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ment. Now, this affection of the tonsils would not come under the heading, properly speaking, Lamictal Online of the subject of our discussion were it not accompanied almost invariably with an extension of inflammation to the upper air-tract in one or other or both directions. Frequently the nasal passages become more or less occluded from swelling and infiltration of the turbinated bodies and the mucous membrane lining * Read before the American Laryngological Association at its tenth annual congress. the miHo-phurynx. Accompanying this condition there in a nasal intonation of voice, and when tlu' tongue is deprcHsed to look at the throat a miissof thick while or yellowish mu- cus tills up the inleivjil l(ct\vicii the pharyngeal wall and the Purchase Lamictal Online margin of the soft palate. inime«liately an effort of hawk- ing takes place, sOrder Lamictal Online down the pharyngeal wall some of it is prone to enter the larynx and produce a slight monjentary sensation of suffo- cation or fre()uent harsh cough, until it is expelled Order Lamictal by an effort of expectoration. Whenever, as will also occur, these attacks are accompanied by considerable hoarseness, it Cheap Lamictal is the generally received impression that the child Lamictal Rashes has in some unexplained manner taken cold. Now, although I believe that a not dissimilar state may occasionally occur from " catching cold," yet I am of the opinion that the digestive organs, and particularly the stomach, are, as a rule, directly responsible for these effects, always admitting that a check of perspiration, or sitting in a draught, or getting a wetting, may in a sensitive child produce acute indigestion, even though there has been no evident error in diet. To strengthen my interpretation of the cases referred to, I would lay emphasis on the fact that the best medication of a similar condition is active purgation and low diet for several days. Local medication of the nose, fauces, phar- ynx, or larynx is of far less importance. Having considered the effects of acute dyspepsia in children, 1 would direct your attention to chronic digestive disturbances. To locate precisely in small children the seat of their suffering is frequently difficult. This statement is nowhere truer than of the stomach and bowels. There are some children, frequently sons or daughters of poor parents, not rarely of well-to-do people, who have coated, flabby, indented tongues ; habitual Lamictal Mg foul breath ; yellowish conjunc- tivae ; thick, sallow-looking skin of face ; small or capricious appetite ; distended abdomen ; confined or loose bowels. These same children are constantly having vomiting at- tacks, stomachal or abdominal pains, and Buy Cheap Lamictal are ordinarily list- less, peevish, fretful, and ill disposed to play or be amused. Here, then, is a clear picture of dyspepsia, which might, of course, readily be enlarged or elaborated. How frequently in just such cases do we hear parents state that their child is unable to rest at night because it can Lamictal Discontinuation not breathe through its nose ; that, even when it goes finally to sleep, it is rest- less and uncomfortable, and awakens with a start, frightened and crying out ! Such children are liable to croupy attacks, in which hoarseness and spasmodic dyspnoea are very pro- nounced. Now, if we examine the nose and throat, we are apt to find some of the following conditions : lu the nose the turbinated bodies are swollen and pale-looking, Lamotrigine Lamictal and fre- quently on one or both sides almost touch the nasal Buy Lamictal Online septum in more or less extensive areas ; often, indeed, there is no in- terval between these organs. The post-nasal space habitu- ally contains a quantity of thick mucus, which the child can not detach by its own effort, but which spontaneously dis- lodges itself from Buy Lamictal Lamictal Use time to time, and which, when Lamictal Xr it reaches the lower pharynx, is usually swallowed, thus helping much April 20, 1889. ROBINSON: DYSPEPSIA. 425 to increase the dyspepsia which already exists. The pharynx, fauces, palate, tonsils, and larynx are all more or less pale- looking and relaxed. The uvnla is apt to be elongated and somewhat infiltrated. The tonsils are sometimes considera- bly enlarged, but not in the majority of instances. Cough is a very frequent symptom. Occasionally it is a distressing, paroxysmal cough, caused by local irritation of the larynx from the presence of mucus, or by nerve irritation, or as a reflex from the elongated uvula tickling the base of the tongue or epiglottis. When Purchase Lamictal we Rash Lamictal inquire into the efficient causation of such a condition, we Generic Lamictal are obliged to confess that great ignorance of or inattention to the most ordinary diet- ary requirements is Lamictal Lamotrigine the source from which so mucli trouble arises. It is interesting to observe in this connection how absolutely regardless many people are as to whether a child's bowels are moved every day regularly, Lamictal Buy as to the amount of sugar, or butter, or rich sauce a child may get at separate meals or at odd intervals during the twenty-four hours. And yet the great importance of proper care in these respects can not be a matter of reasonable doubt to any one who has closely observed the effects of the simplest remedial measures in restoring perfect equilibrium to the

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