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has been dulled, high blood pressure has been low- ered, etc. But is this assumption correct? Are symptoms essentially morbid manifestations? Study of the processes of nature convinces us that whatever nature does regularly is usually done for a constructive purpose. Nature is not an anarchist, she is a conservative. The conservation of a normal state of health is one of her prime objectives, and when she does something unusual in unusual condi- tions, especially if she has been observed to do the same thing regularly in similar conditions, the pre- sumption is that she is acting constructively and not destructively. The symptom of high blood pressure 2.5 Mg Cialis is a clear illustration 2.5 Mg Cialis of this point. Accepting the doctrine that whatever the circulatory apparatus does regularly is in the interests of an adequate circulation, high l)lood pressure appears as a manifestation of com- pensatory activity to meet some circulatory require- ment. 2.5 Mg Cialis It may signify that the organism is trying to maintain an adequate 2.5 Mg Cialis circulatiorr in the presence of some obstruction, or 2.5 Mg Cialis of some extra demand for 2.5 Mg Cialis elimination : the high pressure may be required for the benefit of a vital region whose blood supply is impeded by arteriosclerosis ; or it may be required for elimination of waste products whose elimination has been rendered more burdensome or more dif- ficult bv pathological changes in the kidneys or else- •Presidential address before the Medical Association of the Greater City of New York, February 18, 2.5 Mg Cialis 1918. May J5. I9i8.] CORNWALL: SOME ASPECTS OF SYMPTOMATIC TREATMENT. 975 where. It appears plainly as a physiological instead of a pathological procedure, and as regularly useful 2.5 Mg Cialis rather than harmful. Fever aj^pears, perhaps, a more recondite symptom than high blood pressure; but we cannot doubt that in general, fever is also an evidence of Nature's reparative activity, perhaps part of her curative plan and not a disease ; although the 2.5 Mg Cialis contrary idea has so far prevailed that the name of this symptom has been incorporated into the names of several dis- eases, as typhoid lever, scarlet fever, intermittent fever, etc., thus perjjetuating the mistaken notion of its nature. The following facts seem to give the clue to the meaning of fever: Invasion of the body by pathogenic bacteria, except when the invasion is local or trivial, is regularly attended by a rise 2.5 Mg Cialis of temperature ; and in invasion by pathogenic plas- modia, as in malaria, the same thing may happen. In those bacterial and plasmodial diseases which are regularly accompanied by a continued or an inter- mittent fever, the febrile movement diminishes or ceases when recovery is in sight or the activity of the pathogenic 2.5 Mg Cialis microorganisms has been controlled. In general, the height of the fever is in proportion to the severity of tlie infection. In cases in which the height of the fever does not correspond to the severity of the infection, but is comparatively low, the prognosis is generally worse than when it is as usual : pneumonia with a considerable involvement of lung or a virulent type of pathogenic organism, and a comparatively low temperature, has generally a worse prognosis than when the fever is of the customary degree. The presence in the blood of the toxins of pathogenic 2.5 Mg Cialis bacteria, introduced as vac- cines, regularly excites a reaction fever, as if the body inferred from the presence in the blood of the toxins of the bacteria the 2.5 Mg Cialis presence of the bacteria themselves, and reacted accordingly. Also, absorp- tion of toxins produced in the alimentary canal by bacterial activity may similarly excite a reactionary fever. Diarrhea, in general, appears as nature's attempt to rid the bowel of matters which disturb it. Con- stipation is not always easy to understand, but sometimes it can be interpreted as a conservative action on nature's part, as in certain inflammatory conditions in and around the alimentary canal. Pain is plainly nature's method of letting us know that something is wrong with our body, and in most cases the region of the botly where the trouble is locateil is indicated. With this understanding of the nature of symp- toms, viz., that they are regularly evidences of Nature's work in combating disease, if not part of her combative process itself, what becomes of symptomatic treatment? Have we any warrant at all for treating symptoms? The answer to this (|uestion is a qualified yes ; for wc have it under certain conditions ; and it is this: \\'hile Nature's intentions arc always right, and while she always works in the right direction, she has not yet achieved, through the slow process of evolution, perfect and universal success in her ada])tation of means to ends. She has not yet be- come absolutely and altogether oflicicnt in her thera- peutic procedures, wonder ful thougli her accom- plishments are. One of the failings which she some- times shows is in not knowing when to stop, especially in 2.5 Mg Cialis conditions which do not yield readily to her constructive procedures. In the presence of very difficult or insuperable conditions she some- times loses her head, so to speak, and keeps on with her hyper- or 2.5 Mg Cialis hypo- or abnormal functionings to such an extent as seriously to disturb the organism or even to threaten it with new trouble. When this is the case, legitimate indications for symptomatic treatment may appear, and we may have a just warrant for interfering with Nature; we may have to hold her hands when she is thrashing around too wildly in a desperate or futile fight. Also unusual functioning may be kept up so long as 2.5 Mg Cialis to threaten to become a habit or a truly functional disorder, and for that reason may be a legitimate object of symp-