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in simple inflammatory cases, is always doubtful. The relations of capillary bronchitis to lobular pneu- monia are so intimate that they may most profitably be con- sidered together. Lobular or broncho-pneumonia is the last step in the progression of the catarrhal inflammation from without inward. Beginning in the larger or medium-seized tubes, it grad- ually extends toward the pulmonary alveoli. At any point in its course the progression may cease, and the type of the case will vary with the limitation of the inflammation. The less severe cases are those in which the morbid pro- cesses stop short of the lobular bronchi, and the tubes are not sufficiently occluded to prevent the circulation of air. They are characterized by great dyspncea, manifested by increased frequency of the respirations, paleness or lividity of the surface, and considerable prostration. The respira- tions in children run up to from 60 to 100 a minute, while the pulse is rapid and somewhat small, its character varying Best Price On Levitra Canada with the degree of exhaustion. The lividity may not at first be very apparent upon the face, but can always be seen by examining the finger-nails. An inexperienced observer might be deceived in regard to the degree of prostration, because of the restlessness and jactitation of the sufferer. The majority, however, are quiet. The physical signs are those of acute general bronchitis — Best Price On Levitra Canada increased resonance of the anterior and superior portions of the upper lobes, with no marked change on percussion elsewhere ; and, in addi- tion to others, the fine, subcrepitant rale. The chest ex- pands pretty freely. The cough is not so violent as in tra- cheitis or tracheo-bronchitis. In the case of old people the respiration and pulse are not so rapid ; indeed, the former is sometimes, in very adynamic cases, but very moderately accelerated. The breathing in all cases has somewhat more of effort connected with it than it has in lobar pneu- monia. In another class of eases the swelling and the accumula- tion of viscid nmcus so interfere with the passage of the aerial Best Price On Levitra Canada tide that some of the bronchi are, practically, obliter- ated. The lobules to which they lead, receiving no air from without, gradually lose what they already have, either by absorption of it, or through the inequality of the expiratory and inspiratory forces, and their collapse is the result. The occurrence of this accident may be recognized by observing an increase of the dyspnoea and cyanosis, increased labor in breathing, and by the Best Price On Levitra Canada impediment to expansion of the lungs. As Best Price On Levitra Canada the bony thorax expands, the intercostal spaces, particularly in the lower regions of Best Price On Levitra Canada the chest, sink in, and the contraction of the diaphragm draws inward the lower costal cartilages, the ensiform appendix, and the epigas- trium. If the collapsed areas are extensive, a dampening of the percussion resonance occurs and the vesicular nmrmur dis- appears. The auscultatory signs are obscure, and only to be recognized by one who has become familiar with them through practice. In the third class the inflammatory process extends to the alveoli, and we have the development of splenization and hepatization of the lobules. This is usually accompanied by a rise in the temperature, and, if the afEected lobules are suf- ficiently numerous and become fused into a solid mass Best Price On Levitra Canada of considerable size, dullness on percussion, bronchial breath- ing, and bronchial voice announce the fact to the diagnos- tician. When the pneumonic patches are scattered, the diagno- sis can only be made by taking note of the increased gravity of the symptoms, the rise in temperature, and an alteration of the respiratory sounds which is difficult to describe and can only be recognized by the trained ear. In fact, it is at times only possible to suspect it, without being able to make a positive diagnosis. This broncho-pneumonic inflammation is most likely to occur in association with the infectious dis- eases. This description of capillary bronchitis and its results is in accordance with the views of Professor Germain See,* and is adopted by me because of its harmony with my own ideas, founded upon clinical experience and the results of post-mortem investigation. Broncho-pneumonia in the young and middle-aged adult is of rare occurrence and less grave import. In the treatment of capillary bronchitis and broncho- pneumonia there are two important indications to be met : First, to combat the inflammatory process in the bronchial mucous membrane ; second, to sustain the heart. To combat the bronchitis, we must, in the first place, make use of counter-irritants, or revulsives, both internal and external. Internally, at the beginning of the attack a cathartic should be given, its activity to be proportioned to the vigor of the patient. The most useful of them all is calomel, in a dose sufficient to relax without actively purg- ing. The salines are out of place in this affection ; and, should we not give Best Price On Levitra Canada calomel, rhubarb and soda, or castor-oil, is the best for children, and the various warm vegetable cathartics for adults. Externally, the counter-irritation should be made with mustard, turpentine, or a stimulating liniment. Flaxseed poultices with mustard may be used, but their weight is objectionable when the breathing is very laborious. The frequent application of mild turpentine stupes is probably the best. In spite Best Price On Levitra Canada of the opinion of some distinguished writers, I can not but think that blisters are the worst form of counter-irritation. If small, they do very little good, while, if large, they inflict an Best Price On Levitra Canada unnecessary amount of suffering upon the patient, and tend to increase ' Des maladies sp6cifiques non-tuberculeuses du poumon," Paris, July 24, 1886.] WESTB'kOOK: DIAGNOSIS AND TREATMENT OF DISEASES OF THE CHEST. 89 the depression of the vital powers. With infants they should, in my opinion, never be used. The patient should be kept in a well-ventilated apart- ment, in a moist atmosphere, and not too warm. It is a frequent practice to maintain the temperature of the room in which a child with capillary bronchitis lies at 80° to 90° F., or even higher. / believe that no good can be accom- plished by this, and am confident that I have seen it do great damage. In febrile diseases generally, it is unwise to