believed that I had to deal with an ulcerated epithelioma. I ex- pressed this belief to the physician in charge, who agreed with me both in the prognosis and as to the treatment. Neverthe- less, mistrusting the information supplied by our friend, and wishing to find something to modify our judgment as to the na- ture of the disease, in which we could not thoroughly discover some of the symptoms of epithelioma, we resolved to apply an anti-syphilitic medication, watching its effects most carefully. Immediately after, on consultation. Dr. Pizarro commenced to take Gibert's " syrupus deuto-iodureti hydrargyri," at the same time gargling frequently with a solution of potassium chlorate. This medication produced such very prompt and bad results that it became necessary to suspend it immediately and to substitute compounds of iron, bitter tonics, and such restorative diet as the want of digestive strength and the difliculty in swallowing solid food would allow. When the organism became somewhat re- stored the specific treatment for syphilis was resumed ; but the lesion at the palate extended so very much and took on so bad an aspect in a few days that we were compelled to give up the specific treatment, and thus we became more positive than at first in the idea we had formed of the disease. The physician in immediate attendance upon Dr. Pizarro had to leave the city at this time, and I was then compelled to take entire charge of the patient. As it astonished me to find that this great ulcer did not produce lancinating pain, that it never bled, and that it never acquired a greater hardness now and then I had some doubts on the subject, although I remained under the impression of luiving to deal with an epithelioma. From the moment I took charge of the patient I prescribed a potion con- taining sodium arseniate, to be taken in gradually progressive doses; gargles with a solution of resorcin ; and powdered iodo- form, to be applied to the ulcer after having it washed with a solution of borax. For a month the ulcer continued to extend in periphery and in depth until it had destroyed more than one half of the uvula, a great part of the soft palate, and the amyg- daliB, as well as a portion of the pharynx. When I had lost all hope, the ulcer suddenly stopped its progress, and became covered by healthy-looking granulations of good consistence ; cicatrization commenced to take place, and was finally completed in three months, some irregular scars re- maining, depressed in some places, prominent in others, partly discolored at intervals, red at others, soft here and hard there, the posterior being adherent to the pharyngeal wall. The lin- gual psoriasis still kept on. Deglutition became norma! again, and my patient's restoration to health took place in a short period. It is now more than a year and a half since the oc- currences narrated, and Dr. Pizarro's cure still holds good. Reflectina; upon all these facts, I became aware that my friend's disease had been a lupus, whose evolution I had witnessed without suspecting it even a single moment. But, as there is nothing to occupy the mind Levitra 10 Mg Orodispersible Tablets of a practitioner more important than an error of diagnosis, I have availed my.self ever Levitra 10 Mg Orodispersible Tablets since of all the opportimities presenting to de- termine with the greatest possible accuracy those characters which made me doubt about the epitlieliomatous nature of Dr. Pizarro's illness. I am now Levitra 10 Mg Orodispersible Tablets going to state, in the short- est possible way, what my obsenations and experience have taught me about lupus of the throat. This disease makes its appearance at any pei'iod of life ; as I have seen it in adults oftener than in children, I can not agree with Hebra in its Levitra 10 Mg Orodispersible Tablets being a disease peculiar to childhood. I have observed it oftener in Levitra 10 Mg Orodispersible Tablets men than in women, and, although it is to be met with in every constitu- tion, the greatest number of those attacked who have come under my care were of a lymphatic temperament.. A good many of them had sufEered from scrofula, others from syphilis, a few from herpes, and some of them, like Dr. Levitra 10 Mg Orodispersible Tablets Pizarro, had been and were still subject to rheumatic mani- festations. E.xception made of the diathetic states just mentioned, I have been unable to ascertain anything with regard to its inheritance. If the men whom I have treated were smokers, I do not dare to attribute to tobacco any part in the causation of the disease, as there are but very few men in Spain who do not smoke. Neither have I found that hard drinkers were more liable to suffer from lupus, as I have seen very many cases in persons who would not even drink a small quantity of Levitra 10 Mg Orodispersible Tablets wine at table. I have never been able to discover that great efforts of voice, ha- bitual exposure to an atmosphere overloaded with irritating substances, cauterization of the mucous membrane of the throat, the influence of heat or cold, or any local agencies whatever, are to be considered as especially prone to pro- duce this disease. Levitra 10 Mg Orodispersible Tablets I have never had the opportunity of observing the ini- tial manifestations of lupus in the throat, but I have been able to detect the first steps in the invasion of the sound places attacked by the lupus later in the disease. Sometimes the mucous membrane assumes a purplish color, swells up, and becomes granular, aud one or two of the granulations develop so much as to reach the size of a pea, or even that of a hazelnut. .Occasionally the tubercles Levitra 10 Mg Orodispersible Tablets be- come prominent in the throat previous to alteration in the mucous membrane, and without differing from its normal color. They may either remain superficial, as if they were hypertrophic papillte, or they may attack all the mucous tissues, and even penetrate down to the submucous connec- tive tissue. Their form is rounded, the tubercle being either hemispherical, oval, flat, or conical. Their surface is smooth and brilliant, but, Levitra 10 Mg Orodispersible Tablets if several of them become intimately united, they appear as a single mass, rounded, cloven, and anfractuous. The lupous tubercle can be distinguished by its very red color from the leprous tubercle, which is opaque and of a turbid white. It is very seldom that a single tumor is observed in hipus, as is the case in car- cinoma. Generally there are several of them, either scattered or grouped, but always quite distinct. I have seen them si- multaneously in the wall and in the wing of the nose, in the tongue, in the palate, and in the ventricular bands. On pressing Levitra 10 Mg Orodispersible Tablets them they present a sort of elastic resistance. July 10. iSKti.i DE LA bOTA Y LASTUA: THE STUDY OF LUfUS OF TEE THROAT. 37 which can be better felt than explained. This hardness is greater than that of inflammatory infiltrations, but it never reaches the consistence of the epitheliomatous tumor. Those parts on which the tubercles develop become rigid, for which reason their natural movements are sluggish, re- strained, or entirely lost. Therefore the tongue can not eouduet the food for its convenient mastication ; the palate does not succeed in closing the uaso-pharyngeal space dur- ing deglutition, nor does it assume a proper position for articulation ; the epiglottis allows the food to get into the larynx, and the vocal Levitra 10 Mg Orodispersible Tablets cords do not vibrate sufficiently.