of a case of chronic cystitis of several years standing, consequent upon gonorrhoeal stricture. Upon examination I detected the stricture about one inch anterior to the neck of the bladder, permitting very slight drainage. The contents of the bladder came away in drops with great tenesmus, and was muco-sanguinopurulent in character. I ascertained that the mucus membrane of the bladder was much ulcerated and its walls immensely thickened. The condition of my patient was exceedingly unfavorable, anæmic and very nervous, requiring preparatory treatment. I immediately placed him upon a tonic course of medicine, supplemented by a nourishing diet, and soon had him in a condition to attempt perinea! section, having previously relieved the stricture. During my preparatory treatment I used nit. arg. injection to the extent of a 20-grain solution, repeated at intervals of two or three days, followed by antiseptic irrigation. October 15th, I performed the usual bi-lateral operation with the double lithotome cache, after which the bladder was thoroughly washed out with tepid water daily, to which was added listerine and the bi-borate of soda. A 20 grain solution of arg. nit. was used every four days, followed by antiseptic injections and the warm hip bath. A common female catheter was kept in situ during his treatment to prevent the closure of the wound. At the end of six weeks he was dismissed. In a letter received from him two months afterward, he reported himself as entirely well. In case of stone, of course the only treatment open to the practitioner would be perineal section.

And now, in conclusion, I desire to impress upon practitioners the drainage plan of treatment as suggested my father, Dr. Paul F. Eve, for inveterate cases, as offering much the best avenue of escape from death by the unfortunate patient.

CATARRHAL MUCOUS MEMBRANE.*

BY

P. W. LOGAN, M. D., KNOXVILLE, TENN.

Gentlemen and Fellows of the American Rhinological Association:-Catarrhal Mucous Membrane of the upper air passages, being a subject too lightly considered by many medical men, is one to which we shall briefly direct our attention. Catarrhal trouble prevails to a greater extent, and is of more frequent occurrence, than any disease or class of diseases to which human flesh is heir. The profession generally pays less attention to this ailment, its symptoms, ætiology, reflex phenomena and treatment, than any other disease to which we are liable. Throat specialists, as a rule, resort to measures too harsh and irritating in the treatment of Catarrhal Mucous Membrane. Treatment should be repeated at proper intervals, and continued until all active symptoms are relieved. Usually improvement will continue after treatment has been discontinued, but in many cases a few treatments, each fall and spring, will be necessary until the diseased structures are made to "grow well." Dr. T. F. Rumbold, I believe, is the only author (if my memory serves me), who advises this course. As a rule, chronic diseases require chronic treatment. It is certainly the case in chronic catarrhal mucous membrane. The original seat of catarrhal conditions is often overlooked. We should realize the fact, that the nose was made to breathe through, that it is an important part of man, and more liable to disease than any other portion of the respiratory tract. We naturally breathe through the nose, the mouth being closed. This necessarily exposes its mucous membrane to some of the exciting causes of catarrhal inflammation; for instance, a change*Read before the American Rhinological Association, St. Louis, Mo., October, 1884. Chas. A. S. Sims, Secretary.

able, chilly atmosphere, an atmosphere containing dust and irritating gases, or an atmosphere vitiated and impure. The function of the mucous membrane of the nose being to moisten, warm and filter the air before it enters the larynx, necessarily renders the mucous membrane of the pharynx and larynx less liable to inflammation, excited by the causes just mentioned, than the schneiderian membrane. The original seat of catarrhal inflammation of the upper air passages is the schneiderian membrane. Simple, follicular or dry pharyngitis, laryngitis, tubal and aural catarrh, is preceded by, and is due to a coryza, either acute or chronic. Therefore, in treating Catarrhal Mucous Membrane of the upper air passages, we must recognize the fact, that a tubal, aural, pharyngeal, or laryngeal catarrh, does not exist, without the coëxistence of nasal catarrh; consequently it is necessary to treat the nasal disease simultaneously.

In the language of a German physician, referred to by Dr. Woakes, of London, in the last edition of his Post Nasal Catarrh, "in England he observed that doctors did not interrogate the nose."

Mackenzie, in his second volume of Diseases of Nose, Throat, etc., page 313, foot note, quotes from Dr. Rumbold's work on Hygiene and Treatment of Catarrh, complications, which he says are "fortunately not met with in this country."* Is it possible that the renowned Mackenzie has failed to "interrogate the noses." In one instance, I feel sure that he failed to "interrogate the nose." I refer to the case of an M. D. and preacher of renown, who visited me at my office in Knoxville, being accompanied by Dr. Juo. M. Boyd and other friends. Dr. Boyd and myself examined him. He had formerly visited London, where he was treated by Dr. Mackenzie for laryngeal trouble, the brush having been used "ad finem." Suffice it to say, that this patient had chronic naso-pharyngeal, with slight laryngeal catarrh. On making a rhino-scopic examination of his case, we found muco

* Dr. Rumbold's patient, mentioned in his Hygiene, etc, and referred to by Dr. Mackenzie, as an "unfortunate gentleman, whose nose was no doubt in an exceptionally morbid state," experienced the sensation, while walking, that he was sinking into the pavement up to his knees." Dr. Mackenzie adds: "Such complications of catarrh, however, are fortunately not met with in this country."

pus hanging from the turbinated processes, which reminded me of statactites suspended from the roof of a cave. On asking whether he had had treatment for his nasal trouble, he replied, "That no one had ever made a rhino-scopic examination of his case." Is this not positive evidence of the truthfulness of the German's statement, (quoted by Dr. Woakes, of London,) with reference to the failure on the part of the English physicians to "interrogate the nose?" I do not like to be personal about this matter, but the doctor must, in this instance, reap as he has sown. Aside from this, it involves an important question of great interest to the profession, which is, failure on the part of physicians to "interrogate the nose."

Americans are certainly capable of making successful rhinoscopic and laryngo-scopic examinations. They most assuredly have had ample material from which they could record their observations, and with truthfulness, notwithstanding the failure on the part of the English to "interrogate the nose," or observe symptoms and "complications," which had been witnessed in America. The pharynx and larynx are frequently tortured by the mop or brush, saturated with irritating solutions for weeks and months, without recognizing the coëxistence of a chronic catarrhal condition of the schneiderian membrane.

It is of paramount importance in all cases of Catarrhal Mucous Membrane of the upper air passages, to examine anterior and posterior nares, vaults of pharynx, pharynx and larynx. Reflected laryngeal irritation or inflammation, is relieved by treatment of original nasal disease and larynx. The nose is too often overlooked; in the language of our German confrere, it is not sufficiently "interrogated" in the treatment of throat and ear diseases. While rheumatism is considered by some a cause of sore throat, in my opinion, it is generally a result of the catarrhal condition or diathesis: a sequence and not a cause of catarrhal inflammation. The usual cause of catarrhal inflammation of the upper air passages, is "taking cold." Each attack of cold renews and incre ses the catarrhal condition, until the patient complains of having cold, almost continually if not constantly. A patient in this condition is very liable to muscular rheuma

tism, from the fact, that he takes cold very readily, and taking cold produces rheumatism. As the catarrhal habit is improved, the rheumatic manifestation is lessened, "pari passu," and the power of resisting deleterious effects of changes in the weather is increased. In other words, as the catarrhal diathesis is increased, the rheumatic trouble is increased. As the catarrhal habit is les

sened, the occurrence of rheumatism is less frequent. There is no question of the fact, that muscular rheumatism is a frequent concomitant, and result of a catarrhal condition of the upper air passages. An established catarrhal habit renders the subject liable to pharyngitis, tonsillitis, uvalitis and laryngitis. Relieve the catarrhal condition, and you will very greatly lessen the liability to a recurrence of these troubles. A laryngitis should not be permitted to continue until serious inroads are made upon the general health, and a dyscrasia established. Indeed, feebleness of constitution should be promptly met by the enforcement of hygienic measures, and the proper local and constitutional treatment. Catarrhal patients, as a rule, require a tonic and sustaining course of treatment. The air passing over diseased surfaces thereby becoming contaminated, tends to lessen vital power. The local inflammation, with its various reflex phenomena and influences, is a source of systemic disturbance, and depressing to vital power. Its invasion of the accessory sinuses and its close proximity to the brain, renders it possible for Catarrhal Mucous Membrane to give rise to a vast amount of trouble. Not only the brain may become involved, but the senses of sight, hearing, taste, and olfaction, may be impaired or destroyed. Why should it not lessen vital power, or in the language of Dr. Woakes, produce a catarrhal dyscrasia? Is it not true, that catarrhal troubles of the upper air passages are much more common and of more frequent occurrence now, than they were fifty to one hundred years ago? Or did medical men, because of a want of information with reference to the nature of these troubles, fail to recognize their existence? It has occurred to me, that our present habits. of life tend to the development of catarrhal inflammation, from the fact, that they are more enervating, and render us more liable to take cold. We live more in doors than formerly, having