the middle or upper turbinated bones, while hypertrophy generally chiefly effects the lower turbinated. The nasal speculum, reflector and probe will generally clear up the diagnosis. When, however, the hypertrophy exists only over the posterior extremity of the inferior turbinated bones, it may assume a polypoid appearance or it may, in the lapse af time, become pedunculated when it must be considered and treated as a true polyp.

The rhinoscope must be brought to bear to reveal this condition by means of whieh the character of the posterior obstructions can be recognized. By far the best means of illuminating the post nasal space is by the use of a small Edison lamp (made by M. A. Spencer & Co.), and so arranged on a small curved handle as to be introduced into the retro-nasal cavity. These lamps are now made so small that they can be used on almost any subject, and unless the stenosis is complete they render the diagnosis certain. If the throat be intolerant of the presence of instruments a spray of a four per cent. solution of hydrochlorate of cocaine will usually afford relief.

Symptoms.-The symptoms are those of chronic nasal catarrh, intensified by the mechanical obstruction. If the stenosis be complete, respiration must be carried on per orem. Even when the occlusion is not perfect in the erect posture, it readily becomes so on assuming the recumbent position, owing to the greater intravascular pressure then present in this region. While a dorsal decubitus may cause an occlusion of both sides, a change to one side may soon be followed by an opening in the upper fossa. These variable conditions are so frequent as to show that more or less œdema is almost a constant accompaniment of the hypertrophy.

In adults this stoppage of the nose gives rise to no little annoyance and the oral respiration is likely to be the cause of considerable irritation in the pharynx, larynx and bronchial tubes. Especially is this marked in the morning after breathing all night through the mouth, when the dry throat is the source of much annoy

ance.

In children of a tubercular or strumous taint, the obstruction in the nose may be the source of very grave danger. Serious affections of the throat may result, or a bronchitis, which, while of small moment in an adult, becomes of grave importance when affecting the small tubes of the child. The greatest danger, however, in these cases, is the unnatural and imperfect breathing which is the result. The air passing directly to the lungs causes

more or less irritation, and the lungs are not so fully expanded as when there is no nasal impediment. These conditions may prevent the perfect development of the lung, and establish here the weak spot which will be easily invaded by tubercle when the conditions are favorable. Sometimes the loud breathing or snoring of children when asleep is the first symptom which directs attention to the nasal condition.

From the thickened membrane there is the usual catarrhal discharge, generally profuse. Owing to the imperfect drainage, this secretion is partly retained, and, undergoing decomposition, gives rise to considerable irritation and an unpleasant putrefactive odor. The sense of smell being frequently destroyed or impaired, the bad odor is only an annoyance to those who are near, while the patient is frequently unaware of its presence.

Owing to the conformation of the nasal fossæ, the secretions have a tendency to flow backward into the throat, giving rise to a troublesome hawking, especially of mornings.

The voice is sometimes markedly affected, the nasal resonance being destroyed. Among elocutionists and singers this is the symptom which most frequently causes them to seek medical advice.

The ordinary complications of chronic nasal catarrh may ensue, the most common being affections of the middle ear, lachrymal sac, antrum of Highmore. and frontal sinus.

Prognosis. If this condition once becomes thoroughly established, it has no tendency to a spontaneous cure-at least not un- . til senile changes have produced a general atrophy of all the tisIf proper treatment is instituted the result will be very satisfactory.

sues.

Treatment. From the etiology of this disease it will be seen that the treatment naturally resolves itself under two heads, viz.: constitutional and local.

The dyscrasia which so constantly underlies this trouble must be carefully studied. In but one other affection of this region does constitutional treatment exhibit more beneficent results. By constitutional treatment I do not mean internal medication alone, but this combined with the general care of the body. Pure air by day and by night is a sine qua non. Especial care must be given to the ventilation of the sleeping chamber. This is the class of patients that live in a continual fear of "taking cold," and are in perpetual dread of a draught. They take cold at every change of

the weather, and are easily induced to remain indoors. A sleeping room well ventilated, a morning cold sponge bath, accompanied by rapid friction of the surface, and a day passed in active, outof-door duties, will usually soon tone up the system so that change in the weather will not be felt.

The general health must be looked after. Proper food, selected to suit the condition of each patient, shonld be given.

Intelligent application of the above suggestions will be all the constitutional treatment required by most patients. But in cer

tain cases should be exhibited cod liver oil, arsenic, bitter tonics, iodide of potash, iodide of mercury, chloride of gold, etc., according to the indications of the case.

However intelligently the general treatment of the case may be carried out, yet it will usually be found to accomplish but little towards a cure until accompanied by local treatment.

In the early stages of the disease the long-continued use of disinfecting astringents in the form of a spray, or powder, or ointment may be of advantage. When, too, the swelling is rather of the œdematous character, then the use of metal bougies or of dilating tents may produce good results. But in the present stage of our knowledge of the pathological conditions present, it appears to me to be a waste of valuable time to speak of anything but the radical method of the absolute removal of the diseased tissue.

Many methods have been devised for accomplishing this end. Long ago the distinguished French surgeon, Nelaton, removed this tissue with a pair of scissors. Strong toothed forceps have been used; a sharp curette; the knife; the ecraseur; wire snare; Paquelin's thermo-cautery; the galvano cautery: or, chemical agents, as fuming nitric acid; chromic acid; glacial acetic acid; Vienna paste; London paste. All these agents have been used with more or less success to produce the same result, viz. the destruction or removal of the redundant tissue.

When the hypertrophic tissue is bunched at the posterior extremity of the cavity, the Jarvis snare may be used to advantage. The nasal cavity is first sprayed with a four per cent. solution of cocaine and a few drops of the same solution are injected into the mass to be removed. The wire (I generally use a No. 7 piano steel wire, as it is much more manageable than a soft or too flexible snare) is then passed around the mass and the loop rapidly drawn home, thus completely severing the enclosed tissue. Dr. Jarvis recommends that this operation be much prolonged (in some

This

of his reported cases, even to four hours) to avoid danger from hemorrhage. This, however, is a very painful proceeding, and there is comparatively no danger from the increased hemorrhage. I have performed the operation repeatedly and have yet to encounter a hemorrhage that cannot be controlled by cold water. method I only now use in those cases where the hypertrophied tissue is bunched or polypoid in form. When the tissue is evenly hypertrophied then by far the simplest method of its destruction is by means of the galvano-cautery, and so satisfactory is this means that I now never think of resorting to any other.

In many cases where there is not complete stenosis the tissue may be caused to atrophy without extensive destruction of the surface mucosa. This may be accomplished by drawing the sharp edge of the cautery knife heated to a white heat through the long axis of the mass, making a deep cut. After this cut has healed and contracted there is left only a fine line of scar tissue so that the normal functions of the membrane are hardly interfered with. One linear cut may not be sufficient, in which case others can be made parallel to the first, and the result will be a still further contraction. Sometimes, however, it becomes necessary to destroy a larger amount of the tissue. In this case the flat side of the knife can be used, or a fine wire coil.

Where a broad surface is cauterized care must be taken to prevent the agglutination of the granular surfaces. This can best be done by the daily introduction of metalic nasal bougies, or by the introduction of a pledget of cotton which has previously been saturated in some oily disinfectant.

CANCER OF THYROID.-Dr. Norman Moore (Lancet, June, 1886,) presented at a meeting of the London Pathological Society a specimen of primary carcinoma of the thyroid from a woman aged forty-six. "The new growth formed a huge mass which had ulcerated through the skin and into the larynx. It completely compressed one recurrent laryngeal nerve, and pressed on both carotid arteries, and had grown through the upper wall of the arch of the aorta, but without causing extravasation of blood." The duration of the growth was four months and it was accompanied by some dysphagia, partial aphonia, but with little dyspnoea.

EDITORIAL.

A. B. THRASHER, A. M., M.D.,

EDITOR.

RUSH MONUMENT.

At the Washington meeting of the American Medical Association, in 1884, steps were taken to erect, in Washington, a monument in commemoration of Benjamin Rush, the eminent physician and philanthropist, "whose active, honorable life was crowned by his honorable death, on the nineteenth of April, 1813, in the sixty-eighth year of his age, when, while trying to save other lives, he fell like a soldier on the battle-field, a victim of the prevailing epidemic of typhus."

Taking into consideration the fact that, while hundreds of citizens from the other walks of life have been honored by monumental statues, but there is yet no such commemoration of any member of the medical profession, the action seems to be a timely

one.

To effect the object, contributions, limited to one dollar, are solicited from all physicians and students of medicine in the United States.

Contributions may be sent to Dr. Geo. A. Collamore, Toledo, Ohio, who will see that they are properly credited and accounted for.

KENTUCKY STATE MEDICAL SOCIETY.

Thirty-first Annual Session, Winchester, Ky., June 24, 25, 26, 1886.

President J. P. Thomas, M.D., Pembroke, called the meeting to order and presented his address. The address was an exceedingly sensible one, which we hope yet to publish in full. He said that lack of coöperation was the great cause of failure in the endeavor to have state laws passed. As an example of the comparative value the Kentucky Legislature places on its animals and citizens, he stated that the State Board of Health were reluctantly granted $2500 to crush out and prevent epidemic diseases among the people of the whole state, "and $6000 was voted from the treas