these boards; upon the contrary, as suggested in my former paper, it will be found that the proportion of applicants able to pass successful examinations will be a certain index of the character of instruction afforded students in the respective schools. While the proportion of applicants successful is only eightytwo per cent., it will be found that from the schools heretofore operating under a high grade of requirement that, thus far at least in the work of these boards, nearly all graduates are successful in obtaining a license upon examination. In substantiation of this conclusion I again submit data, using therein the same schools as in my former paper. The following table indicates the proportion of students successful on examination from alumni of schools heretofore operating under the three years' curricula: I cannot but conclude, gentlemen, that efficient medical legislation will operate to bring about the following results, as applied to the profession and public: 1. It will protect the people by affording a profession of greater intelligence. 2. It will suppress charlatanry. 3. It will reduce the number of persons practicing medicine to a number commensurate with the demands of the people. 4. It will reduce the number of medical colleges, at present far above legitimate demands. 5. It will raise the general standard of professional fitness, assuring us a professional prestige in the future, becoming the most important of the learned professions. In conclusion, we appeal to the profession to renew their efforts in securing efficient medical legislation, believing its operation will result most beneficially to both the public and profession. CHRONIC NASAL CATARRH. Read before the Memphis Medical Society, May 28, 1895, BY EDWARD C. ELLETT, M.D., Clinical Assistant in Ophthalmology and Otology, St. Joseph's Hospital, Memphis; Formerly House Surgeon, St. Agnes Hospital, Philadelphia, and Wills Eye Hospital, Philadelphia. A disease which afflicts probably seventy-five per cent. of our urban population, and causes troublesome symptoms in half of these, must be of interest to every practitioner of medicine. I do not believe I overestimate its frequency. The golden harvest reaped by the so-called "catarrh specialists" and by the proprietors of the various nostrums for the relief of this disease, is evidence of what a large portion of the gullible public become their patrons, and how persistently they search for relief. I believe chronic nasal catarrh in all its forms is susceptible of relief in the majority of cases. It is not to be treated by a spray for every patient who has "the catarrh," but by judicious treatment based on the exact diagnosis of the pathological condition present. An appreciation of this fact by the profession generally, and the willingness to give these cases the attention they require, will do much to rob the name "catarrh" of the halo of disgust and dread with which these eminent specialists have surrounded it, and redound in many ways to the credit of the profession and the benefit of the people. Since careful diagnosis is ever the corner-stone of successful treatment, a few words as to the ways and means of examining the nose will not be amiss before discussing the disease itself. It may seem dogmatic to mention only the means that have proven most satisfactory to me, but there is such an endless variety of instruments for the purpose, all of which cannot be described, that it is better to speak only of those with which I am best acquainted. The necessary appliances are few and simple. A concave head mirror (Fig. 1), three or four inches in diameter and of a twelve-inch focus, is essential; the light may come from a convenient window, or from some source of artificial light; a sixteen candle power incandescent light, with ground glass globe, is exceedingly neat and satisfactory, and if not supplied with a cumbersome condenser, can be used for all other purposes for which artificial light is needed. In the absence of electricity, an Argand gas burner or student's lamp are excellent substitutes. As to the speculum for anterior rhinoscopy, Bosworth's 'Fig. 2) presents the advantages of simplicity, of being self Fig. 2 Bosworth's Nasal Speculum. retaining, and of being adjustable with one hand. Aural specula serve the purpose, but give a view of a more limited field. Any instrument is of value to him who is accustomed to its use, and the choice must always be a question of individual habit. * I am indebted to Messrs. Dutro & Hewitt of this city for the cuts of instruments which illustrate this article. Posterior rhinoscopy is a more formidable procedure than anterior. It necessitates the use of a tongue depressor, a small plane mirror, and for a careful examination, I think a palate retractor is essential. White's retractor (Fig. 3), introduced EA.YARNALL PHILA. Fig. 3 White's Palate Retractor. after cocainization of the fauces and pharynx, is self-retaining and comfortable, and permits a deliberate and thorough examination of the posterior nares by means of the small mirror. The details of these methods are found in all textbooks, and practice of them alone can lead to skill in their employment. In the use of any method, cocainization of the nasal mucous membrane is often of service. This can be accomplished by using a four per cent. solution of cocaine in the atomizer, or applying it with a cotton-armed probe. These "cotton carriers" (Fig. 4) are very useful in all manipulations around the nasal chambers. Fig. 4 Allen's Cotton Carrier. There are three distinct forms under which cases of chronic nasal catarrh appear (Lefferts): (1) Simple chronic rhinitis. Atrophic rhinitis has so little in common with the other two forms that we may well leave its discussion to another time. It is usually a sequel of purulent rhinitis in children, though many competent observers describe it as a cicatricial stage of hypertrophic rhinitis. The nasal mucous membrane is erectile and exceedingly sensitive. Any local irritation causes dilatation of its blood vessels, and by their influence on the vascular system, violent exercise, emotion, excitement and stimulants produce the same effect. Fear will contract the vessels, as will also a variety of drugs, notably cocaine. These changes are kaleidoscopic in their rapidity, evidence of the prompt susceptibility of the membrane to external influences. Except atrophic rhinitis, chronic nasal catarrh arises from repeated attacks of acute catarrh, common "colds." Pathologically the process is that of inflammation everywhere. The vessels dilate; the blood current at first accelerated is soon retarded; exudation of leucocytes and proliferation of these and the fixed connective tissue corpuscles produces temporary hypertrophy. These products largely disappear with the subsidence of the acute attack, but each one adds its increment of permanent organized tissue, as is readily demonstrable with the microscope. The mucous membrane of the nasal cavity is divided into the respiratory portion and the olfactory portion. The respiratory portion covers the inferior turbinated body and partly appears on the lower portion of the septum and anterior portion of the middle turbinated body. The olfactory portion covers the rest of the cavity. The gross difference between the two is in the greater thickness of the respiratory portion. This is apparent in a specimen which I have had in alcohol for some months, and can be appreciated in the living state by touching the parts with a probe. The respiratory portion contains many more mucous and serous glands and larger and more numerous vascular channels. Its sub-epithelial layer is thicker than that of the olfactory portion, and its epithelium is ciliated. Hence for anatomical reasons it bears the brunt of acute and chronic inflammatory changes, and hence this portion, i. e., the boundaries of the inferior meatus, concern us most in the consideration of chronic nasal catarrh. From this outline of the pathology it will be seen that there is no sharp dividing line between simple chronic rhinitis and hypertrophic rhinitis. They merge insensibly into each other. A further division of these forms, which represents the successive steps in the pathology, is made by Mackenzie. He divides simple chronic rhinitis, from a pathological point of view, into |