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It is medications with pseudoephedrine order persantine 100mg fast delivery, therefore medicine to stop contractions order persantine online, important to treatment 21 hydroxylase deficiency cheap persantine on line consider the nature of the stressors when studying stress and menopausal symptomatology medicine stick purchase 25mg persantine with visa. Stressors, particularly those heightened by relationship variables, may play an important role in midlife women’s lives. In the early 1980s, Greene and Cook conducted two studies examining stress and menopausal symptomatology. In the first study, Greene and Cooke (1980) found that while women may experience increased menopausal symptomatology across the climacterium, the severity of symptoms was directly related to life stressors, not to menopausal status. Their second study demonstrated an additive effect for the type of life-event stressors that commonly occur during the midlife years (Cooke & Greene, 1981). More recently, Peterson and Schmidt (1999) found that midlife women who reported increased stress due to sleep problems, home stress, and financial stress also reported stress related to sex difficulties. When cross-sectional data were examined, peri-menopausal women who reported increased stress related to their sexual relationship also reported greater sleep difficulties and increased stress related to marital problems. For example, the importance of relationship quality as a buffer against stress was demonstrated by Craddock (1996) who found that couples experiencing lower stress reported higher levels of satisfaction with the quality of their marriages and with their immediate and extended families than did couples experiencing higher stress. After a year, couples who had reported higher stress reported greater deterioration in marital quality and family relationships than did those who had reported lower stress. Another area that may cause stress stems from the multiple demands on midlife women, particularly those as wife (Franks & Stephens, 1992). About 60% reported lack of companionship with their husband and conflict over childrearing practices as top stressors. Over half also identified poor communication, not enough appreciation from the husband, and the unavailability of the husband as stressful. Approximately 40% complained about their husband’s emotional or job problems, about not getting along with their husband, and about sexual relationship problems. Increased stress from a variety of sources, particularly a husband, was related to poorer well-being. Friedemann and Webb (1995) also found that the quality of marital and family relationships was implicated in the ability of women to cope with life stressors. Factors that contributed to feelings of cohesion and togetherness in their relationships appeared to buffer them against the impact of stress. For a married woman, the most important and readily available source of social support is her husband (Smith, Redman, Burns, & Sager, 1986). Supportive relationships in which couples demonstrated care and concern, affection, helpfulness, and sensitivity toward one another appeared to provide a buffer against emotional distress for each other (Conger, Rueter, & Elder, 1999). The above review reflects the complexity of midlife women’s lives, particularly as they experience menopause. This study sought to enhance under standing of midlife women by investigating the inter-relationships among stress, marital quality, sexual satisfaction, and menopausal symptomato logy. It was predicted that: 1) Stress would be highest for peri-menopausal women while sexual satisfaction would be highest among pre-menopausal women; 2) Quality of the marital relationship, marital satisfaction, and stress, would significantly predict menopausal symptomatology, with quality of marital relationship as the most powerful predictor; 3) Sexual satisfaction would be significantly related to menopausal symptomatology; 4) Perceived stress related to husband would be negatively related to marital satisfaction and positively related to conflict in the marital relation ship, while perceived social support from husband would be positively related to marital satisfaction and negatively related to stress; 5) Stress and sexual satisfaction would predict marital satisfaction; and 6) Women in satisfying marriages would report lower levels of stress and less meno pausal symptomatology than would women in dissatisfying marriages. Method Participants and Recruitment Midlife women were recruited from university settings, elementary and junior high school staff, business offices, and medical settings across the United States to participate in this study. They had to be married or living in a committed relationship for at least one year, to be between the ages of 40 and 60, and to identify their partner or spouse as their most significant relationship. Women recruited through medical offices could be as young as 37, if they had been diagnosed with menopausal symptomato logy. Over two-thirds had a mean yearly income over $60,000 and had at least an undergraduate degree. The women, who were primarily Caucasian (n = 213; 95,1%), represented suburban, urban, and rural areas. The majority (n = 144; 64,3%) self-identified their menopausal status based on behavioral descriptions provided by Hunter and colleagues (1986) of menstrual cycles for the previous 12 months. Pre-menopausal women indicated that they menstruated on a regular and predictable cycle for the past 12 months (n = 55; 38,2%). Peri-menopausal women indicated that they menstruated but experienced irregularities related to frequency, duration, and flow, and were experiencing menopausal symptomatology (n = 28; 19,4%). Post-menopausal women reported no menstrual cycles for the past 12 months (n = 61; 42,4%). For an additional 80 women, meno pausal status was based on medical data obtained when they sought help for menopausal concerns and agreed to participate in the study. Of these, nine (11,3%) were diagnosed as pre-menopausal, 46 (57,5%) as peri-meno pausal, and 25 (31,3%) as post-menopausal. Design Women were classified according to menopausal status and by marital quality. Menopausal status had three levels: pre-menopausal (n = 64; 28,6%); peri-menopausal (n = 74; 33,0%); and post-menopausal (n = 86; 38,4%). Using procedures established by Roth-Roemer and Robinson Kurpius (1996), women were also classified by marital satisfaction-satisfied (n = 61; 27,8%), moderately satisfied (n = 109; 49,8%), and dissatisfied (n = 49; 22,4%) based on their Dyadic Adjustment Scale (Spanier, 1976) score. Instrumentation Participants completed a demographic questionnaire and five self -report instruments. One point is given for either “yes, definitely;” or “yes, sometimes” responses, while zero points are given for either “no, not at all,” or “no, not much” responses. Total possible scores can range from zero to 36, with higher scores reflecting more menopausal symptoma tology. In her study with midlife women seeking medical intervention for menopausal concerns, Maresh (1998) have reported an internal consistency of 0,64. Total scores are standardized to range from 0 to 100, with higher scores indicat ing greater sexual dissatisfaction. An alpha coefficient of 0,92 and a one -week test-retest reliability of 0,93 were reported by Hudson and colleagues Maresh (1998) and Fielder (1998) reported internal consistencies of 0,76 and 0,93, respectively. Social support is defined as how dependable and available a partner is to listen and provide help with pro blems or to engage in social activity. Conflict is defined as negative emotions, such as anger, guilt, and mistrust related to interpersonal inter actions with the spouse. Depth of relationship is defined as the significance of the relation ship in a participant’s life. Parti cipants responded to each statement on a Likert-type format that ranged from 1 (not at all) to 4 (very much). Scores within each subscale were summed and then averaged to range from one to four, with higher scores indicating a greater presence of social support, conflict, and depth. Fielder (1998) reported alphas of 0,88 for social support, 0,87 for conflict, and 0,88 for depth. A total score, derived by summing the scores on each of the four subscales, reflects overall marital satisfaction and adjustment. Possible scores range from 0 to 151, with higher scores indicating greater satisfaction. Studies targeting midlife women have also shown strong Cronbach alphas ranging from 0,85 to 0,95 (Fielder, 1998; Robinson Kurpius and colleagues, 2001; St. The modified version consists of three scales: total events, total change, and total distress. Each scale is divided into events related to personal stress (37 items), to husband/partner stress (18 items), and to family/friend stress (30 items). Provided with a list of events, participants answer “yes” or “no” based on whether they have experienced each event and then rate on a 4-point scale ranging from “none” to “extreme” the amount of change the event caused and the inten sity of distress felt. A total score for each of the events, change, and distress scales is derived by summing the points related to each scale for each of the three sources (self, husband, and family). Sample items include “You have been unemployed and seeking work for a month or more? The three distress scales (self, husband, and family) were used as measures of perceived stress in this study. Results Preliminary Analysis Initially, potential differences between women recruited through medical offices and women recruited from community sites were tested by computing Student t-tests on demographic and outcome variables. As expected, the women seeking medical treatment for their menstrual concerns had higher incomes, were younger, and had greater menopausal symptomatology than did the community women.
- Yersinia pestis infection
- Glaucoma iridogoniodysgenesia
- Pierre Robin syndrome hyperphalangy clinodactyly
- Periodontal disease / Periodontitis
- Yellow fever
- Pfeiffer syndrome
- Corneal anesthesia deafness mental retardation
- Nose polyposis, familial
- Microcephaly micropenis convulsions
This caution is because of the increased risk of injury if a seizure takes place during the activity hair treatment cheap persantine 100mg mastercard. Immediate Treatment: the main concern is to medicine while pregnant purchase persantine 100 mg without prescription make sure that the victim of a seizure does not incur harm 5 medications generic persantine 25 mg line. Clear the area around the person who is having the seizure so the person cannot get hurt or hurt anyone else treatment erectile dysfunction buy genuine persantine line. Prevention: Athletes who take medication for a seizure disorder should follow the prescription in accordance with the physician’s orders. In a school setting, medica tions must be kept and administered according to school policy. The athletic train er should always be aware of athletes who are susceptible to seizures by making sure that health histories are thoroughly conducted and documented. Appendicitis the vermiform appendix is a narrow worm-shaped tube that attaches to the cecum, a portion of the large intestine. If the appendix becomes inflamed, symp toms similar to those of an intestinal flu virus may result. This condition, known as appendicitis, causes symptoms such as pain in the lower right quadrant of appendicitis the abdomen, nausea, vomiting, fever, and either diarrhea or constipation. The symptoms of appendicitis usually appear suddenly—over a period of 2 to 3 hours. The sudden onset of onset of abdom inal pain abdominal pain should always be treated with great caution because if the andother flu-like appendix bursts, the infection will spread into the abdominal cavity. Genetic Heart Conditions On rare occasions, an athlete may have a genetic heart defect and not be aware of it. The presence of such a defect may cause the athlete to suffer cardiac arrest with or without a precipitating injury. Under such conditions, the physical exertion that is put forth in practice or play may stress the heart muscle to the point that it is unable to meet the demands of the body, causing a myocardial infarction (a heart attack). These instances are quite rare, but it is important to remember that they can occur and to be prepared for them. Common Viruses Common illnesses, such as a cold or influenza, are generally not considered to be emergencies. In fact, because of their contagious nature, these illnesses can threaten the health and performance of an entire team! Treatment for either type of virus generally focuses on palliative measures, aimed at making the patient more comfortable. Both viruses can cause respiratory symptoms such a runny or stuffy nose, sore throat, headache, cough, and fatigue. If fever or body aches are present, the illness is more likely to be a flu virus than a cold, but there are exceptions to this rule of thumb. Some flu viruses affect the gastrointestinal tract, causing nausea, diarrhea, vomiting, dizziness, fever, and chills. People suffering from such viruses will experience great discomfort and should be monitored carefully. Dehydration is always a possibility when vomiting, diarrhea, or high fever is present. If symptoms do not improve after five days or if the athlete has a fever or severe diarrhea, the athlete should be referred to a physician. In all cases, make sure the athlete stays hydrated, especially when vomiting or diarrhea occur. Some medications have been banned at certain levels of competi tion, and an athlete’s use of these medications could lead to disqualification. Follow-up Treatment: Make sure the physician’s orders are followed, if applica ble. Prevention: One of the primary ways to prevent the transmission of a virus is to practice good hygiene. Is was a hot, dry, and smoggy day in Riverside, California, where the Poly Bears were competing against the M. Richard, the star runner for the Bears, was ahead of the pack at the 21/2-mile mark when his breathing became labored. Richard is an asthmatic and had left his inhaler at home, in a rush to make it to school that day. Even though his breathing became labored, he was determined to keep the pace up and win the event. The Poly Bears had set up emergency stations at each 1/2-mile mark to look for any type of medical condition. The team must also be prepared for other conditions, such as acute appendicitis or a seizure that may occur unexpectedly and require immediate action and treatment by the sports medicine team. Proper emergency procedures must be set up ahead of time for all the different conditions and events, from the golf course to the swimming pool. If the team is not properly prepared, the condi tions can turn into an uncontrolled medical emergency. Not enough can be stated about the importance of gathering a proper, accu rate, up-to-date, and complete medical history for each athlete. Having this history will help prepare the sports medicine team for most medical emergencies. It is essen tial that the athletic trainer, coaches, and other members of the sports medicine team are informed about the athlete’s medical conditions. Additionally, being aware of emergency procedures is the best way of preparing for the sudden onset of med ical conditions that can lead to emergency situations. Moist and pale skin, drooping eyelids, and shallow breathing are all symptoms of . The vermiform appendix is a - tube that attaches to the cecum. A direct blow to the chest can cause to a heart that is already weakened. Discuss the importance of taping techniques in the prevention and treatment of athletic injuries. Athletic adhesive tape has been put to many imaginative uses: as nametags on lockers, shirts, cloth tape backed w ith and football helmets; to improve the grip on a baseball bat; to prevent socks from adherent, used in sliding down; as a temporary splint on a cracked crutch or cane; and as a patch over preventing and supporting the tear on the fabric of a tackling dummy. With this information, basic taping procedures can be applied with adjustments and refinements being made through trial and error and feedback from the athlete. Before beginning any taping procedure, put the athlete in a comfortable posi tion that can be maintained until the procedure is finished. Athletic taping does not prevent injuries, although in some cases the taping pro cedure can decrease the severity of the injury. If an athlete is throwing curve balls improperly, taping the elbow is not going to help. Instead of taping the ankles of an entire basketball team to prevent sprains, the athletic trainer may institute an ankle strengthening program, or have players change to high-top shoes or a type of preventive ankle brace. Athletic taping and wrapping are just part of the arsenal the athletic trainer has to offer to the athlete. With all taping and wrapping procedures: * If pain or soreness doesn’t decrease or go away, a further evaluation and diagnosis will be needed. If the extremity changes color or starts to get cold, the taping or wrapping is probably too tight and must be redone to the athlete’s recommendations. If the procedure is done using underwrap, it is still best to start the taping procedure with the tape directly on the skin to add security. If an athlete comes to you after practice and complains of itching or a rash where the tape was, this is a sign of an allergy to the tape or tape adherent. A properly prepared area to be taped should clean and dry, and all oils should be removed for better adhesion. Cover all cuts and blisters with an adhesive bandage containing some type of skin lubricant. Then apply skin lubricant and foam padding on any friction or pressure areas before applying the underwrap. The Need for Quality in Athletic Adhesive Tapes Athletic users of adhesive tape consume large quantities in a unique manner: ath letic trainers, coaches, athletic training students, etc. Probably the greatest single use of adhesive tape by the athletic trainer is in prophylactic strapping of the ankle. This preventative taping is done prophylactic daily, usually in a short time before practice or games. Applications of strapping adhesive tape to other parts of the body such as the hand, wrist, shoulder, and taping that helps to knee are, of course, done during this same short time period.
I have every imaginable arthritis-friendly utensil medications major depression cheap generic persantine canada, jar opener medicine river animal hospital discount persantine 100mg fast delivery, lightweight serving dishes and more treatment meaning purchase persantine 100 mg on-line. With the help of the Arthritis Foundation symptoms liver disease purchase persantine 100 mg with amex, I’ve begun to turn those “Nos” into “Yeses. Question: What advice would you give to a newly-diagnosed patient or parent/caregiver? It’s crucial you feel a connection that enables you to open communication and develop a partnership. Learn and practice as many self-management skills you possibly can: keeping body weight under control, staying active, exercising, pacing yourself. For these people, there is substantially more time for greater disability to occur. There are currently no medical or surgical treatments Pain and physical limitations are a source of shame and that will improve this alarming trajectory. Recent Risks of revision surgery are especially pronounced in the studies have reported a rate of infection of 0. There were more than 80,000 primary procedures in 2011, increasing by around 3 percent annually. Public health interventions to reduce the prevalence of obesity in this population could reduce health inequalities. But the immune system can go awry, mistakenly attacking the joints with uncontrolled infammation, causing joint erosion and damage to internal organs, eyes and other parts of the body. There are many types of arthritis that fall into the category of autoimmune infammatory arthritis. The goal of treatment for these diseases is to reduce pain, improve function and prevent further joint damage. Eileen: They’re a reminder to me that this disease affects many people in many ways. I’ve had some surgeries on my joints, but even then, I was able to return to work promptly while recovering. There have been days when I haven’t felt well, but I’ve learned that keeping myself busy has been a helpful coping strategy. I have decent medical insurance, but prescriptions, copays and lab work are all costly. I had signifcant fnancial hardship from hand and wrist surgeries, and it took quite a while to pay off the out-of-pocket expenses. One of the biggest challenges was accepting that I could no longer be as independent as before. Over time, I realized I no longer had a choice and had to ask for help if I needed it. I could no longer open syringes, help turn a patient over, safely help someone walk who was weak. So, I became a nurse educator and have worked in the same hospital for 35 years in a variety of nurse-related roles. Some days I hardly think about it at all; other days I think about it a lot and feel down. This creates infammation that causes the tissue that lines the inside of joints to thicken, resulting in swelling and pain in and around the joints. If infammation goes unchecked, it can damage cartilage, the elastic tissue that covers the ends of bones in a joint, as well as the bones themselves. Over time, there is loss of cartilage, and the joint spacing between bones can become smaller. Over the years, she has immersed herself in leadership roles with the Foundation and speaks nationwide to inspire patients living with chronic illness. Following, in her own words, is Liz’s story about living with these conditions and how the statistics she reviewed in Arthritis by the Numbers relate to her personally. Even though I was active in afterschool activities, like the swim team, my fatigue was constant, and I started to develop joint and muscle pain. About a month before my diagnosis, I jokingly told a friend, “It feels like I have arthritis. The school nurse found that I had a fever, and my joints, muscles and lymph nodes were swollen and sore. In my work with different arthritis groups, I am seeing more and more patients who are teenagers and young adults. I hope better access to care and understanding of rheumatic disease will help them experience relief and support like I did. Because my doctor was so involved with the Arthritis Foundation, she talked about ways it could help me. My friends and family also wanted to be supportive and help in fundraising and events. I’m glad I did, because it helped me meet people and fnd resources to help me cope and adjust to my “new” life. Liz: the turning point for me was connecting with fellow patients through the Arthritis Foundation. Being part of the Arthritis Foundation community is important for a variety of reasons. Lupus is systemic, meaning it affects a wide part of the body, including the joints, kidneys, skin, blood, brain and other organs. According to a 2016 Nielsen consumer needs survey conducted for the Arthritis Foundation, 90 percent of these patients say they can meet the goals they set for themselves. Caucasians (Rus 2002) the disease appears to be more common in urban than rural areas in California and Pennsylvania. Racial Distribution African-Americans, Hispanics and individuals of low Minority and ethnic groups are affected more than Caucasians. These results suggest that Disease onset occurs at a younger age among Afri improved health information exchange could positively impact can-Americans. Medical/Cost Burdens Symptoms affect the individual’s work, quality of life, Both direct medical costs associated with an individual’s care self-management and self-effcacy. In an autoimmune disease, the immune system mistakenly attacks healthy tissue, leading to infammation in the body. In Sjögren’s syndrome, the infection-fghting cells of the immune system attack the normal cells of glands that produce moisture and other parts of the body. In addition to affecting the eyes and mouth, the disease can affect the skin (abnormally dry skin), joints (infammatory arthritis), lungs, kidneys, blood vessels (purpura, Raynaud’s disease), digestive organs (disorders of the esophagus, stomach, intestines, liver, and pancreas), the throat and larynx (voice-related disorders), and the nervous system. The condition exists as an individual rheumatic disease, but may also be seen with other autoimmune non-rheumatic and/or non-glandular diseases, such as autoimmune thyroid disease or celiac disease. Prevalence (Primary Sjögren’s Syndrome) Comorbidities (Secondary Sjögren’s Syndrome) It’s estimated that 4 million people in the U. Human and Economic Burdens Some patients reported disturbed sleep caused by increasing Health Burdens stiffness and aching. Others slept so deeply that they did not notice the disease’s predominant effects are on the tear and salivary the stiffness until they woke up, but even then, they were still tired. However, brain fog can be caused by different factors and should They also have an increased risk of cerebrovascular events be evaluated by a health care provider. Scleroderma involves the buildup of scar-like tissue in the skin, but it can also damage the cells in the walls of the small arteries. Scleroderma may occur in two forms localized scleroderma and systemic sclerosis. Systemic sclerosis tends to be the more severe form of this disease, but fewer people are affected by it. This kind affects the skin on the face, fngers and hands, and lower arms and legs. For many, the frst symptoms are Raynaud’s phenomenon and puffy fngers, which can begin several years before other symptoms. However, some people experience severe Raynaud’s phenomenon, gastrointestinal problems or serious effects on the lungs. It may affect any part of the body, especially the hands, arms, thighs, chest, abdomen and face. Diffuse scleroderma may affect the blood vessels, heart, joints, muscles, esophagus, intestines and lungs. Kidney problems may lead to high blood pressure and, if untreated, kidney failure. In addition, scleroderma is diagnosed at a medical costs of younger age in African-Americans.
But when the piles are strangulated symptoms of mono order persantine 100mg amex, "choked tight" by the sphincter muscle symptoms 5 weeks 3 days discount persantine 100mg online, hot fomentations 10 medications that cause memory loss generic persantine 100 mg on line, poultices and soothing remedies give the most relief medications kidney failure cheap persantine online visa, because they reduce spasmodic contractions of the muscle and allay the pain. This can be given frequently; ten to twenty drops of laudanum can be added to the poultices when the piles are very painful. For inflamed piles, the following combinations may be used:- Gum Camphor 1 dram Calomel 12 grains Vaselin 1 ounce Mix thoroughly and apply freely around the anus and in the rectum on the piles. The external parts should always be bathed with hot water, thoroughly, before using. Gum Camphor 2 drams Chloretone 1 dram Menthol 20 grains Ointment of Zinc Oxide 1 ounce Mix and apply directly to the piles. When there is a slight bleeding, water of witch-hazel extract, one to two ounces to be injected into the rectum. An ointment composed of equal parts of fine-cut tobacco and raisins, seedless, chopped fine and mixed with enough lard, makes a good ointment to apply on both external and internal piles. Tea of white oak bark, boiled down so as to be strong, and mixed with lard and applied frequently, is good as an astringent, but not for the very painful kind. If necessary remove any feces that may even then be retained, by injections of soap suds or warm water containing oil. It is best to rest in bed, if possible, after stool for the rest relieves the congestion and soreness. An abundance of out-door exercise, when the piles are not present, or bad, consisting of walking or simple gymnastics may usually be indulged in; violent gymnastics and horseback riding must be avoided. Meats: tender broiled, boiled or baked beef-do not eat the inside part to any great amount. The foods should not be too highly seasoned; vinegar is not to be used to any extent and this excludes pickles, etc. Make the patient as comfortable as possible, by applying cold or hot things to the part, rest in bed, mild laxatives to keep the bowels open. Cut it open as soon as possible, and it should be laid wide open, so that every part is broken up. The dressing should be as usual for such wounds and removed when soiled and the wound washed out with boiled water and then gauze loosely placed in the bottom and in every corner of the wound. Such patients should be built up with nourishing foods, and should remain quietly in bed. It has two openings, one upon the surface of the body near the anus, and the other in the rectum. The patient in poor condition should be given the treatment suitable to his condition, according to the advice of a trusted physician. The right kidney usually lies lower than does the left, but even then, the lower part of this kidney is an inch above the upper part of the hip bone, or an inch above a line drawn around the body parallel with the navel. The long axis of the kidneys corresponds to that of the twelfth rib; on an average the left kidney lies one-half inch higher than the right. At the inner border of each kidney there is an opening called the pelvis of the kidney, and leading from this, small tubes penetrate the structure of the kidney in all directions. After allowing the seeds to soak for several hours remove the same and tea will be ready for use. This is a very good remedy, as the cascara sagrada acts on the bowels and the buchu and uva ursi acts on the kidneys, carrying off all the impurities that would otherwise be retained in the system and cause trouble. There may be pain or dragging sensation in the loins, or intercostal neuralgia; hysteria, nervousness, nervous dyspepsia and constipation are common. Sometimes there are attacks of severe abdominal pain, with chill, fever, nausea, vomiting and collapse. The urine shows a reddish deposit and sometimes there is blood and pus in the urine. If the symptoms are present, replace the kidney while the patient is lying down and retain it by a suitable belt. If the symptoms are of the severe kind an operation may be needed to fasten the kidney in its proper condition. Milk is excellent where it is well borne; if not well borne give easily digested meats, such as chicken, roast beef, broiled steak and lamb chop; fish of various kinds and vegetables, such as spinach, carrots, asparagus and cauliflower; of fats, butter, cream, and chocolate; for constipation, cider, buttermilk, grape-juice, fruits and honey. The urine is scanty, and there is increased specific gravity (normal is 1015 to 1020) and contains albumin and a few casts. Rest in bed, and as a diet use only milk; if the congestion is bad, use dry cupping over the kidneys and inject large quantities of hot normal salt solution in the bowels. If you can get the patient into a sweat the congestion will be somewhat relieved by it. The kidney is enlarged dark red, the urine is diminished, with albumin and casts and sometimes blood. The headache is severe, usually on the back top of head (occipital) and extending to the neck; there is persistent vomiting with nausea and diarrhea attending it. This is worse at night, when it may resemble asthma; fever if persistent, is usually slight until just before death. Coma (deep sleep) may develop either with or without convulsions or delirium, and is usually soon followed by them; sometimes by chronic uraemia or recovery. The symptoms are less severe than those of acute uraemia, but similar, and of gradual onset, sometimes with symptoms of the acute attack. There is often constant headache and difficult breathing; the tongue is brown and dry, sometimes there is nausea, vomiting, diarrhea, sleeplessness, cramps of the legs and much itching may be present. The urine is scanty, dark colored, of increased "specific gravity" and contains albumin, cells and casts. After some fever disease, the onset is gradual with anemia, swelling of the eyelids, face and extremities; scanty thickish urine containing casts, then headache, nausea, vomiting, little or no fever, dry skin. In these cases there may be gradual recovery, attack of uraemia, or they may end in chronic nephritis. You can give gruels made of arrowroot or oatmeal, barley water, beef tea and chicken broth. As the patient gets better, bread and butter, lettuce, watercress, grapes, oranges, and other fruits may be given. The patient should drink freely of mineral waters, ordinary water or lemonade, these keep the kidneys flushed and wash out the "debris" from the tubes. One dram of cream of tartar in a pint of boiling water, add the juice of half a lemon and a little sugar; this when taken cold is a pleasant satisfactory diluting drink. Cream of tartar one dram, juice of lemon, sugar sufficient, water one pint, may be given whenever desired. There should be hot water baths daily or oftener; or you can produce sweating by placing hot water jars around the patient, and watch to see whether it is too weakening. It can also be done by introducing steam underneath the bedding, that is then lifted a little, so that the steam vapor can circulate about the patient. It may come from acute inflammation of the kidneys that was due to exposure, pregnancy, or scarlet fever, or follow excessive use of alcohol, etc. In children it usually follows acute inflammation of the kidneys or scarlet fever. The epithelium of the tubules is granular, or fatty or the tubules are distended and contain casts. In other cases, the "small white kidney," the kidney is small and pale either at first or as a later stage of the large white kidney. The surface is pale, rough and granular; the capsule is thickened and partially adherent; the surface is thin with white and yellowish areas of fatty degenerations. The interstitial tissue is much increased; epithelial degeneration in the tubules extensive. There is also the large red kidney, and with any of these types the left heart may be enlarged and the arteries thickened. Usually there is a gradual onset with paleness and puffiness of the eyelids, ankles or hands in the morning. Later there is difficult breathing, increased watery swelling of the face, extremities and dependent portions of the body; worse in the morning. There is a pasty yellowish pallor, afterwards dropsy of the abdominal and chest cavities. The urine is diminished, high colored, specific gravity usually 1020 to 1025 with much albumin. You can give gruels made of arrowroot or oatmeal, barley water, beef tea, and chicken broth, but it is better to keep strictly to milk. As the patient gets better, bread and butter, lettuce, watercress, grapes, oranges and other fruits may be given.
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