onds tepid water is applied to the spot and an antiseptic dressing applied. The scab separates without suppuration and leaves no cicatrix.

To the objection that the influence of vaccination may have been diminished by the treatment, he says "One might as well contend that small-pox treated as it has been by me in the same way, was no longer small-pox, but some milder and less protective malady."

One objection to this treatment is that there is no cicatrix and consequently no evidence of vaccination.

I might say more upon this topic, but as I have some cases of vaccination by puncture to show you, I will only add that if I have taken up too much of your time in the discussion of what you may regard as a thread-bare subject, I trust you will pardon the intrusion.

DISCUSSION.

DR. EDWARDS:-I want to mention one case that did not take. The case was a nurse 22 years of age-never had been successfully vaccinated. He had been with the disease three months at a time, been vaccinated many times, but not successfully. I remember one time he took pus from a

from a patient suffering from... trouble. He did not take it. I find that patients who have not been vaccinated have much more severe attacks of the disease than others. I recall one case, a young man who had been vaccinated six different times. His mother had varioloid mildly. He took down with the disease in twelve days-during this time I vaccinated him twice, but neither time successfully. He took confluent smallpox and died of the disease.

Another family, where there was one case and three people present-none of them vaccinated. One patient had confluent small-pox. After sending a nurse in, three days later, I found there was one young lady not vaccinated. She allowed me to vaccinate her, although I had some trouble in doing so. She took the disease in twelve days, confluent small-pox, and died of septic trouble. Her mother died in three days from the disease-she had not been vaccinated.

Dr. Faulds said they had been vaccinated sixty days previous to this; this is, however, a mistake. The patient was two

months old when vaccinated, and had varioloid and recovered. This one person who was referred to by the essayist as being one of sixteen people present, and all were vaccinated and took down with the disease in different forms-he was a man 45 years of age, vaccinated in childhood, and later in life thirteen years previous to being quarantined, his wife died and two children died in the same house.

I think that where Dr. Faulds speaks of re-vaccination every two weeks, it is necessary, where we find a case of smallpox and those present have come in contact with the patient, it is necessary to take some other method. Dr. T.—.......... has offered a method of vaccination and re-vaccination in three days. If the first takes, the second one will only take in the same way and the wound is of not much consequence.

Dr. Welsh's cases in the patients admitted to the Hospital. None were admitted who had been vaccinated ten years previous.

DR. WEAVER :-I remember when a child, going to the farmhouse where a physician came eight or ten miles to vaccinate all the children in the community. I have vaccinated myself many times since, always without any results. I have attended about thirty cases of small-pox, in 1881 and 1882, but never had any fear of it, and I think I am perfectly immune.

DR. F. L. MCKEE-I think the subject has been very thoroughly covered. I wish to correct the statement of Dr. Faulds, in reference to my case. I had been vaccinated when three months of age-my father was then treating small-pox. At the Small-pox Hospital in Plymouth, I vaccinated and revaccinated myself nine times last winter. I had broken out with varioloid, but not (with) inoculation. was in the Mrs. Davies, who had diabetes.

The

NASAL OBSTRUCTION.

BY DR. EDWARD R. RODERICK, WILKES-BARRE, PA.

READ MARCH 4, 1903.

By first reminding you of the work the normal nose was intended to do, I desire to call your attention to the various conditions that arise from a nose that is not normal. A normal nose has free passages, and healthy mucous membrane lining it. To filter, warm and moisten the inspired air and to be used as an organ of smell is the original purpose. As nasal obstruction in itself is not usually a dangerous condition, but rather a most uncomfortable and unhealthy one, it does not receive much attention from either the victims or their family doctors. The reason for this neglect is, that most cases of obstruction have their start in infancy, and keep on increasing until finally we have more or less constant obstruction of one or both nostrils. Never having experienced the comfort of breathing through the nose without any special effort they keep on blowing and picking the abused nose until they have the good fortune to fall in the hands of a competent rhinologist.

The diseases, pathological and anatomical changes due to nasal obstruction demand that a more careful consideration be given it as one of the underlying causes of the conditions I shall mention. The family physician should impress on parents the importance of keeping their children's nasal passages in a healthy, clean condition. In nasal breathing the hairs at the anterior openings act as a filter and keep out many germs. that otherwise would land directly in the pharynx and larynx.

In looking over your cases you will find that mouth breathers are the persons that make a doctor's practice grow. They are predisposed to pneumonia, bronchitis, croup, tonsilitis, with resulting large tonsils, ear-ache, and running ears, and laryngeal diphtheria, which is more serious than nasal diphtheria. The changes in the facial anatomy resulting from a constant obstruction from childhood up, consists of a narrowing of the anterior nares due to collapse of the alae of the nose, from

non-use or excessive force in inspiration. The eyes are heavy, dull and watery and the voice is thick and muffled.

Beginning at infancy the most frequent causes of nasal obstruction are adenoids hanging in front of the posterior nares, purulent catarrh and foreign bodies. Removing the adenoids, extracting the foreign bodies and cleansing the nose as often as necessary prevents much future trouble as time advances. We have enlarged turbinates, spurs, and deflections of the septum, polypi, single and multiple. We have also an interchangeable obstruction, which is due to the blood rushing into the dilated vessels on the side that happens to be the lowest at the time. Another cause is the drying of the discharge from the diseased membrane, which form crusts. The conditions caused by an enlarged inferior turbinate are, inability to breathe freely through, occlusion of tear duct from swelling of anterior end and congestion of the Eustachian tube from swelling of the posterior end of this turbinate. The inferior turbinate is reduced in size by cauterization with either acid or electric cautery. The middle turbinate becomes the most distended and enlarged of the turbinate bones. It very seldom shows a true hypertrophy but rather is the receptacle for the secretion of the ethmoid cells, of which it is a combination. In the enlarged soggy middle turbinate bone we find the hidden cause of many chronic troubles. It blocks the openings of the frontal sinus and antrum of Highmore, resulting in severe neuralgias on account of the distension caused by the retained secretions. It also prevents free access to these cavities, necessary in their treatment. The enlarged middle turbinate, on account of the pressure on the septum and walls of the nose, causes neuralgia to run to the tip. It also causes the nose to widen over the bridge. People with large middle turbinate complain of dizziness, loss of memory, head noises, dull headache and lack of concentration. These conditions are supposed to result from lack of ventilation of the brain, due to the air being prevented from reaching the cribiform openings. The middle turbinate is reduced by cutting off part of the end allowing the cells to empty their contents and contract.

A turbinate undergoing polypoid degeneration is productive of polypi. The large single polypi cause more discomfort than the grape-like multiple variety. A large polypi, with a large pedicle acts as a valve in expiration or in blowing the nose. I have had three cases of single large polypi, which were too large to be drawn forward through the nose, but had to be pushed back in the mouth. Snaring polyps, without cutting away the base merely leaves a place for a new crop in the future.

Large spurs are the sources of many nose bleeds and also of reflex conditions, such as Asthma. A deflected septum was generally supposed to be the result of a blow or fall, but it has been shown to result also from the septum growing larger than the rest of the nose, so was compelled to shorten itself by bending in some direction. Deflections are corrected by cutting, filing or crushing the cartilage to get rid of its elasticity and by means of plugs or splints keep the parts in a straight position until firmly united.

In conclusion let me say that you cannot find better satisfied patients than those that have their nasal obstruction relieved and also because, when thoroughly performed it is as permanent a result as is generally found in medicine.

CASE REPORTED

BY DR. G. T. MATLACK, WILKES-BARRE, PA.

READ MARCH 4, 1903.

The case which I wish to report is one of typhoid fever, accompanied with a profuse general eruption which appeared over the entire surface of the body. The infrequency of such profuse eruption in this disease and the question that might arise as to a differental diagnosis, makes the case sufficiently interesting to report.

Miss J. W., age 20, was admitted to the Wilkes-Barre City Hospital, February 15, 1903, with the following history of the present disease. Patient has been living in Ithaca, New