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SCHWYZER: MALARIAL ASGEIOSPASM. 1045 toins were, in the first attacks, of a cerebral char- acter (the aphasia) ; Alli Coupon later peripheral (local par- aesthesias, for instance, in the region of the ulnar nerve). It was not a polyneuritis (no pain, motor disturbances, or anaesthesia), in fact the picture in Case No. i, or in the other cases, could not be explained by any purely nervous trouble. The symptoms most resembled those found in severe arteriosclerosis, or arterial lues, but neither of these processes was present in my principal cases. It must, therefore, have been a functional dis- turbance of the circulation, which caused the symp- toms in the blood vessels. There are two kinds of functional disturbances : contractions and dilata- tions, the former leading to local anaemias, the latter to hyperaemias. In our Alli In Canada cases it was contractions, or angeiospasms. Spasms Alli On Sale of this kind explain the sudden onset of the parjesthesias and its sudden disappearance, and account for the variability of the symptoms. Angeiospasms are quite frequent under many conditions, and are well known to cause local ischasmias, and their consequences, paraesthesias and anaesthesias. They occur in the cerebral arteries, and not infrequently in the coronarv- arteries, giving rise to false angina pectoris and cardiac asthma. They often occur in the extremities, and are not rare in the internal organs. They even influence the renal Coupon For Alli circulation, and the production of urine can be interrupted by angeiospasms. With several of my patients I could clearly estab- lish that, during the attacks, I had to deal with a spastic contraction of some of Alli 120 the arteries, In pe- ripheral paraesthesias I found, on the affected side, the radial artery contracted and the pulse much smaller than on the normal side. I also found the blood pressure higher on the affected side, meas- urpd with Potain's sphygmomanometer in the radial artery ; but this does not seem always to be the case. I took pulse tracings several times during the attacks, and found Price Of Alli the affected pulse to be much smaller than normal, Alli For Sale also much smaller than in the free interval. The blood pres- sure in the fingers, measured Alli Sale with Gaertner's tonometer, was invariably lower on the aft'ected side. The location of the spasms was, in our cases, either cerebral or peripheral. In Case No. i, the first three attacks indicated plainly cerebral angeio- spasms, while later the spasms were located in the arteries of the extremities. In Cases Nos. 3, 6, and 8, there were cerebral attacks also, while the cere- bral symptoms Alli Canada Alli Coupons Alli Prices observed in Cases Nos. 2, 5, and 7 pointed more to a disturbance of the general blood distribution, which manifested itself Alli On Line by anaemia of the central nervous system. So I consider the angeiospasms but indirectly responsible for the dizziness, nausea, faintness, etc. It now remains Alli Uk to show that, in our cases, the angeiospasms were due to malaria. The toxines produced by malarial germs have a great tendency to attack the nervous system. Neuralgias, espe- cially of the intermittent forms, are amongst the most frequent utterances of chronic malarial infec- tion, and even malarial neuritis and polyneuritis are not rare. Why should not the vasomotor nerves, therefore, suffer under the influence of the malarial toxines, and lead to either a contraction or dilatation of the arteries, according to whether the vasocon- strictors or vasodilatators are irritated, or para- lyzed? Malaria, eo ipso, is a great strain on the peripheral vasomotor nervous system, as chills ami chilly sensations are always accompanied by general vasoconstriction, while during the subsequent fever and perspiration, the blood vessels of the periphery show extreme dilatation. It is possible that in Alli Cost our cases the angeiocontractions represent the chill, and this would explain the intermittent attacks. In some patients we Coupons For Alli find the condition of the blood vessels reversed : we find extreme vasodilata- tion appearing in intermittent Coupon Alli attacks. Of course, locally, Alli Ireland we find the opposite of ischasmia, we find enormous hyperaemias and Alli Price swelling of the affected parts. I can mention a few instances of the hy- perjemic type. 1. A patient in my service at St. Francis Hospital a few years ago complained of an intermittent swell- ing Alli Shop of the tongue. Every second day, at six o'clock in the evening, her tong^le swelled up to such a size that she had to keep her mouth open to allow it to protrude to keep from suffocating. Quinine, given

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