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39 while," and in one there was said to be slight mental con- fusion afterward. In six cases it is stated that the patients were personally free from other evidences of nervous disease, and in four there were such evidences. In Krishaber's case the first loss of consciousness occurred from sudden emotion, and was not preceded by cough. Subsequent attacks, even though caused by emotion, were preceded by cough. In McBride's case there was a Levitra Cost Increase tendency to spasm, exaggerated tendon reflex, ankle clonus, spasmodic action of palate mus- cles, and stricture of the gullet. Gray's patient had been subject, seventeen years before, after a scalp-wound by a bullet, to losses of consciousness like the present, but with- out cough, which continued for two months. Russell's pa- tient was stated to be of a decidedly nervous constitution. In regard to other evidence of disease, five patients are stated to have had chronic bronchitis, three to have had simply a cough, two had gout or rheumatism, one had syphilis, one had diabetes, and one probably had catarrhal pneumonia. In none of the attacks was there any biting of the tongue, frothing at the mouth, or involuntary micturition. Local examination showed hypersBmia of the larynx in six cases, granular pharynx in four, and was negative in two cases. The record shows that in seven cases treatment relieved the patient, temporarily at least, of the symptoms under dis- cussion. The most common forms of treatment were by as- tringents to the pharynx, counter-irritation over the larynx, and the administration of bromides internally. Levitra Cost Increase I have announced the subject of my paper as " Laryngeal Vertigo" because Charcot has called attention to his cases Tinder this name, and because, while I believe it to be an entirely erroneous designation, other names which have Levitra Cost Increase been proposed are also open to the objection that the nature of the affection is unwarrantably assumed by Levitra Cost Increase using them. Krishaber reports his case, for instance, under the title " Spasm of the Glottis in the Adult." Gray desig- nates the affection " Laryngeal Epilepsy," while McBride strengthens Krishaber's definition by calling it " Complete Spasm of the Glottis in the Adult." Now, in the Levitra Cost Increase first place, it is necessary for us to consider if there is evidence Levitra Cost Increase in the cases reported of what can properly be called vertigo. I think not. If any one of my hearers has seen, or had described, Levitra Cost Increase or will get a pa- tient with aural vertigo to describe an attack to him, I believe he will agree with me. Let us see what the usual train of symptoms in Meniere's disease is. First a tinnitus aurium, then the surrounding objects begin to revolve round and round, or over and over, or the patient feels as if going round himself; he reels if walking, Levitra Cost Increase and finally may fall, but seldom becomes unconscious, and ends with an attack of nausea and vomiting. A reflex aural vertigo presents much the same course, only tinnitus aurium is not so commonly Levitra Cost Increase a precursor. I think, from a comparison of this statement with the history Levitra Cost Increase of our cases, it will be evident that they do not present what can properly be called a \?ertigo, but simply a giddiness, or, as it is sometimes called, a lightness of the head, a mild degree of which nearly every one has felt after coughing or making prolonged expiratory efiort of any kind. If it were a real vertigo, a serious disturbance of equilibration, an easy explanation of its occurrence would be to place it in the same category as the stomachic vertigo ; in fact, an aural reflex, brought about by the connection of the pneumogastric with the labyrinth through the sympa- thetic. Let us consider for a moment now the question of epi- lepsy. It is evident that none of the cases presented the severe form of this disease. There was no biting of the tongue, no frothing at the mouth, no involuntary micturi- tion, and no mental impairment afterward. May we class the attack, as Gray would have us, as one of " le petit mal " ? If, as Gray suggests, we use the term epilepsy in its more catholic sense (as Hughlings Jackson employs it) when speaking of all sudden actions of nerve- cells, then we could not exclude from this category any case of temporary loss of consciousness, no matter what in- termediate mechanism there might be, and sucli decidedly neurotic cases as Gray's and Krishaber's might well be here placed. It will be remembered that Gray's patient had similar attacks, years before, after a scalp wound, and that Krishaber's patient had his first attack of loss of Levitra Cost Increase conscious- ness after sudden emotion, without any previous cough. The fact of loss of consciousness, however, does not compel us to consider a case epileptic, for asphyxia and syn- cope may produce temporary unconsciousness. Neither does the fact that there were convulsive movements of limbs in three cases make them epileptic, for convulsions are by no means rare in the Levitra Cost Increase laryngismus and whooping-cough of children. There is no doubt about the possibility of the production of " Levitra Cost Increase reflex epilepsy " by a pediculated jjolyp in the larynx, as shown by Sommerbrodt's case.* This pa- tient had, without doubt, genuine epileptic attacks with all the characteristic .symptoms and results, which disappeared at once after the removal of the polyp. The same patient, fifteen years before, had a short Levitra Cost Increase series of epileptic attacks, which were Levitra Cost Increase attributed to a cicatrix in the dorsal surface of the right hand, and which disappeared after the excision of the cicatrix. Other similar cases are well known. The question for Levitra Cost Increase us, however, is whether such an ex- planation is necessary for cases of Levitra Cost Increase loss of consciousness fol- lowing cough. While I do not deny that mild epilejitic attacks may originate from slight sources of irritation in the larynx, it seems to me that we have more reasonable ex- planation in other ways. Our profession has long been familiar with loss of con- sciousness in sudden spasm of the glottis, notably in cases of foreign body in the larynx, but also in children with laryngismus and whooping-cough. Let us, then, look at the possible mechanism of dizziness and loss of consciousness through the agency of spasm of the glottis. Proof of the occurrence of spasm of the glottis, however, is given in but few of our cases. The best presen- tation of this theory has been given by McBride. McBride assumes that in Levitra Cost Increase every case the attack was " ])re- ceded by a short cough, or, in other words, by a series of "Berl. kliu. Woch.," September 25, 1876.