Stomatitis. Simple stomatitis is easily treated; it has not the same characters as exudative stomatitis (vide that disease), and the gangrenous variety (noma), which is observed especially in marshy countries. This kind must be combated by quinine, chiefly the arseniate, and by the application of muriated honey:—

A granule every hour, at the commencement of the disease, that is, when the lips and inner aspect of the cheeks assume a palish hue.

Stupor must be combated by arseniate of strychnine :

A granule every hour, alternately with arseniate of quinine.

Glossitis. This inflammation is most often caused by the abuse of mercury, and by certain poisons or virus. It must be combated by strychnine, and the arseniates, as in stomatitis. It is dangerous to make deep incisions in the tongue, on account of the hæmorrhage and prostration. In case of need, tracheotomy should be performed in order to prevent suffocation.

Locally, chlorate of potash and chloral gargles should be used.

Amygdalitis or Tonsillitis-This inflammation is only dangerous when it is due to miasmatic causes, which call for the employment of strychnine, and the arseniates. Drastic purgatives senna, scammony, etc., are necessary here to cause a prompt cleansing of the mucous membrane. The following is useful for that purpose :

Eau de Vienne, 60 grammes; sulphate of magnesia, 15 grammes; syrup of mint, 30 grammes.

Anginas. I designate under this name those stridulous affections which menace suffocation, in consequence of spasm of the air-passages, and exudations or pseudo-membranes. These diseases are generally miasmatic, and consequently require the employment of strychnine and the arseniates. These

medicaments must be vigorously pushed, and spasm should be combated by hyosciamine. (Vide Diphtherias.)

Pleurisy. Pneumonia.-These inflammations often proceed both together. They differ, however, according to whether the pleura or the lung is particularly affected.

In pleurisy, the pains are lancinating and pungent (pleuritic points). They must not be confounded with intercostal or pleurodynic pains, which are induced by the contraction of the intercostal muscles. Pleuritic pains are felt even apart from respiration, as when the patient tries to withhold his breathing. The pulse is small and quick, and the face is shrunk and generally pale. Auscultation reveals crepitant and sibilant râles. The cough is dry, or at least followed by only slight expectoration; always serous. The disease begins with a violent shivering. It is necessary, therefore, from the outset, to administer arseniate of strychnine, arseniate of quinine, and digitaline ::

A granule of each, together, every half-hour.

The chest must be dry-cupped, and immediately afterwards

*

As an adjuvant to the dosimetric treatment of the various inflammatory affections of the throat, ear, etc., I would strongly recommend the application of Leiter's temperature regulator, by means of which cold may be continuously applied to any region. In tonsillitis, inflammation of the fauces, enlarged thyroid gland, laryngitis, diphtheria, acute inflammation of the mastoid process, and suppurative catarrh of the middle ear, great benefit has been derived from the use of the above apparatus, by Dr. Lennox Brown, Senior Surgeon to the Central London Throat and Ear Hospital. Professor Politzer, of Vienna, is of opinion that "local bleeding, or Wilde's incision" may be avoided in acute inflammation of the mastoid process, by abstracting heat by means of the temperature regulator. The same holds good no doubt (avoidance of bleeding) for inflammations in most regions of the body. Uniform heat may be applied equally well with the apparatus, if required. For a description of the regulator, vide article by Dr. Lennox Brown, in the "Specialist," December, 1881. Messrs. Krohne and Sesemann, 8, Duke Street, Manchester Square, London, are agents in this country for the apparatus. It may be obtained in a variety of forms suitable for application to every region of the body. It is also cheap, so that it may easily come into general use.-H.A.A.

it must be rendered immoveable by means of a circular bandage; for it is important to prevent the movements of the thoracic walls, which exercise a painful friction on the inflamed pleura. As a drink, lemonade, with the addition of Seidlitz salt, should be given, in order to provoke an abundant exudation through the digestive and urinary mucous membranes.

This treatment has particularly in view the prevention of effusion into the pleura, which generally takes place at an early period of the disease.

The reaction having come on, it must be combated by aconitine and veratrine :

A granule of each, together, every quarter-of-an-hour, until the pulse and temperature fall.

In pneumonia, the patient experiences a feeling of ebullition in the chest, with great oppression and impediment to the lung circulation; the face is injected and swollen; the expectoration is frothy and sanguinolent; the pulse is hard; and the respiratory murmurs are absent, though occasionally there may be bronchial râles; dulness on percussion.

It is obvious that the expression of the disease is different from that of pleurisy, and that it is needful to succour the patient by disembarrassing his lungs by bleeding. Nevertheless, arseniate of strychnine, arseniate of quinine and digitaline, must also be given, in order to favour the return of the lung to its normal state, and to prevent infiltration or pulmonary cedema :

A granule of each, every half-hour until sedation. As a drink, lemonade, with Seidlitz salt.

The re-action should be combated by aconitine and veratrine, as in pleurisy. Narcotics must be abstained from as much as possible. To relieve the cough and facilitate expectoration, a kermes potion should be given. Recourse might also be had to scillitine :

A granule every half-hour, with almond emulsion.

Broncho-pneumonia must be treated in the same manner. The result of this treatment will be to prevent the anatomopathologic lesions, against which art is so often powerless. Besides, it is founded also on the progress of the disease. Bouilland pretended to jugulate acute diseases of the chest by consecutive bleedings; such treatment can be comprehended when the patients are vigorous, and of sanguine temperament; but bleeding does not modify in the least the vitality of the lung (the suffering organ), and by the void which it produces, forms a species of gulf, into which all the blood in the body endeavours to precipitate itself. It is therefore more rational to contract the pulmonary tissue by the arseniates; in this manner, if bleedings are necessary-being required when respiration is difficult-they might be less copious, and less frequent.

The counter-stimulant treatment by tartar emetic, I do not pretend to reject, but I think that, in the greater number of cases, it would be better to make use of the defervescent alkaloids.

I will say nothing concerning the treatment by alcohol, except that it can only be expedient in countries where there is an abuse of alcoholic liquors. But, even then, the employment of arseniate of strychnine, arseniate of quinine, digitaline, etc., cannot be dispensed with.

I ought here to say a word concerning capillary thoracocentesis, or pneumatic aspiration. Notwithstanding the energy with which pleurisy is combated, it often happens that effusion takes place, which requires a prompt evacuation, under penalty of seeing the patient perish by suffocation. It is in such cases that capillary thoracocentesis becomes a sheet-anchor. Even in doubtful cases, it should be performed, because it cannot in any manner aggravate the situation. Dulness, bruit de souffle, ægophonia, or bronchophonia are often wanting, or when

* For an account of the alcoholic treatment of pneumonia, vide Todd's "Clinical Lectures."-H.A.A.

present, may be insufficient signs for indicating the extent. of effusion. Enlargement or bulging of the affected side, is also an insufficient sign. But there can be no doubt that the patient is being suffocated, and that it is imperative to render him immediate aid. The aspiratory needle must be plunged into the chest-wall, at the dull and projecting point, and the absence of resistance will indicate its arrival in the fluid. If, however, the effusion is not there, the operation must be repeated at an adjoining point, until the liquid is discovered and drawn out by the aspirator.

Pericarditis.- Carditis. - Endocarditis. Inflammation of the heart and its membranes is characterised by pungent pains of a stabbing nature, and by disturbances in the circulatory and respiratory rhythms. New-leather-like, blowing, rasping and sawing sounds are heard on auscultation. The disease commences with shivering and leipothymy, which proves that the organ has been suddenly surprised, and that it is needful to aid it by arseniate of strychnine and digitaline-

A granule of each, together, every half-hour.

The English physician, Cullen, called digitalis the opium of the heart; but as opium stupefies the brain, digitalis, in like manner, stupefies the heart. It is necessary, therefore, to associate digitaline with the arseniates. It is evident that the movements of the heart have been suddenly disturbed, and that distension of its walls has been the consequence. Tone must, therefore, be given to the organ, in order that it may return to its normal condition, and it must not be weakened by improper blood-lettings. A void has been produced, which the abstraction of blood prevents filling up. Thence, disturbances of circulation and respiration. The physician, however, must be on his guard against the re-action, and the moment it passes beyond a certain point, it must be moderated by aconitine and veratrine:—

A granule of each, together, every half-hour, until the pulse and temperature fall.