muscle is imperfectly supplied with blood, is the
main factor in all coronary lesions, whether narrowing
of the orifices of the arteries, atheroma of their walls,
or thrombosis or embolism of their channels.
In seeking to explain the relation of the arterial and
myocardial changes to the symptoms of angina we pass at
once into the Tenormin Tablet region of speculation. On turning to the
therapeutical indexes and finding a list of twenty or more
drugs recommended in a given disease you may be quite
safe in concluding that our knowledge of the treatment
of the affection Purchase Tenormin Online is, to say the least, imperfect; and so,
when you Tenormin 50mg read the tabular list of the theories of angina,
covering nearly four pages of Huehard's Traite, you may
feel assured that the last word has not yet been said
upon the subject.
The view which is based most directly on the coro-
nary-artery disease is one which, as I shall tell you,
dates really from the early part of the century, and
finds its explanation Buy Cheap Tenormin in the remarkable phenomenon
known as intermittent claudication. Bouley,* Sr., the
celebrated French veterinarian, described an affection
in the horse, in which, after being driven for fifteen or Tenormin Iv
twenty minutes, the animal stops, the hind legs get
stiff, and soon it is unable Purchase Tenormin to stir. It may Order Tenormin fall down,
and apparently be in great suffering. In from half an
hour to an hour it will recover and Tenormin Syrup will go on com-
fortably for another fifteen minutes, and then an attack
recurs. In such cases, Order Tenormin Online post mortem, the artery of the
affected limb has been found blocked with a clot, or,
when both hind legs have been involved, the abdominal
aorta has contained a thrombus.
Charcot, while an interne in the service of Eayer,
described in man a condition corresponding to this in-
termittent claudication in the horse. He says f that
one day a patient in the service told him that he was
not able to walk for more than a quarter of an Tenormin 25mg hour
without being taken with cramps in the legs. After
resting a while he would get better, and was able to
resume his walking, and then a crisis recurred. At
the autopsy he found a ball encysted in the Tenormin 25 neigh-
borhood of the iliac artery, and a traumatic aneurysm
which had obliterated the artery in its lower part. The
circulation was carried on bv collateral channels, which
* Nbuvean dictioitnaire pratique de medreine, de ehirurgie et d'hygiene
veterinaires. Toroe deuxieme, pp. 540. Bouley and Renault, 1856.
f Lecons du mardi. Tome i, p. 45.
572
OSLER: ANGINA PECTORIS AND ALLIED STATES.

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