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persistently dilated condition of these vessels. In lead |K)isoning, sleeplessness may occur during the attacks of colic, not only because of pain, but also through direct irritation of nervous tissue' by the poison. The circulatory condition, moreover, is such, the vascular system as a whole being in spasm, as would maintain a full blood supply to the brain even Where Can I Buy Cialis In The Uk during physical repose, insomnia being thus favored, .\mong the many other forms of toxic insomnia, that attending intestinal stasis is of special importance, being so frequently encoun- tered. .Sleeplessness and headache probably arise in a somewhat similar Where Can I Buy Cialis In The Uk manner in these cases. The toxic materials causing these symptoms ujwn ab- sori)tion into the bloodstream are considered usually to be either products of the action of bacteria upon food — chiefly protein food — or intermediate substances formed during the digestion of food by the secretions of the alimentary tract. Insomnia and headache might conceivably result either fcom direct excitation of nervous structures by the poisons absorbed or from a paralyzing action on tlieir jiart upon the walls of the intracranial ves- sels. The known fact, howe\er, that typical putre- factive amines may be set free through bacterial activity in the intestines suggests that a general rise in vascular tension is at times the main circulatory factor in these symptoms, the actions of the putre- factive amines being in many ways similar to those i)f adrenalin, but as a rule more pertinent. For the production of insomnia, we may note, the degree of vascular spasm retiuired is only such as will present the sagging of blood from the brain to dependent portions of the body which Where Can I Buy Cialis In The Uk is believed to occur nor- mally in the period of sleep induction ; for the pro- duction of headaclie. on the other hand, disregard- ing for tlie moment any direct irritating action of the poisons on intracranial tissues, a more marked disturbance of the general circulation Where Can I Buy Cialis In The Uk may be pre- sumed necessary-, a painful degree of pressure on these tissues being exerted. Hence, possibly, the fact that in persons with intestinal stasis, a tendency to insomnia sometimes exists in the absence of all headache. In febrile conditions in general, the state of the circulation is at times such as to favor sleeplessness. While, in most acute infections, hypotension exists at the height of the fever, and toxic material in tht blood may eventually paralyze the vasomotor centre, an opposite condition usually exists in the earlier stages of the disease, the beginning intoxication ex- citing the vasomotor centre and also the contractile vessel walls themselves, thus tending to maintain or increase the intracranial circulation. The augment- ed heart rate Where Can I Buy Cialis In The Uk of fever, and at the eutset, the con- traction of the skin vessels which takes place during MODERN TREATMENT AND FREVENril-E MEDICINE. -[('•-) the rise in temperature, may likewise contribute to tills end. Sleeplessness in the presence of renal im- jjairment has been ascribed to high blood pressure due to intoxication of the nervous system by the poisons circulating in the blood. Similarly in gouty subjects, apart from insomnia due to pain, there may occur a persistent irritability, evidently of toxic ori- gin, Where Can I Buy Cialis In The Uk predisposing to wakefulness or at least to super- ticial or broken sleep. The rather close chemical relationship of the purin bodies to caffeine is of in- terest in this connection. In the treatment of these toxic forms of insomnia, ai)i)arently in part excitative or directly nervous and in part congestive in origin, a number of different therapeutic ol.'jects can with advantage be sought, \iz. : I. The cause, such as alcohoHc excess, lead in- toxication, or the underlying factors of coprostasis or other toxic conditions should be removed. 2. Where removal of the cause can be effected but slowly or not at all, elimination of toxic material is an important palliative. In lead poisoning, the iodides may thus be of assistance. In the insomnia of fecal intoxication, frequent colonic flushings, in- testinal antiseptics such as betanaphthol and phenyl salicylate, increased consumption of water, hydra- gogue cathartics, and systematic ingestion of bran, agar preparations, or mineral oil, are often produc- tive of much good. In febrile, renal, and gouty in- toxications, diaphoretic, diuretic, and cathartic meas- ures, according to indications, are available. 3. To overcome the circulatory factor in toxic insomnia, warm baths or other applications of hydrotherapy, postural measures, light friction massage, and if necessary general vasodilator drugs, in particular the spirit of nitrou.s ether in moderate dosage, may be ai)propriate. 4. To promote directly the contrac- tion of congested intracranial vessels the coal tar an- .ilgesics seem best adapted ; ergot has seemed effec- tual at times, but its relative action on the general and the intracranial vessels is an uncertain quantity. .V To overcome the excitative or directly nervous factor in toxic insomnia, as a temporary measure or where otlier means have failed, such drugs as the bromides, chloral hydrate, veronal, or trional may l)e required, always to be used in the smallest effec- tual dose and to be discontinued at the earliest pos- sible moment. (To be concluded. ) Use of a Fixing and Coloring Agent to Facili- tate Primary Suture of Wounds. — D'elbet {f'rcssc iiicdicalc. December 17, 1^1/) presents a report concerning Le (irand's method of fixing and coloring contused tissues, before their excision, with a mixture of formaldehyde solution and methylene blue. His attention having been called to the danger attending contact of forty per cent, formaldehyde with exposed vascular trunks, Le Grand now uses a twenty per cent, solution only, in which is dis- solved five per cent, of methylene blue. While even this solution is not entirely devoid of action on ar- teries, it cannot be further diluted or the proper coloration of the contused tissues will not appear. To protect arteries when exposed, therefore, Le Grand coats them with some fatty substance before using the fo -maldehvde mixture. Even a thin layer of normal tissue overlying an artery, how- ever, suffices to protect it from injurious action by