herein before suggested, oysters and other shell fish, heating food, condiments, coffee, chocolate, vanilla cream, and stimulating drinks, and all eatables and drinkables which are known to have a partial aphrodisical effect upon the sexual system, should be used, if used at all, in the early part of the day, and as carefully avoided in the latter part of the day or evening. Even fruits, cooked or uncooked, taken in the afternoon or night, are usually found to increase the liability to involuntary emission. This may be due to the exciting effects of some fruits, but, in most cases, it results from the impaired digestion of the patient, in consequence of which a fermenting process ensues, filling the blood with a material no less heating than that obtained from the most objectionable condiment. In the early part of the day a free use of fruits, perfectly masticated so as to rupture the fruit cells and mingle their contents with the saliva, is usually found to be advantageous even in cases having dyspeptic complications. Feather beds, and an excess of bed-clothing, are to be avoided. The temperature of the body should be kept as low as possible, without incurring the risk of taking cold. Lying upon the back is a habit not at all conducive to the recovery of one affected with the disease under consideration. In such a position the spine and sacral plexus become heated. This heat is conducted to the genital organs, which are in a morbid state of activity. A common spool fastened to the bare back by a piece of tape passing through its center and tied around the body, will usually prove efficient in keeping the patient off his back. One who secretes urine freely, and at the same time sleeps soundly, may prevent the distending bladder from pressing unduly upon the seminal organs by setting an alarm clock to awaken him at a timely hour to get up and void his water. The morning, by most people, is selected for defecation; but for parties affected with spermatorrhoea it is well to attend to this important matter at some regular hour not remote from the usual bed-time, for the reason that all pressure upon the spermatic vessels from an otherwise distended rectum will be prevented.

Doubtless many practitioners listening to the foregoing suggestions respecting methods, remedies and hygienic rules, could add much which their own experience has found to be useful in the treatment of spermatorrhoea. It would be of inestimable service to sufferers from this disease if the knowledge which each possesses could be contributed to our society, and find publicity in our State Transactions, to the end that a literature, both pathological and therapeutical, might be created in this neglected department of medical science. In concluding this essay my great regret is that its preparation has been attended with such momentary interruptions as to prevent me from presenting what I had to say as coherently and systematically as I had desired.

NASAL CATARRH,

ITS CAUSES, SYMPTOMS AND TREATMENT.

BY B. F. CHAPMAN, M. D., of Brooklyn, N. Y.

Nasal catarrh or catarrh in the head, Rhinitis and Coryza as it is technically called when in the acute or inflammatory state, and Ozana when it has assumed the chronic form, was believed by Hippocrates and Galen, to be a flow from the brain, a sort of cerebral purge, escaping through the pituitary gland and sphenoid bone, and through this channel reaching the nose. Schneider who held a professorship in the medical college at Wittenberg, whose name the mucous membrane of the nose still bears, published a treatise in 1660, showing the fallacy of this supposition by anatomical demonstration, and that no canals existed through which such discharge from the brain could take place.

With our present knowledge of anatomy and therapeutics, it is evident that nasal catarrh can only be the result of an inflammation of the mucous or Schneiderian membrane. It is caused principally by repeated colds which settle in this particular locality, although various other causes tend to produce the disease.

Catarrh in the head is often met with as an epidemic, and the question frequently arises, is it contagious? There is no question in my mind, but that this disease may be, and often is, contagious from direct contact with the secretion, as in using the same handkerchief, and in bringing the organ in contact with a diseased one, as in the act of kissing. There is an abundance of evidence in favor of this theory. We often observe members of the same family attacked one after another, without being able to account for the event by any ætiological reason, such as exposure to cold or change in the weather, for the production of the latter cases. I have known of several instances of newly-married people, where one of the partiesTM before marriage was in a perfectly healthy condition, never having had even a symptom of catarrh, while the other had suffered from the disease in its chronic form for a number of years perhaps, and after a few weeks or months decided catarrhal symptoms were developed in the one previously healthy, and remained until successfully treated.

The fact of epidemics of this disease is difficult to explain in any other way. No one will attempt to deny that the poison from a gonorrhoeal discharge is capable of infecting the mucous membrane of the nose or the conjunctiva, as cases are repeatedly brought to the notice of the profession where the poison has been transmitted to either membrane by the fingers, not only of the patient himself, but of another party. It has often been observed also, that new-born children were

affected with nasal catarrh and conjunctivitis, where no other cause could be attributed than a gonorrhoeal or catarrhal discharge from the mother during labor. I am satisfied that the larger proportion of cases of catarrh, as well as conjunctivitis in new-born babes should not be attributed to sudden changes in temperature, but rather to an infection in the vagina of the mother in the form of the local inflammation above mentioned. It, therefore, appears that the nose does not differ from other mucous membranes in its capacity for infection by vitiated secretions, nor is there any reason for believing the secretions of the membrane of the nose to be less infectious than the secretions of any other membrane. It is true some people show a decided predisposition to this disease, and attacks are often brought on from the slightest exposure, while others may expose themselves to all of the ordinary causes, without its having the least effect upon them.

CAUSES.

The most frequent cause of nasal catarrh is repeated colds, sudden changes in the atmosphere, wetting the feet, living or working in damp apartments, fine particles of dust floating in the atmosphere, the inhalation of acrid gases, the pollen of certain plants, etc.; all conduce to this disease. Young children during the first years of their life are perhaps most subject to acute catarrh, next to them in point of liability are persons of middle age, youth and aged persons being most exempt.

SYMPTOMS.

The first symptom of this disease in its acute form, is usually a feeling of lassitude over the whole body. It may be ushered in with a decided chill, or only a sense of chilliness, with a feeling of weight or pressure in the forehead, especially between the eyes. There is a sensation of tightness as if a band was drawn around the head. There may be a dryness in, or an excessive watery secretion from, the nose, with more or less redness and swelling of the mucous membrane, with perhaps a disposition to sternutation and lacrymation. The secretion gradually increases from a watery to a mucous discharge, and finally becomes more or less purulent in its character. There is usually a partial loss of the sense of smell, and in many cases that of taste also. All of these symptoms are of a more or less aggravated form according as the disease progresses. It may effect the external surface of the nose and the lip is liable to become inflamed and excoriated from the secretion, it being in most instances of an acrid nature. Erysipelas of the nose is not an unfrequent complication of this disease, and may extend over the whole face.

The inflammation frequently extends backward to the eustachian tube, producing ringing in the ears, difficulty of hearing, etc., or it may, and frequently does, extend further down the respiratory tract producing pharyngitis, laryngitis, bronchitis and even pulmonary consumption. Every case of consumption it has ever been my misfortune to lose, could be traced directly to catarrh in the head as its primary cause.

The disease, however, more generally terminates in the chronic form, and it is to this, that I would more particularly call your attention, as it has usually assumed this character before the physician is consulted. In this connection we generally find a chronic inflammation of the mucous membrane of the nasal cavity with deeper lesions. Ulceration of the soft parts, caries of the bone and abnormal growths within the nose are often associated with chronic catarrh. The secretion differs materially from that of acute catarrh, and may vary, both in quantity and quality. There are forms in which the discharge is very abundant, while others deserve the name of dry catarrh, as there is scarcely any secretion, but on the contrary the membrane is usually dry and parched.

In many cases the secretion flows freely from the nostril, while again it is so thick it has a tendency to form crusts.

These crusts present an unnatural greenish appearance, unless they contain blood, or particles of coloring matter. If so they may be any or many colors. These crusts are sometimes so firmly attached to the membrane that it is with difficulty that they are removed. By the decomposition of them, a peculiar odor is produced which is communicated to the breath as it is exhaled; and is, by some writers, termed ozæna. This disease, however, does not occur until ulceration of the soft parts and caries of the bone take place; yet, in my experience, ulceration usually occurs soon after the formation of these crusts. These ulcers generally penetrate deeply and destroy the periosteum when disease of the bone takes place. This process may go on until the whole bony structure of the organ is destroyed, and, as a result, the bridge of the nose falls in, and permanent disfigure

ment is the result.

TREATMENT.

One

On the treatment of this disease no two writers exactly agree; yet nearly all declare that only a portion of cases of chronic catarrh arə amenable to treatment, at least with any certainty of cure. great difficulty that we all have to contend with is, the patient is not brought to the physician's notice until the disease has become chronic and of long standing. Frequently ulceration and caries have set in, and much more time must necessarily be employed in treatment, and in some cases it may be too late to effect a perfect cure. The first requirement in the treatment of these cases is to thoroughly cleanse the parts from all accumulations and vitiated secretions; the second is to restore the tissues and bone, if they are diseased, to their normal condition; and third, to remove the unpleasant odor, if any be present. For this purpose various instruments have been used and recommended by the profession from time to time, among which are the nasal douche, the nasal syringe, steam and other atomizers, all of which, so far as I have tested them, have their objections, and have proved unsatisfactory in my hands. This led me to try and devise some means of applying remedies to the whole nasal cavity in such a manner as to overcome all objections, and, at the same time, if possible, have the treatment pleasant.

After many trials I am now satisfied that I have succeeded in making

an instrument that will meet all of the above requirements, and will accomplish the thorough and successful treatment of nasal catarrh in all its forms, as well as throat and bronchial diseases. The instrument I refer to is made of hard rubber, and so constructed as to throw only the finest particles or spray entirely over the whole mucous membrane of the nasal cavity.

As may be seen by the accompanying cut, by simply screwing on the large bulb for the nostril, as shown in figure 1, that cavity is completely filled, so there is no throwing the spray over the face, or flowing back of the liquid to soil or stain the face and dress. Then, in order to make the treatment thorough, by removing this bulb and attaching the duck-billed bulb. (fig. 2), the instrument can be placed well back in the mouth, and the bill introduced behind the arch of the soft palate, when the spray may be directed upward, entirely covering the posterior nares.

For treating the larynx or vocal chords, the bill is simply directed downwards as seen in figure 3 when the spray can be made to entirely cover those parts.

For

treating the bronchial tubes and lungs, the plain round bulb shown in figure 4 is attached when the patient is requested to take deep inspirations, thus carrying the finest particles of the spray to the affected parts. The heavier portion condensing in the throat may be swallowed or expectorated. I use the Richardson double air bulbs and prefer them as they produce an uninterrupted current- the tubing of which is attached to the instrument at a. The air is thus driven into the bottle which causes the liquid to rise through the tube b into the main tube c, through which the tube b passes its entire length, coming to a point inside the bulb and through which the liquid is forced in a minute stream. Inside the main tube and around the center one is a channel through which the compressed air passes, meeting the fine stream inside the bulb, escaping through its opening in the form of a beautiful spray.

REMEDIES.

As to the remedies for the treatment of this disease, we all have our favorites, but as they vary in character it may be well to classify them as follows: Resolvent, astringent, anodyne, alterative and disinfectant. Among the remedies named in the first class, and which should be used at a temperature not below that of the blood, may be mentioned chloride of sodium, chlorate of potassium, carb. of sodium, sulphate of soda, borate of sodium and bromide of potassium, used in the strength of from one to ten or fifteen grains to the ounce of water.