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Posture as an Aid in the Diagnosis and Treat- ment of Cardiac Affections and Dropsical Condi- tions of Various Origin. — In this paper Dr. Hexrv W. tlERG said that some diseases enforce the assumption, consciously or unconsciously, of strained positions of the body and limbs, and so characteristic were these postures in various condi- tions that they played a very important part in the diagnosis of many diseases, both medical and surgi- cal. In other cases a knowledge of the pathology of various affections had taught the physician to put the patient in postures most favorable to the cure of his malady. Again, enforced positions of the patient were practised as aids in the recognition of pathological conditions, as, for instance, chest effusions. Having referred to various other condi- tions in which posture was made use of in medical practice, he said that the simplest application of it in the Is 150mg Of Viagra Safe diagnosis of cardiac Is 150mg Of Viagra Safe conditions was the em- ployment of the left sided recumbent posture in auscultating the heart. The instinctive demand on the part of patients suffering from advanced car- diac disease for the scmicrect or entirely upright posture had long impressed Dr. Berg with the fact that the postural treatment of cardiac conditions was of vital importance. The application of such postural treatment, however, was not simple. On the one hand a weak myocardium and insufficient cerebral circulation demanded recumbency ; on the other, the most urgent need of the organism, as voiced by the patient, inrlicatcd an erect or semi- erect posture. Much work had been done by vari- ous observers to determine the changes which resulted in the position of the heart during the 9o6 PROCEEDINGS OF SOCIETIES. [New York .Medical Jourx erect, as compared with the "flat on the back"' recumbent posture. It had been shown that there was a gain of from ^j to % of an inch in Is 150mg Of Viagra Safe the depth of the chest cavity in the upright position, and this was equivalent to an increase of the space occupied by the heart, ui the standing position, of one sixth of its depth (anteroposterior measurement). Fur- thermore, the lowering of the various organs by the force of gravity largely increased the longitudinal diameter of the thoracic space occupied by the heart. For these and various reasons, which were mentioned, the erect posture was the position in which the heart did its work under the most favor- able conditions, though less work was required from the heart in a recumbent position of the body. The body demanded frequent intervals of rest, even in health, and the constant maintenance of the vertical posture was impossible. In disease, how- ever, with an incompetent heart under stress, every aid to cardiac activity was brought into play, and we found that the patient had a tendency to assume a combination of the erect and recumbent postures. These principles could be effectively applied as aids in the diagnosis and distinction of the various murmurs heard in patients suffering from organic valvular lesions. Thus, the knowledge that the heart tended to lie more vertically in Is 150mg Of Viagra Safe the erect pos- ture, and more horizontally in the recumbent, in- volved the conclusion that in mitral stenosis and aortic regi:rgitation the passage of the blood through the valves was favored by gravity in the erect posture, and that the munnurs heard with these lesions would be louder when the patient was erect or sitting ; for the blood current causing, and synchronous with Is 150mg Of Viagra Safe these murmurs was downward. On the other hand, mitral regurgitation and aortic stenosis murmurs would be better heard in the re- cumbent position, because this favors the direction of the current synchronous with and causative of these murmurs. The murmurs accompanying tri- cu-spid regurgitation and pulmonary stenosis were also best heard with the patient recumbent. The same was likewise true of all anaemic murmurs with the exception of those over the pulmonary valves and of the venous hum, which were best heard in the standing or sitting position, when the pulse was accelerated. In the treatment of valvular disease posture would be an aid only when it Is 150mg Of Viagra Safe was such as to increase the force of the flow through the valves in stenosis and diminish its force in regurgitation. Unfortunately, not one, but several, valves were often affected, and still Is 150mg Of Viagra Safe more frequently Is 150mg Of Viagra Safe a valve was affected with obstruction and regurgitation at the same time. In these cases Dr. Berg had found that that posture which diminished the force of the flow in the regurgitation direction (disregarding the stenosis element of the lesion") would be of most therapeutic value and most comfortable for the patient. This, in the vast majority Is 150mg Of Viagra Safe of instances, was the erect or semirecumbent pf)sture. Mitral regurgitation was much benefited by this, while aortic regurgitation per sc was not affected bv it, though in most cases its complications were thus greatly benefited. Myocardial changes, whether primary or secon- dan^^ he went on to say. very frequently resulted eventuallx- in marked dilatation of the heart, and this in time produced evidences of cardiac failure, such as dropsy, pulmonary oedema, enlarged liver, and renal involvement. In these cases any postural procedure making more room for the dilated heart v.ould enable its weakened muscular wall to work under better advantage, and were the erect posture feasible in such ill patients, it Is 150mg Of Viagra Safe would undoubtedly be the position of preference. These patients, how- ever, often could not sit up either in bed or on a chair ; yet the dyspnoea, cyanosis, and orthopnoea precluded the recumbent posture in bed, even when the shoulders and head were raised by pillows. Such patients Dr. Berg had placed in bed with the head of the bed raised as in the Fowler position, or what he preferred to call the reversed Trendelenburg po- sition. The object of this was, first, to remove the pressure on the diaphragm by the action of gravity on the liver and other abdominal organs, and, sec- ond, to give the patient the benefit of the increased