On

pallid, with a weak pulse, and very exhausted. removal to the sick bay, I noticed a discoloration of the trousers about the thighs; and, on examination, detected bleeding from the penis. On retracting the prepuce, a jet of red blood spurted out. Calling in the assistance of my chief, we succeeded in stopping the hemorrhage by pressure and styptics, but, as may be imagined, not without some trouble. It transpired that the poor fellow, an Irishman, of a low mental type, had a chancre. He thought to get rid of it by incision; and, in doing so, wounded the dorsalis penis artery. The pocket-knife with which he cut himself was in his pocket, one blade having a smear of blood on it. Had a little longer time elapsed before he was noticed, death would have ensued, perhaps leading to various surmises; and, as he was disliked by his mates, this might possibly have caused unjust suspicions against one or other

of them."

THE USES OF NITRATE OF SILVER.-Dr. Chas. K. Mills, speaking of nitrate of silver (Philadelphia Medical Times), said that in nervous disorders he had found it one of the most useful remedies. In posterior spinal sclerosis, it ranked next to iodide of potassium. In chorea he had given it also with apparent success; and sometimes it seemed to be of use in sclerosis of the lateral columns. In epilepsy it was not so good as the bromides, or as the zinc salts with belladonna.

GOITRE IN THE LOWER ANIMALS.-Goitre is not an affection peculiar to man alone (Cincinnati Lancet and Clinic). M. Adam, veterinary surgeon at Augsburg, has remarked that after staying a certain length of time in that city a number of horses were attacked with goitre. There are only a certain number of stables where goitre shows itself, all situated at the east of the city. It is impossible to determine the cause of it. Goitre is not rare with the dogs of Augsburg, and is unusually frequent with the inhabitant of that city. The disease does not prevail in Switzerland, however.

EPIDEMIC OF WHOOPING-COUGH IN LONDON.-TOward the close of 1881 whooping-cough became epidemic in London, and it has since been very prevalent and fatal there. During the first thirteen weeks of this year there were 2,224 deaths from this disease, which is about three times the usual rate.

DISINFECTION BY BROMINE.-Dr. Wernick is said to have made the use of this powerful disinfectant practicable by employing a patent siliceous sponge, invented by Dr. Frank, and which is saturated with the bromine. A piece of this sponge left for a few hours in a closed room will completely disinfect it.

A NEW TREATMENT FOR PRURITUS.-Dr. H. K. Steele, of Denver, Col., sends to the Cincinnati Lancet and Clinic a description of a new method of treating pruritus of vulva or anus: "The remedy is quinia sulphate, rubbed up with only sufficient lard to hold it together. The nearer you get the full strength of the quinia the more efficacious it will prove. Apply freely and thoroughly. It has proven a specific in my hands."

A NEW WAY TO PUT OFF OLD AGE.-Dr. William Schmöle, Professor of Pathology in Bonn, has written an ingenious work, entitled, "Wissenschaftliche Künste zur Verlängerung und Verschönerung des menschlichen Lebens," or "Scientific Method of Prolonging and Making Comfortable Human Life." He bases his method upon the hypothesis, that the

condition known as old age is produced by a misproportion between the organic framework and inorganic constituents of the human body. In order to prevent this condition and preserve the elasticity of youth, it is only necessary to introduce some substance which will dissolve the excess of mineral matter and allow of its absorption and excretion. Such substances are the inorganic acids, and chief among these, citric acid, the next in value being lactic acid. Citric acid is best taken in the form of lemon-juice, and it is recommended that a person swallow the juice of from two to eight lemons daily, year in and year out! Such a practice also secures one against the attacks of rheumatism, which afflict old age. It also prevents the degeneration of the arteries and the calcifications of the vascular systems. Our speculative author also avers that many of the fevers and inflammatory diseases of old age are due to reflex and sympathetic processes. He states that a treatment which benumbs these reflexes will tend to ward off such complications. For this purpose he advises small and frequently repeated doses of acetate of morphia. The number of cases illustrating the effects of this scientific elixir vitæ are small. One person, who fed himself on lemons as directed, died at the age of 110, and then his death was an unnatural one.

GERMAN MEDICAL PROFESSORSHIPS.-In place of the late Professor Duchek, who held the Chair of Internal Medicine in Vienna, either Professor Erb or Professor Nothnagel will be called. In Professor Klebs' place, at Prague, Professor Eppinger, his assistant, is to be nominated.

THE NUMBER OF STUDENTS AT THE VIENNA UNIVERSITY during the past semester was 4,823. Of these, 1,412 were medical students, being double the number present four years ago.

MORTALITY FROM EXCISION OF THE THYROID.-In a review of the subject of extirpation of the thyroid for goitre and other troubles, Kocher (CorrespondenzBlatt) gives the following statistics: Among 193 cases, in which the gland was not affected by any cancerous growth, the mortality was 23. Among 21 cases of cancerous disease, the mortality was 13. Of the first series Professor Billroth removed 50, with a mortality of 6; Kocher 38, with a mortality of 5.

SUCCESSFUL VACCINATION AFTER SMALL-POX.-E. C. Carter, M.D., Assistant Surgeon U. S. Army, writes: "Two soldiers, who had had small-pox, were successfully vaccinated at Angel Island, Cal. Only one, however, had well-marked variola scars.'

THE LATE ERSKINE MASON, M.D.-RESOLUTIONS. -At the stated meeting of the New York Pathological Society, held May 10, 1882, the following report was read and unanimously adopted:

This society has heard with profound regret of the death of Dr. Erskine Mason, at one time its presiding officer. For many years an active member, he took a deep interest in the work of the society, and was a regular attendant at its meetings, presenting many valuable specimens, and taking part freely in its discussions. He will long be remembered for the clear and intelligent manner in which he presented his cases, and for the valuable lessons he deduced from them. By the death of Dr. Mason, this society has lost one of its most active and efficient workers, and a member who, by his kindliness of manner had endeared himself to his associates. Strong in his convictions, he was nevertheless always courteous in discussion to those who held dif

INTESTINAL OBSTRUCTION.-Dr. J. C. Dreher, of Smithville, Ohio, writes: "In reading the article 'On the Treatment of Some Forms of Intestinal Obstructions by Opium,' by Prof. George E. Post, M.D., in the RECORD of April 22, 1882, I am reminded of a case which came to my notice a few years ago. Mrs. C- seventy years of age, had an irreducible femoral hernia, intolerable pain, and fecal vomiting. Taxis, enemata, tobacco poultices, etc., proved unavailing, and an operation was decided upon, but the patient preferred death to the cutting. Tobacco poultices were again continued, and five-grain doses Dovers every three hours administered. On the fifth day of treatment, she had three or four spontaneous moves. All pain and sensitiveness of the parts ceased on the second day of the opium-treatment. Her recovery was rapid, and she is alive and well this day. The Dovers used in this case contained potas. bromide instead of sulphate, but of course the opium did the work." FOUR MICROCEPHALI AND ONE CLINOCEPHALUS IN ONE FAMILY.-Dr. Tirizzi reports the cases of five children of a Catanian couple, of which four were microcephalic and one clinocephalic. Two microcephali are still living; the author dwells at length upon the history of one of these, a male, gives a short résumé of the history of the other, a female, and briefly refers to the remaining children. The male microcephalus has strange habits and very little intelligence, but his senses are unimpaired. He delights in running. In her tendencies and character the female differs altogether from the male. In concluding, the author avails himself of the cases described to combat the evolution theory, according to which man is derived from the ape; he considers a microcephalus not a type of man reverted to the primitive human form, but as a simple anomaly or aberration from the normal type. "We admit neither transformation, pantheism, or materialism," he writes. "Our ideas may be regarded as old and obsolete, but this is of little importance to us, inasmuch as distinguished men and men of profound thought hold the same opinions as we. Unless facts, carefully observed and well authenticated, and undisputable proof are offered to sustain other theories, we will not deviate the least from the path we have laid out."-Annali Universi di Med. e Chir., June, 1881.

THE DANISH VETERINARY SOCIETY has offered a prize of 2,000 francs, and a second of 1,000 francs, for the best essays on the benefits to living animals which have resulted from vivisection. The essays may be written in Danish, Swedish, English, French, or German.

PROFESSOR ARLT, the venerable oculist and senior member of the Vienna Medical Faculty, celebrated

on April 18th the jubilee of his seventieth birthday. Professor Arlt has kept in active practice up to the present time. He now retires as a teacher in the University.

ANALYSIS OF BITTERS.-Dr. H. W. Vaughan, State Assayer of Rhode Island, has made a report on the analysis of the various "bitters" found in the market, classifying them in three divisions: 1, beverages; 2, medicinal beverages; 3, reputed medicines. The percentage of alcohol in some of class 1 is as follows: Hostetter's, 43.20; Baker's, 40.57; Drake's Plantation Bitters, 38.24; Wild Cherry, 35.89; Standard Wine Bitters, 25.49; Peruvian Bitters, 22.40; Sherry Wine Bitters, 22.40; California Wine Bitters, 18.20.

Those of the second class vary from 40.10 per cent. of alcohol in Atwood's Quinine Bitters to 16.68 in Luther's Temperance Bitters. Those of the third class, professedly designed as medicines, but very well suited for forming a taste for all kinds of strong drink, vary from very strong to very weak. For instance: Richardson's has 59.14; Warren's Bilious Bitters, 29.60; Atwood's Jaundice Bitters, 25.60; Puritan Bitters, 25.50; Hoofland's German Bitters, 20.85; Oxygenated Bitters, 19.23; Walker's Vinegar Bitters, 7.50; Pierce's Bitters, 6.36.

ENDOWMENT OF JEFFERSON MEDICAL COLLEGE.A movement is on foot to secure a permanent endowment fund for the college. The subject was proposed at the Alumni meeting and referred to the Executive Committee. At the Alumni supper one member pledged himself to raise $1,000 before the next meeting of the association.-Coll. and Clin. Record.

THE MIDDLEMORE PRIZE IN OPHTHALMOLOGY.— We are requested to remind intending competitors for this prize that all essays must be forwarded by May 31st next, under cover, with a sealed envelope bearing the motto of the essay, and containing the name and address of the author, addressed to the General Secretary of the British Medical Association, 161A, Strand, London. The amount of the prize is £50; and the subject of the essay is "The Scientific and Practical Value of Improvements in Ophthalmological Medicine and Surgery Made or Published in the Past Three Years."

MEDICAL REGISTER OF NEW YORK, NEW JERSEY, AND CONNECTICUT.-Vol. XX. of this annual for the years 1882 and 1883, commencing June 1, 1882, has made its appearance promptly on time, and is full of the usual interesting material. The city list is increased by one hundred names, and a full list of all the apothecaries in this city and Brooklyn has been added. It is got up in its usual style, and reflects credit upon the indefatigable editor, Dr. W. T. White.

THE ABORTIVE TREATMENT OF BUBOES.-Dr. M. K. Taylor, Assistant-Surgeon, United States Army, describes (American Journal of Medical Sciences) a very successful method of treating buboes, adopted by himself. When the glands have reached a moderately large size, he freezes the surface with ether, seizes the gland between the fingers and injects about twenty minims of a carbolic acid solution (gr. iv. to 3 j.) Pain and soreness leave very soon, and the patients are generally able to resume work within three or four days. Dr. Taylor has tested his method on as many as 150 cases. He has used it successfully also in non-specific enlargement of cervical glands.

Vol. XXI.-No. 23. June 10, 1882.

Original Communications.

A STUDY OF NASAL CATARRH, BASED ON PATHOLOGICAL INVESTIGATION. By F. H. BOSWORTH, M.D.,

PROFESSOR OF DISEASES OF THE THROAT. IN THE BLLEVUE HOSPITAL MEDICAL COLLEGE, NEW YORK.

TWO FORMS OF THE DISEASE, RHINITIS HYPERTROPHICA AND RHINITIS ATROPHICA, CONSTITUTING IN ITS LATTER STAGES THE SO-CALLED OZENA.

THAT Our knowledge of nasal catarrh is based far more on clinical study than on pathological investigation is not surprising when we remember how rarely post-mortem examinations are extended to the nasal mucous membrane, and also that in those cases which demand the removal of diseased tissue this ablation has been usually accomplished by means of destructive agents. Since Dr. Jarvis introduced his ingenious snare écraseur, I have made very extensive use of his instrument in the nasal cavity, and in this manner have been able to remove portions of the diseased membrane en masse, and in such a shape that they have furnished me with sections for microscopical study in which the structure of the membrane has been absolutely unmutilated. I have thus secured specimens from all portions of the nasal cavity, and in all varieties and stages of catarrhal inflammation. Nasal catarrh is an unfortunate and indefinite name, but it has been dignified by such long-time usage that it is very difficult to abandon it. We may accept the term "catarrh" as defining the prominent symptom of the disease, viz., an inflammation characterized by a fluid discharge in distinction from a croupous or diphtheritic inflammation in which the exudation is membranous; but an excess of fluid discharge is also met with in syphilitic and strumous disease of the nose, and these diseases are ulcerative in character, and bear no relation whatever to catarrhal disease of the nose, and should never be classified in the same category. Excess of discharge is also a symptom of nasal polypus, fibroid, and other tumors, the presence of foreign bodies, etc., but these affections are not to be regarded as varieties of nasal tarrh.

ca

On the other hand we may use the term nasal catarrh as defining the character of the morbid process which is going on in the nasal mucous membrane, viz., an inflammation of a catarrhal character, and this, it seems to me, is its proper significance. There still, however, remains an element of indefiniteness. By common consent the termination itis is used to designate inflammation, as bronchitis, etc., but as we proceed upward in the air passages, we stop at pharyngitis, and, dropping an excellent system of nomenclature, designate an inflammation of the lining membrane of the nose as nasal catarrh, and then loosely use the name to cover a number of totally distinct diseases. The Germans have adopted the name "rhinitis" to define an inflammation of the nasal mucous membrane, and in the interest of exactness it is to be desired that the name may be generally adopted, in our text-books at least. All inflammations of mucous membranes are either catarrhal. croupous, or diphtheritic. By common usage, when we use the name bronchitis, pharyngitis, etc., we refer to a catarrhal inflammation, while the latter varieties are designated by the prefix

617

In

croupous, or diphtheritic. We may then understand rhinitis to define a catarrhal process. my study of the pathology of the nasal membrane, I find that the whole subject of chronic nasal catarrh, so-called, may be embraced under two varieties, one of which consists in a true hypertrophy, while the other is characterized by atrophy of the membrane. Following the above nomenclature,

these are:

First.-Rhinitis hypertrophica chronica.
Second.-Rhinitis atrophica chronica.

The first variety corresponds to what we usually call hypertrophic nasal catarrh. The second variety corresponds to what is usually called dry catarrh, and, in its later stages, ozæna.

For a better comprehension of the changes which take place in the membrane as the result of these morbid processes, the structure of the normal mucous membrane may be briefly described. That portion of the nasal cavities which is above the upper border of the middle turbinated bones is called the olfactory tract, while the lower portion is called the respiratory tract. The structure of the mucous membrane in these two regions differs quite markedly. In the olfactory region there is found a thick, soft membrane, containing numerous glands peculiar to itself, together with epithelial and olfactory cells, in which the olfactory nerve terminates. This region I believe to be rarely if ever involved in the morbid processes which characterize nasal catarrh.

In the respiratory region we find a mucous membrane which resembles more closely the ordinary membrane.

In Fig. 1 is shown a section of a typical mucous

diagrammatically:

FIG. 1.-Section of a Mucous Membrane, drawn a, submucous layer of connective tis-ne; b, mucous membrane proper, containing blood-vessels, nerves, closed follicles, connective and elastic tissue-fibres, and marked by villi; c, epithelial layer; d, simple follicle; e, racemose gland.

membrane, drawn somewhat diagramatically. It is composed of three layers, an epithelial layer (c), the

mucosa proper or adenoid layer (f), and the submucous connective-tissue layer (a). In the respiratory tract of the nose the epithelial layer is composed of ciliated epithelia, with the ciliary vibratory movements toward the posterior nares. The mucosa proper is composed largely of connective tissue, with a few fibres of elastic tissue. In this layer is found a large number of blood-vessels and nerves, together with a numerous distribution of glands of the acinous variety (d), but with more tortuous outlets. It is in the submucous layer, however, that the most striking changes from the simple type are found. Kohlrausch, in 1853, described what he supposed to be merely large venous sinuses, as existing in this layer of the membrane. In 1873, Bigelow,t of Boston, demonstrated that these so-called sinuses or loops of Kohlrausch composed a true erectile tissue. The observations of Kohlrausch were made by injecting the jugular vein, while Bigelow inflated the tissue locally, demonstrating the existence of a true erectile tissue, in the same manner as is done with the penis.‡

FIG. 2.-Section of the Cavernous or Erectile Tissue of the Middle and Lower Turbinated Bones, inflated and dried, x 2 diameters. (Bigelow.)

This tissue is very beautifully shown in Fig. 2, from Bigelow's original article, the parts having been first inflated, then dried, and the section made. This cut, it may be mentioned, also shows why, after cutting operations upon this tissue resulting in hemorrhage, the use of hæmostatics is utterly futile, as has been my almost unvarying experience, and that the only resort for the arrest of the bleeding is in the use of plugs.

Returning now to the morbid changes as the re

Müller's Archives, 1883, p. 149.

+ Boston Medical and Surgical Journal, April 29, 1875. + Satterthwaite: Manual of Histology.

FIG. 3.-Rhinitis Hypertrophica Chronica: A, epithelial layer; B, limiting structureless membrane; C, adenoid layer; D, blood-vessel filled with blood; E, acinous gland; F, venous sinus, composing the so-called erectile tissue.

RHINITIS HYPERTROPHICA.

The accompanying cut, Fig. 3, represents a section of a mass removed from the posterior portion of the lower turbinated bone. The changes may be described as follows: The whole mucous membrane is markedly thickened and deeply corrugated. The epithelial layer is augmented or increased in width. The outermost layer of epithelium in specimens from middle turbinated bones exhibit fine ciliæ, while in sections from the lower turbinated bone the ciliæ are occasionally wanting in places. There are deep valleys running downward into the adenoid layer which are filled with stratified epithelia. The latter consists of elongated epithelia, ten to twelve layers in diameter. The layer nearest the adenoid tissue is occupied by distinctly developed large columnar epithelia, which, especially where they go to fill the valleys, are very large, and composed of several strata. The boundary line between the epithelia and the adenoid tissue is everywhere well marked, and in some places there is even present a layer without distinct structure, the so-called structureless membrane.

The adenoid layer is very wide, and is composed in most of a myxomatous reticulum, with numerous lymph-corpuscles, while in some portions the lymphcorpuscles are very scanty, and the whole mucosa is composed of very dense decussating bundles of fibrous connective tissue. The mucosa is in all instances richly supplied with relatively wide capillary blood-vessels, mostly filled with blood. The acinous mucous glands are very numerous and evidently increased in size and number. They are composed of cuboidal epithelia, which, in many instances, exhibit the features of inflammatory corpuscles. The ducts

of the glands are traceable into the valleys on the surface of the membrane, where their columnar epithelia blends with that of the outer epithelial coat.

The submucous coat, beneath the adenoid tissue, consists of a broad layer of either myxomatous, or fibrous reticular structure, in which there are present enormously enlarged blood-vessels of a venous character. These veins are so abundant that they compose a true erectile tissue. The connective tissue, however, between these large veins is broader than is usually found in true cavernous tissue, and is supplied with bundles of smooth muscular fibres. The muscle-coat of the veins is also increased in breadth.

The arteries, though scanty, are all of a wavy course, constituting the so-called helicine arteries. The submucous layer also contains a number of racemose mucous glands, increased in size. The presence of these glands in this layer of the mem-. brane is, I believe, anomalous. Around these glands there are found, as a rule, heaps of lymphccrpuscles.

The characteristic features of hypertrophy of the nasal mucous membrane, then, may be briefly summarized as follows:

First.-Increase of the covering epithelium, without desquamation.

Second.-Increase of the adenoid layer and its capillaries, with stagnation of blood, together with a new formation of fibrous connective tissue replacing the adenoid layer.

Third.-Increase of the racemose glands, both in the adenoid and submucous layer.

Fourth.-Hypertrophy of the connective tissue between the enlarged veins in the submucous layer. Fifth. In advanced stages of the hypertrophic process, an absence of lymph-corpuscles, they having evidently been transformed into connective tissue.

There are certain deductions which it seems to me may be clearly drawn from the study of these morbid changes. In the early stages of the disease we have to deal with merely an excessive secretion from the diseased membrane. As the later morbid conditions develop, we find two new features added, viz.: the connective-tissue hypertrophy, resulting in a permanent stenosis; and the dilatation of the venous sinuses, resulting in a liability to constantly recurring but temporary stenosis from turgescence of these vessels under the influence of various irritating causes. The rational treatment of hypertrophic nasal catarrh should therefore be based on the recognition of these three conditions: (1). excessive discharge; (2) stenosis from structural hypertrophy; (3) temporary stenosis from turgescence of the venous sinuses.

1. The proper management of the excessive discharge in the use of the various cleansing and astringent solutions, and the methods by which they are best applied, is familiar to all, and my own views and methods I have given in my work on "Diseases of the Throat" and elsewhere.

2. The treatment of the structural stenosis by the use of destructive agents, such as acetic acid, chromic acid, the galvano-cautery, or by Jarvis' snare écraseur has also been sufficiently described; and I have nothing new to offer. My microscopic examinations, however, it seems to me, show conclusively, that when we have structural changes in the nose, such as have been described, we cannot accomplish their absorption by medicated solutions, but that the tissue must necessarily be destroyed or ablated. As I have shown, in comparatively early stages of the

disease there is an extensive transformation of lymphoid cells into connective tissue, and in the later stages these lymphoid cells have given place entirely to connective tissue; and certainly when the latter has occurred the only resource is in destruction or removal.

In a paper read before the American Laryngological Association, in June, 1880 (Archives of Laryngology, April, 1881), I called attention to the value of glacial acetic acid as a destructive agent in hypertrophy of the nasal mucous membrane. Since that time I have used this agent to the exclusion of all others, and am disposed to speak most positively of its value above all other caustics. So excellent are the results that I have obtained, that I regard it as even more efficient than the galvano-cautery, and certainly far less painful. In those cases which admit of the use of the snare, that should be used. In those cases in which the snare cannot be used, I prefer the acetic acid.

3 When there is a constantly recurring but temporary stenosis, due to a sudden turgescence of the venous sinuses, I think we may infer that the condition is due to an impairment of tone in the muscular coat of the veins, by which, under the influence of various exciting causes, such as a damp atmosphere, etc., the vessel-coats relax and the vessels become distended, in one or both nasal cavities, or perhaps alternating from one to the other. In those cases in which this condition is prominent, I have found excellent results from the use of a very mild faradic current. The electrode which I have devised for this purpose has served excellently well in my hands. It is equally adapted for each nasal cavity, and can be applied to the middle or lower turbinated bones. The current should be applied, as a rule, twice each week, and for about two to three minutes in each cavity.

RHINITIS ATROPHICA.

The accompanying cut, Fig. 4, represents a section of membrane removed from the middle turbinated bone in a case of atrophic, or dry catarrh, which had gone on to the development of fetid discharges. The change may be described as follows:

The epithelial layer is considerably decreased in width. The outer nearly smooth surface is occupied by a relatively broad layer of flat epithelia, partly in a state of desquamation, and entirely devoid of ciliæ. Below this there is found stratified cuboidal epithelium, displayed in five or six layers, while the portion nearest to the adenoid tissue, in some portions at least, is occupied by a row of columnar epithelium. Where the latter is plainly visible, the boundary line between the epithelial coat and the adenoid tissue is distinctly marked. In many places, however, the boundary line cannot be traced, and the adenoid seems to blend with the covering epithelium, while the latter exhibits features similar to those of the adenoid tissue.

The adenoid layer is thinner in diameter than normal, and is occupied by crowded lymph-corpuscles in a very delicate fibrous reticulum. The capillary blood-vessels are small, scantily distributed, and, as a rule, quite empty. The acinous glands are small, and evidently diminished in number. They are lined by a short columnar or cuboidal epithelium, while their ducts exhibit, around a large calibre, well-defined columnar epithelium. Around the scanty acinous glands there are heaps of lymphcorpuscles.

The submucous layer. The adenoid layer