How does asthma differ from whooping-cough?

Whooping-cough is a disease of children; asthma, a disease of adults. The characteristic whoop of pertussis is wanting in asthma. An attack of whooping-cough does not last more than a couple of months, at most; asthma may continue indefinitely. What are the points of differentiation between asthma and paralysis of the diaphragm?

The dyspnea resulting from paralysis of the diaphragm is not paroxysmal, as is that of asthma. Paralysis of the diaphragm is not characterized by an absence of the breath-sounds, followed by wheezing and high-pitched râles. When the diaphragm is paralyzed, inspiration is attended with expansion of the chest and depression of the abdominal wall; in expiration the chest collapses and the abdominal wall is elevated; stimulation of the phrenic nerves restores the normal harmony of action; attempts at bearing down are futile or ineffective.

THE DIGESTIVE SYSTEM-THE MOUTH,

Catarrhal Stomatitis.

What are the clinical characteristics of catarrhal stomatitis? Catarrhal inflammation of the mucous membrane of the mouth may result from the ingestion of irritating substances, from the presence of carious teeth, or by extension from adjacent disease; it may also develop in conjunction with morbid dentition, or derangement of digestion, or in the course of the exanthemata. It manifests itself by redness, tumidity, and increased heat of the structures within the mouth, and by increased secretion. The taking of food is attended with discomfort or with pain; taste is impaired ; and the breath is offensive. As a rule, there is little or no constitutional disturbance.

Aphthous Stomatitis.

What are the clinical features of aphthous stomatitis?

In individuals exposed to unfavorable hygienic conditions, and in those debilitated by disease, small discrete or confluent,

grayish or whitish masses of degenerated epithelium accumulate at various parts of the mucous membrane of the mouth; the desquamation of the masses exposes subjacent ulceration. Mastication in adults and nursing in infants are difficult and painful; the secretions of the mouth are increased; the appetite may be impaired; digestion may be deranged; and there may be diarrhea.

Thrush.

What are the clinical manifestations of thrush?

Thrush, muguet or parasitic stomatitis is a mycotic inflammation of the mucous membrane of the mouth and throat, to which children are especially prone. It is dependent upon the presence of a fungus, termed the mycoderma (or oïdium) albicans. An acid reaction of the secretions of the mouth is an essential condition for the development of the affection. The growth of the fungus and the resulting irritation give rise to the formation of minute curd-like masses upon various parts of the mucous membrane. Forcible detachment of the masses occasions bleeding. The symptoms are those of the ordinary form of stomatitis, plus the flaky deposits containing the characteristic fungus. There may also be diarrhea and a varying degree of constitutional disturbance. In nurslings, the inability to suckle may result in inanition and death.

Ulcerative Stomatitis.

What are the symptoms of ulcerative stomatitis?

Ulcerative stomatitis is an aggravated form of inflammation of the mouth, attended with ulceration, which it is stated is usually unilateral. The affection arises amid conditions of crowding and filth, and in those supplied with insufficient and inappropriate food; it may also be a sequel of other forms of stomatitis, of caries of the teeth, or of the maxillary bones. It is manifested by impaired appetite, fetid breath, increased salivation, pain in eating, and constitutional symptoms of varying intensity. Sometimes adjacent lymphatic glands undergo enlargement.

Mercurial Stomatitis.

What are the clinical manifestations of mercurial stomatitis? Stomatitis sometimes results from the medicinal ingestion of large quantities of mercury, or of small quantities by persons possessing an idiosyncrasy, or as a manifestation of mercurial intoxication by means of articles of food or drink, or from exposure to the metal in certain occupations. The symptoms vary greatly in severity. The gums especially become swollen, reddened, tender, and sometimes ulcerated. The teeth may fall out, and the maxillary bones become carious. The breath is fetid. The saliva contains mercury; its secretion and discharge are inordinately increased, giving rise to the term "salivation,” as descriptive of the affection.

Gangrenous Stomatitis-Noma.

What are the clinical features of gangrenous stomatitis? Gangrenous stomatitis, noma or cancrum oris is essentially an affection of childhood, rare, and almost invariably fatal, which develops in those of depraved constitution, often at the termination of one of the exanthemata, particularly measles. The disorder is manifested by a brawny induration of one cheek, the structures of which undergo disintegration, with resulting ulceration of the mucous and cutaneous surfaces, and, not rarely, perforation. Adjacent portions of the gums may by contiguity become involved in the process. The teeth may fall out and the maxillary bones become carious. The early symptoms may be obscured by those of the antecedent condition. Soon, however, the breath becomes fetid, and, in addition to the local manifestations, the symptoms of septic intoxication may appear, in the midst of which the child may die. Recovery may take place, with hideous deformity of the face. Pneumonia, pulmonary gangrene, and entero-colitis may be compli

cations.

THE TONGUE.

Glossitis.

What are the symptoms of glossitis?

When the tongue is inflamed, from whatever cause, the organ becomes enlarged, tumid, reddened, painful; speech, deglutition and mastication, sometimes respiration, are interfered with, and the secretions of the mouth are increased. The swelling may be so great that suffocation results, unless relief be given by incision. Glossitis may be superficial or parenchymatous, acute or chronic; the intensity and character of the symptoms being modified accordingly. It may be due to erysipelas, either primarily or secondarily. Epidemics of erysipelatous glossitis have occurred, and the name "black tongue" has been applied to this affection. Parenchymatous glossitis sometimes proceeds to suppuration.

Leukoplakia Lingualis.

What is leukoplakia of the tongue ?

Leukoplakia lingualis, or leukoplakia buccalis, is a name applied to a peculiar chronic affection of the tongue or of the tongue and buccal mucous membrane, characterized by the formation of persistent, horny, whitish patches upon the surface, sometimes extending entirely through the epithelial layer. Untreated, it is said to lead at times to the development of carcinoma. Sometimes it appears to be related with gout.

What is glossanthrax?

Glossanthrax.

Glossanthrax is a term applied to the localization of malignant pustule upon the tongue. It is to be differentiated from carcinoma, tuberculosis, syphilis and other affections leading to suppuration or ulceration. The local and constitutional symp

toms are those of anthrax in general. The appearance of the eschar is characteristic and the presence of anthrax-bacilli is diagnostic.

What is nigrities?

Nigrities.

Nigrities, also called black tongue and hairy tongue, is an affection of the filiform papillæ of the tongue, supposed to be due to the irritation of a special fungus. The papillæ in various situations become discolored, thickened, and elongated, giving the appearance of a scattered or compact hairy growth upon the dorsum of the tongue. Desquamation takes place, after which the tongue may remain comparatively clean for a longer or shorter period; then the growth recurs. The affection is to be differentiated from staining of the tongue by tobacco, medicines, and the like.

MUMPS-PAROTIDITIS.

What are the symptoms of parotiditis?

Parotiditis or mumps may be primary or secondary in the course of infectious diseases. It is characterized by pain at the angle of the jaw, followed by tumefaction of the parotid gland, at first on one side and then on the other. Movement of the jaw, as in mastication, is difficult and painful. Deglutition is not interfered with; hearing may be deranged. The secretion of saliva is usually excessive. There are febrile manifestations

of moderate severity.

Orchitis or ovaritis is a peculiar complication of parotiditis. It is likely to occur as the parotid swelling subsides.

THE PHARYNX.

Pharyngitis.

What are the symptoms of pharyngitis?

In acute catarrhal pharyngitis, or angina, the symptoms vary with the intensity and extent of involvement. Ordinarily, there