a household in a way which strongly suggests that it possesses contagious properties when once developed. An attack of sneezing is one of the first symptoms, but this may be preceded by a feeling of indisposition, with chilliness, headache, dryness of the throat, and loss of appetite.

The sneezing is soon followed by the discharge of clear mucus from the nose, which requires the frequent use of the pocket-handkerchief; and there is a feeling of stuffiness in the nose, due to swelling of the mucous membrane. At the same time, the eyes are suffused and water freely, there is pain over the eyebrow from implication of the frontal sinus, the throat is sore, taste and smell are impaired, and there may be deafness from closure of the Eustachian tube. Some febrile reaction is present at the same time. If the catarrh extends to the larynx, the voice is hoarse, and there is constant irritating cough; and its further spread to the lungs will cause the symptoms described below under Bronchitis. After a few days the mucous discharge becomes thicker and more opaque, and may ultimately be quite purulent, continuing thus for a variable period, from two or three days to a week or more. During this time the patient is very liable to fresh exacerbations of the inflammation.

Treatment. In mild forms little requires to be done. Free sweating at night by means of additional blankets, a hot bath, or diaphoretic drugs, often seems to check the disease; if cough be troublesome, a few drops of ipecacuanha wine, with spirits of nitrous ether, or compound tincture of camphor will relieve. Local remedies have been much tried of late. Dr. Ferrier suggested a mixture of subnitrate of bismuth, 6 drachms, hydrochlorate of morphia, 2 grains, powdered gum acacia, 2 drachms: 2 or 3 drachms to be snuffed up in small quantities, in the course of a day. A solution of cocaine (2 to 4 per cent.) may be sprayed into the nostrils. Internally, in a pure nasal catarrh, after the first few days, tonics, such as quinine, will do good.

HAY FEVER.

(Summer Catarrh. Hay Asthma.)

This is a very severe catarrh which occurs to certain individuals, year after year, in the early part of the summer-that is, during June or July, when grasses and other plants are flowering. The symptoms may be chiefly nasal, like those just described, or chiefly bronchial, when the disorder may be called hay asthma. It is undoubtedly for the most part due to the diffusion of pollen grains in the air, and their contact with the nasal, conjunctival or bronchial mucous membrane, in persons peculiarly susceptible to this form of irritation. Such persons are more often men than women, are generally among the middle and higher classes of society, of neurotic disposition, and have their first attack before the middle period of life. According to some authors (Daly, Hack, De Havilland Hall,) there is always, in addition, a

to utter words containing the vowels i and e, which deper of the higher harmonics; such as "three," "ninety-nine ægophony may have a vertical extent of three or four in said to be limited to the upper edge of the layer of liquid. heard in front. Sometimes, also, though rarely, it is hear no liquid is present, but the condition of the tubes is modi way; thus I have known it in pneumonic consolidation, tube containing fibrin.

Auscultation of the Cough.-The patient is directe the physician auscultates the chest. Increased resonance of under the same conditions as increased resonance of the vc lung and cavity); moreover, the cough, and the forced insp it, will reveal the existence of râles that are not obvious on tion. In infants, the spontaneous cough supplies the inform resonance, which is given in adults by speaking.

AUSCULTATORY PERCUSSION.

In this process a stethoscope is placed on the chest, an percussed around it: the stethoscope detects minute differenc It is not much employed, except in the production of the be. d'airain, which occurs in pneumothorax. While the physic the stethoscope to one part of the chest presumed to be the mothorax, an assistant lays a coin on the chest, and strikes coin. The noise is resonated in the hollow cavity, and transn ringing musical note through the stethoscope.

SUCCUSSION.

In cases of hydro- or pyo-pneumothorax, shaking the patie splashing sound, due to mixture of the air and liquid contained cavity.

DISEASES OF THE NASAL PASSAGI

CORYZA.

Coryza, nasal catarrh, or "cold in the head," is so familiar that a brief description will suffice. It is a catarrhal inflamm mucous membrane of the nose, which often involves also the frontal sinuses, pharynx and Eustachian tube, and may spread and the bronchial tubes. It is most commonly the result of expo either by sitting in a draught, staying out late at night, or by and failing to change the damp clothes; but it not unfrequently

to utter words containing the vowels i and e, which depend on the presence of the higher harmonics; such as "three," "ninety-nine." As the area of ægophony may have a vertical extent of three or four inches, it cannot be said to be limited to the upper edge of the layer of liquid. It is occasionally heard in front. Sometimes, also, though rarely, it is heard distinctly when no liquid is present, but the condition of the tubes is modified in some other way; thus I have known it in pneumonic consolidation, with a bronchial tube containing fibrin.

Auscultation of the Cough.-The patient is directed to cough while the physician auscultates the chest. Increased resonance of the cough occurs under the same conditions as increased resonance of the voice (consolidated lung and cavity); moreover, the cough, and the forced inspiration preceding it, will reveal the existence of râles that are not obvious on ordinary inspiration. In infants, the spontaneous cough supplies the information as to vocal resonance, which is given in adults by speaking.

AUSCULTATORY PERCUSSION.

In this process a stethoscope is placed on the chest, and the surface is percussed around it: the stethoscope detects minute differences of resonance. It is not much employed, except in the production of the bell sound or bruit d'airain, which occurs in pneumothorax. While the physician listens with the stethoscope to one part of the chest presumed to be the subject of pneumothorax, an assistant lays a coin on the chest, and strikes it with another coin. The noise is resonated in the hollow cavity, and transmitted as a loud ringing musical note through the stethoscope.

SUCCUSSION.

In cases of hydro- or pyo-pneumothorax, shaking the patient will elicit a splashing sound, due to mixture of the air and liquid contained in the pleural cavity.

DISEASES OF THE NASAL PASSAGES.

CORYZA.

Coryza, nasal catarrh, or "cold in the head," is so familiar to every one, that a brief description will suffice. It is a catarrhal inflammation of the mucous membrane of the nose, which often involves also the conjunctivæ, frontal sinuses, pharynx and Eustachian tube, and may spread to the larynx and the bronchial tubes. It is most commonly the result of exposure to cold, either by sitting in a draught, staying out late at night, or by getting wet and failing to change the damp clothes; but it not unfrequently runs through

a household in a way which strongly suggests that it possesses contagious properties when once developed. An attack of sneezing is one of the first symptoms, but this may be preceded by a feeling of indisposition, with chilliness, headache, dryness of the throat, and loss of appetite.

The sneezing is soon followed by the discharge of clear mucus from the nose, which requires the frequent use of the pocket-handkerchief; and there is a feeling of stuffiness in the nose, due to swelling of the mucous membrane. At the same time, the eyes are suffused and water freely, there is pain over the eyebrow from implication of the frontal sinus, the throat is sore, taste and smell are impaired, and there may be deafness from closure of the Eustachian tube. Some febrile reaction is present at the same time. If the catarrh extends to the larynx, the voice is hoarse, and there is constant irritating cough; and its further spread to the lungs will cause the symptoms described below under Bronchitis. After a few days the mucous discharge becomes thicker and more opaque, and may ultimately be quite purulent, continuing thus for a variable period, from two or three days to a week or During this time the patient is very liable to fresh exacerbations of the inflammation.

Dr.

Treatment. In mild forms little requires to be done. Free sweating at night by means of additional blankets, a hot bath, or diaphoretic drugs, often seems to check the disease; if cough be troublesome, a few drops of ipecacuanha wine, with spirits of nitrous ether, or compound tincture of camphor will relieve. Local remedies have been much tried of late. Ferrier suggested a mixture of subnitrate of bismuth, 6 drachms, hydrochlorate of morphia, 2 grains, powdered gum acacia, 2 drachms: 2 or 3 drachms to be snuffed up in small quantities, in the course of a day. A solution of cocaine (2 to 4 per cent.) may be sprayed into the nostrils. Internally, in a pure nasal catarrh, after the first few days, tonics, such as quinine, will do good.

HAY FEVER.

(Summer Catarrh. Hay Asthma.)

This is a very severe catarrh which occurs to certain individuals, year after year, in the early part of the summer-that is, during June or July, when grasses and other plants are flowering. The symptoms may be chiefly nasal, like those just described, or chiefly bronchial, when the disorder may be called hay asthma. It is undoubtedly for the most part due to the diffusion of pollen grains in the air, and their contact with the nasal, conjunctival or bronchial mucous membrane, in persons peculiarly susceptible to this form of irritation. Such persons are more often men than women, are generally among the middle and higher classes of society, of neurotic disposition, and have their first attack before the middle period of life. According to some authors (Daly, Hack, De Havilland Hall,) there is always, in addition, at