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When the tubercles develop exuberantly in the larynx, Levitra Prices breathing becomes embarrassed and may become siridulous. Even apnoea may result. Contrary to what happens in car- cinoma and in leprosy, which almost always produce, the one lancinating pains, the other a more or less complete anaesthesia, there is no alteration whatever in Levitra Prices the sensitive- ness of the parts affected with lupus. After a shorter or longer period the tubercles soften and become ulcerated. This melting down does not take place in a complete man- ner. Levitra Prices In some cases only the surface of Levitra Prices the tumor becomes fissured or excavated as a margin to simple excoriations. In others the destructive process attacks Levitra Prices a greater or smaller portion of the tubercle in its entire depth, producing ulcers which dip out of sight in the midst of the tissues. In the former cases the affected mucous membrane appears de- Levitra Prices nuded, red, smooth, purple, and granular. It is painful upon palpation. It does not bleed either upon pressure or spontaneously. The cure is difficult and is always followed by indeli- ble scars. In the latter instances the ulcers appear either under the aspect of deep crevices, with raised, rounded, red, hard, and perpendicularly cut borders with a narrow and smooth bed ; or as heavy Levitra Prices losses of substance which affect all the thickness of the tissues, and whose ravages neither iiponeurosis, cartilage, nor bone can check ; their borders are prominent, congested, and elastic, and their bed is granular, uneven, bright red, sensible to pressure, never hiemorrhagic, and always covered with a sanious and puru- lent secretion. This indolence and want of ha?morrhage are never found in carcinoma, nor are they observed in tuber- culosis. In some cases the ulcers are developed in a slow but fatal manner, in others they spread with Levitra Prices astonishing rapid- ity, while in some others they stop in the beginning, but how far their ravages may reach it is impossible to predict. I have found them superficial and of the size of a lentil after having existed for a long time. I have seen them de- velop in a few days, occasioning horrible mutilations. I have observed them remain apparently perfectly Levitra Prices quiescent during months and even years, and then suddenly and with- out any perceptible cause take on such destructive activity that their ravages have been quite frightful. I have watched them progressing continuously, in spite of the greatest care, to stop short at the most unexpected moment. When the healing of an ulcer is complete there remains an irregular soar, raised in some places, depressed in others ; red in the former and white in the latter instance ; a very retractible scar, which produces great deformities. Lupous scars differ from those originating from syphilitic ulcers in that these Levitra Prices latter are white, radiated, and depressed. Sometimes there are preternatural adhesions of the arches to the posterior pharyngeal wall, of the Levitra Prices uvula to the arches, of the pillars to the back of the tongue, of the cheeks to the gums. The aryteno-epiglottic folds, the ventricular bands, and the vocal cords may unite together in a greater or less extent, pro- ducing alteration of voice or aphonia, difficulty of respira- tion, or its complete obstruction. Cicatrization always takes place slowly, stops without Levitra Prices any apparent reason, or is easily destroyed. Besides the scars there remain Levitra Prices infiltrations which deter- mine the enlargement of the part, the corresponding mu- cous membrane keeps purple, bright, granular, and dry, generally with more or less desquamation of epithelial scales without any resulting excoriations. Nevertheless, the submucosa appears uncovered occasion- ally, and some patients have come to me quite frightened at feeling the pain produced by the contact of the papillfe with some exciting substance, believing in consequence of it that there was about to be a repetition of their former suf- ferings. But, fortunately, up to the present moment I have never seen such an unpleasant result. All practitioners agree in one thing — viz., that Levitra Prices lupus in the mucous mem- branes is by far more difficult to Levitra Prices Levitra Prices heal than the same process in the skin. This I am qnite ready to acknowledge, but, without boasting about originality, I must state that in many cases I have found Levitra Prices quite efficacious the treatment Levitra Prices that I apply to that terrible disease, no matter whether the lupus resides on the external or on the internal integuments. I do not despise nor condemn, as do German writers, internal medication. I prescribe iron and cod-liver oil to scrofulous patients, mercurials and iodine compounds to syphilitic ones, arsenical preparations to the herpetic, alka- line solutions to the rheumatic, and bitter tonics and invig- orating medicines to those whose constitution has been im- paired by any previous disease, Levitra Prices by overwork, or by insuffi- ciency of nourishment. Levitra Prices It seems Levitra Prices to me that this general treatment has an active influence on the success of topical medication, from which we can not part, as through it we obtain undeniable success. When the lupus is not ulcerated I apply a caustic substance. Until a few months ago I have used the tinctura iodi, but, having obtained wonderful and rapid cures with lactic acid in the cutaneous lupus, eredens et non exedens, I have not hesitated to apply it to the mucous membrane of the nose, of the lips, of the cheeks, of the tongue, of the gullet, and even that of the larynx ; and I can assert that I have met with no other inconvenience but the natural pain, the inten- Levitra Prices sity of which has been as varied as the number of patients I have observed. In ulcerated lupus also I sometimes make applications of the lactic acid, but more frequently I wash the affected region with a solution of borax, coverino' it afterward with powdered iodoform. Levitra Prices I always prescribe gargles with a Levitra Prices so- Levitra Prices lution of resorcin (one per centum), and my patients are submitted to the strictest hygienic regime. All patients who havo submitted themselves to this Levitra Prices treatment have recovered in a longer or shorter period ; but 38 KNWET: "LARYNGEAL VERTIGO: [N. T. Mbjd. Joi K., I must confess my belief that, in some instances, the cure has been realized rather in the natural evolution of the dis- ease than by virtue of therapeutic measures. " LAEYNGEAL VEETIGO." * Bt FREDERICK I. KNIGHT, M. D.,