acid after the removal of any fibrous
growth where you could not in the mucous
or lymphoid.
Dr. Crawford. — I have treated a great
many of cases of those chronic troubles in
the nose. Where there is considerable
hypertrophy I usually use chromic acid in
combination with glycerine. I have never
had any trouble. I then use either the
Siler's tablets as a wash, and if I find it is
not reduced I use chromic acid again, with
the absorbent cotton and probe. The worst
trouble I find is upon the margin of the
palate. Along there is thickening, and
sometimes that portion adjacent to the
margin is the most troublesome diffi-
cultly that I have witnessed in those cases.
I have not had luck with anything better
than after using the chromic acid with the
glycerine than using hot gargles of bicar-
bonate of soda and alum, used three or four
times a day as a gargle. I have used also
tincture of iodine with olive oil, equal por-
tions, with the probe and absorbent cotton.
If I have not had the success I desire I use
a solution of nitrate of silver and to that I
add glycerine, and have a curved instru-
ment that I pass through the mouth and in
that way, with frequant gargles, I have
had reasonable success, but it is a very
troublesome and unsatisfactory method any
way you take it, because when this disease
becomes chronic it is difficult to remove it.
Another thing. You find that after retir-
ing if your patient Lies upon his back his
mouth will gradually open and he will
breathe through it, and it becomes dry and
feverish, so I usually have them sleep upon
the side, and if I cannot have that done
satisfactorily I have a large roll of cotton
rolled up to considerable bulk and put it
around the body so they cannot lay upon it,
and they lay on the side and breathe better,
and hence the dryness and unpleasant
breathing is not so great as it would be by
laying on the back. I do believe in the
chromic acid treatment with glycerine. I
think it is a most excellent one.
Dr. Duson. — I have had no experience in
the use of chromic acid in solution. I have
always used it fused on the end of a probe,
and I find it then difficult enough to manage.
Unless the part to which it is applied is
perfectly dry it has a tendency to run and
to get over a larger amount of surface than
you want it to. I have only used the
curette, and liave found it satisfactory I
have never attempted to use any cautery. I
have never yet found a growth so fibrous
that a sharp curette would not cut through.
If you remove it with a snare you will
usually leave a base that has to be treated
so why not do it all at once with the curette
without going through two operations.
They are not as a rule as fibrous as the
faucial tonsils, because there is not so much
friction to make them so. In regard to
THE CHARLOTTE MEDICAL JOURNAL.
435
what Dr, Battle said about the growth
disappearing ; it is a well known fact that
if you examine the growth from time to
time you will find different conditions at
almost every examination. Very often upon
examination particularly in acute cases the
naso-pharyngeal space will be entirely
blocked up. Then again the growth will
be almost flattened. I think the proper
thing to do is to curette, Of course there
are times, as when the enlargement follows
measles, when we should wait a few weeks
to see what it will do, but if after waiting
the tonsil is large enough to be seen I think
it should be removed. I have always used
chloroform, and I am prejudiced against
everything else. I have never seen any
bad results from it, particularly in children.
I have used it a great deal and it has always
been satisfactory. I have never had a re-
currence that I know of. Very often in
operating on these cases the curette is not
pat far enough forward, but if you are
particular to feel around to be sure that no
part of the gland remains in the space after
the operation is performed I do not think
you will have any.
Sanitary Supervision of Schools.*
By R. Percy Smith, M. D., Sunnybrook, Md.,
Lecturer on Hygiene at the Baltimore
Medical College, Baltimore, Md.
It is a well known fact to many physi-
cians, especially those who have devoted
much attention to the subject, that many of
the most distressing, painful and destruc-
tive maladies owe their origin or intensific-
ation at least to certain injurious influences
of school life. School are, indeed, properly
named in many instances the "hotbed for
disease." It becomes a requisite thing to
properly cope with the world that the
mind should have a good system of intel-
lectual training, but in doing so we should
endeavor to avoid injury to bodily health.
It therefore becomes our duty to carefully
consider these matters, inquire what these
injurious influences are, and, as far as pos-
sible, avoid, mitigate or remove them. It
is not possible for the laity to realize fully
these facts, unless our profession should
call their attention to the subject, and it is
a duty we owe them and the rising genera-
tion that many irreparable damages done
during early childhood should be avoided
by our counsel and advice. Authorities in
school hygiene assert that badly constructed
*Read at a public meeting of the Baltimore
County Medical Association, Towson, Md.
school houses, defective ventilation and
lighting, inefficient removal of the bodily
excretions, or the obnoxious gases generated
by their decomposition, improper school
furniture and furnishing, such as seats,
desks,- books, &c., want of elementary
knowledge of hygiene on the part of the
teacher, overstudy, carelessness on the part
of parents or attending physician, and
many other causes too numerous to specify
are responsible for a large number of serious
diseases, among which I might mention the
following as most frequent :
1st. Nearsightness.
2nd. Pulmonary consumption.
3d. Spinal deformities.
4th. Nervous and digestive disturbances.
5th. Contagious diseases.
As to the first — nearsightedness — it is
hardly necessary to argue to prove that it
has increased enormously in the past few
years. One has merely to look around
them to see the large proportion of young
persons compelled to wear glasses in order
to use their visual organs to the best advant-
age. This is sufficient evidence to prove
the assertion. There is also abundant evi-
dence to prove that the increase is due to
pernicious influences of certain unhygienic
conditions to which many children are sub-
jected in the schools. It cannot be argued
that visual defect is a necessary accompani-
ment of school work, or that it cannot be
avoided without giving up educating child-
ren or reducing their education to a mini-
mum, for during the past few years in one
of the large schools of Germany that recent-
ly was constructed on hygienic principles
the reduction in the proportion for the same
number of years previous was fron 31 per
cent, to 12 per cent. As the tendency to
nearsightedness in hereditary and progres-
sive, the same must come when the great
majority of educated people will be near-
sighted, unless some measures are adopted
to check the increase, The principal causes
of nearsightedness in schools may be sum-
med up as follows :
I St. Improper shape and construction of
the room.
2d. Improper construction of seats and
desks.
3d. Bad lighting.
4th. The distance of the objects to be
seen, for example, maps and blackboards,
and their position with reference to the
light.
5th. Type, paper and printing of school
books.
6th. Length of time for study.
As to the shape of the room, it should be
oblong, with windows in one side only ;
there should bo no windows on the opposite
THE CHARLOTTE MEDICAL JOURNAL.
side, for cross lights are better avoided.
The area of the windows clear of sash
frames should be not less than one tenth,
and not more than one-fourth of the flloor
area of the room. The construction of
school desks should be arranged parallel
with one another, but at right angles from
the windows, and scholars should sit with
the left hand nearest the windows, so the
illumination of books and lessons will be
from the left front. A line dropped from
the near edge of the desk should strike the
front edge of the seat, so the pupil may sit
erect while writing or reading from a book
resting on the desk. For lighting the room,
the windows should reach as high as the
ceiling of the room and open directly into
the external air. The side of the room
from which light enters should face the
north in ord&r to avoid direct sunlight.
The distance of maps and blackboards
should not be over 30 feet, for attempts to
accommodate the eye at a greater distance
will cause a muscular strain and induce a
gradual elongation of the antero-posterior
axis of the eyeball with the production of
myopia. The books should be of clean
paper and not translucent, and type of
print for young children should be pica,
and older children small pica. The length
of study for young children should be
broken by frequent intervals for play, and
two writing lessons should never follow
each other. I might add in reference to
construction of desks that the height of the
seat from the floor should equal the length
of the scholar's leg from the sole of the foot
to the knee. The depth of seat from front
to back should not be less than S inches ;
the seat provided with a straight back, and
a covered pad or cushion to fit into and sup-
port the small of the back and loins.
2d. Pulmonary consumption. As pul-
monary tuberculosis is now known to be
highly contagious, there is no doubt that
seeds of this fatal disease are often implant-
ed in the youthful system during school
life. The causes of this disease are now
recognized to be two — exciting or direct
cause being the germ (bacillus tuberculo-
sis), and predisposing or indirect causes
such as badly-lighted and ventilated rooms,
a necessary improper position of the body,
interfering with full expansion of the chest ;
unsanitary surroundings and heredity. We
can readily see how school rooms favor the
development then of this disease when we
remember that the chief mode of dissemin-
ation is from the sputum of consumptives
(which always contains the specific micro-
organism) being allowed to dry and become
ground into dust is inhaled by those in the
same room. Suppose then a child is attend-
ing school already suffering from consump-
tion ; he expectorates probably on the floor ;
the sputum is soon dried, and all other
children who, predisposed to the disease, are
immediately subjected to that which they are
least able to repulse. It becomes then of
utmost importance that attention should be
paid to the removal of such conditions.
3d. Spinal meningitis. Five-sixths of
the cases of spinal disease and deformity
being during the years of school life. The
disease is over ten times as frequent in girls
as in boys. Improperly constructed seats
and an almost necessary consequent bad
position of the body are responsible for the
greater number of these cases, Defective
lighting has often a decided influence in
producing this disease by compelling the
pupil to assume an improper position.
4th. Nervous and digestive derangements.
These disorders which frequently begin
during school life often persist through life
rendering the individual a chronic invalid.
They are often the result of defective ven-
tilation, over-heating or excessive mental
strain. Prof. Bystroff says that persistent
headache in school children is largely due
to excessive mental strain, and leaving out
of consideration the perculiarities of the
child's nature and the elementary principles
of hygiene. He adds in view of this fact
the appeal of a recent French writer "a
little more muscle, a little less brain,"
seems justified.
5th. Contagious diseases. There is no
doubt whatever that schools are the most
frequent sources of the extension of conta-
gious diseases. Smallpox, scarlet fever,
diphtheria, mumps, measles, whooping-
cough — in fact, all the air-borne diseases are
spread often through schools than any other-
wise. Epidemics of these diseases increase
remarkably during school season, and de-
crease when schools are closed. Suspension
of schools has ended an epidemic that could
not be controlled otherwise. The unre-
stricted manner in which children from an
infected house attend school gives the freest
possible chance for the spread of these ma-
ladies. School Boards require a certificate
of vaccination from children before admit-
ting them to school, but ail of us know of
many instances where children are vaccina-
ted and given a certificate at once, without
waiting to see whether it proved effectual
or not. The blame of course should not
rest upon the school officials, but upon the
physician who gives the permit. May not
one of these children come from an infected
house, and so spread small-pox to others of
like class in the school? Many physicians
are criminally careless about giving such
permits that may be the cause of an outbreak
THE CHARLOTTE MEDICAL JOURNAL.
of this disease, amounting to an epidemic.
The question then confronts us — in what
manner may these many evils be removed,
or at least abated.?
First, by securing proper construction,
ventilation, heating, lighting and furnish-
ing of school houses ; then watching over
the health of the pupils from the time of
their admission to their graduation, correct-
ing habits that may be injurious to health,
and preventing by appropriate measures in
conjunction with teachers, parents and
health authorities, the spread of contagious
or infectious diseases.
There seems a tendency among some
physicians to sneer at the knowledge of
of many Boards of School Commissioners
in their attempts to prevent the spread of
communicable disease, which seems unjust
to these gentlemen, for while their attempts
in many instances are feeble, they are usual-
ly the best their knowledge possess, and un-
til their attention is called to better methods
by the medical profession we should not ex-
pect them to be aware that more effectual
methods exist.
The only successful mode to accomplish
the necessary measures I have indicated is
by the employment of an expert official ap-
pointed by the Board of School Commission-
ers and subject to their authority. Such an
official might be designated as "Sanitary
Supervisor of schools." Such duties could
only be properly performed by an educated
physician who has given especial attention
to hygienic questions, both in their general
and special applications. The duties of
such an official should be to examine all
plans for new school buildings before con-
struction, all school houses before accept-
ance, and school buildings now in use, and
suggest to the Board such changes as will
make them more appropriate from a hygie-
nic point of view. He should examine all
new pupils applying for admission to de-
termine whether they are properly vaccina-
ted ; vaccinate all who need it ; keep watch
over the course of instruction and see that
no children are overburdened in their daily
tasks ; receive due notification through the
teacher or health department of any conta-
gious disease among school children, or in
any house from which children are attend-
ing school. He should be able to give ex-
pert opinion upon paper, type and print of
books before they are adopted. He should
give instructions by lectures or otherwise to
teachers upon the principles and practice of
school hygiene, under such regulations as
the Board may adopt. He should visit ev-
ery school in the county at least four times
a year and make such suggestions for sani-
tary improvements as appear necessary.
He should test the eyes of all school chil-
dren iit least once a year, and keep as ac-
curate record of such tests. He should re-
port annually in writing to the Board of
School Commissioners upon the the work
performed during the year. Special reports
may be required of him at any time upon
questions coming within his duty, and he
might at times aid the Board with advice
and suggestion. It is obvious that political
services would not neccessarily qualify a
man for these duties; and the appointment
should not be contingent upon political
views or activity, but upon his merits as a
student of hygiene. The fact is, a Sanitary
Supervisor of Schools requires knowledge
of a special character, which the general
practicing physician rarely possesses, be he
ever so competent or successful in his own
field. The additional expense to a county
or city to employ such a man would be small
when we consider the fact he would be
school vaccine physician ; and, moreover,
any mony expended in the betterment of
the physical and mental condition of the
young of our land will return profit a hun-
dred times over.
I am inclined to believe the reason so lit-
tle attention is paid to the subject of school
hygiene by school authorities generally is
owing to the indefinite manner in which
these subjects are often presented to those
bodies. Some sanatarians seems to think
that mere assertion is all sufficient and will
carry conviction. This is a mistake. Facts
must be collected and arranged in such a
manner that their significance can not be
otherwise than in their true relations, and
it will then not be difficult usually to con-
vince intelligent public men of their im-
portance and of the duty they owe their
children.
I sincerely trust the members of this As-
sociation are alive to the necessity of school
reform which I have advocated. I would
suggest that any movement to secure the re-
sults, whether by legislation or otherwise,
will be time well spent, and in years to
come this society will have the pleasure of
recalling the fact as being the first in this
State to reform school administration.
Mitosis, or Regeneration of the Endo-
metrium.
By Byron Robinson, B. S,, M. D., Chicago.
Mitosis indicates the star-like division of
the chromatin. It (Karyo Kinesis) is the
process of indirect cell or nucleus division,
(a) from tie chromatin is formed the
wreath, rosette or spirem, followed by the
438
THE CHARLOTTE MEDICAL JOURNAL.
aster or star-shaped body, (b) then pithos
or barrel shaped body is followed by the
diaster or double star. (c) subsequently
the protoplasm separates into two parts,
each of which the chromatin arranges itself
into a cell, the whole called the dispirem.
Two daughter nuclei are thus formed
from one mother nucleus. In mitosis epi-
thelial cells originate epithelial cells, stroma
cells, stroma cells and endothelial cells ori-
ginate endothelial cells; in other words,
elements always originate their kind, (a)
In menstruation fragments of surface and
glandular epithelia of the endometrium, as
well as stroma tissue are destroyed expelled.
Fig. I (Kiefer) represents the gonococcus
and short rod like bacilli in subacute gon-
orrhoea, a, a, a, gonococcus, b, double short
rod bacillus, c, long rods, d, diplococcus
flavus.
Mitosis repairs it. (b) In parturition, the
superficial zone of the endometrium, i, e.,
the compact cellular layer of parallel glands
are expelled with the foetal and maternal
parts, mitosis restores it. (c) In traumatic
abrasion of the endometrium, as in curet-
tage and cauterization, large areas of the
superficial epithelia are fragmented and ex-
pelled. Mitosis regenerates it. (d) In
endometritis glandularis or inter-glandularis
the elements as i, superficial and glandular
epithelia; 3, endothelia, and 3 stroma cells
multiply or proliferate.
Mitosis, perhaps, produces the excessive
cell proliferation. In other words, mitosis
or excessive cell proliferation or regenera-
tion is pathologic. It is the field of hyper-
plasia. The rich mitosis in restoring or re-
pairing elements of the endometrium is a
suggestive study — both as to aetology, prog-
nosis, and surgical intervention. It re-
quires much time and vast material. The
last of which fortunately the service of Dr.
Lucy Waite and myself, at the Mary
Thompson Hospital, furnished a wide range.
The regeneration of the endometrium, as
all investigators announce, is very rapid
w^^^^^
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Fi£. 10.
Fig. 2 (J. A. Amann). Longitudinal
section throngh uterus and vagina of foetus
in second half of pregnancy. Dr, begin-
ning of depressions for (cervical) glands.
Pp, pp, enormous branched papillae in re-
gion of portio vaginalis, c, cylindrical epi-
thelia in cervix, PI, flat epithelia, T, cross
section of uterine end of oviduct. G, vascu-
lar zone of uterus. Observe there are no
depressions for corporeal uterine glands.
and vigorous. In the excellent labors of
Dr. Amann, to whom I am indebted for
excellent cuts, are found many suggestive
views. Immediately after menstruation,
which is chiefly a passive process of the
endometrium, after parturition or traumatic
abrasion, rich mitosis may be observed in
the restoring elements of the endometrium.
The four elements of the endometrium, viz. ;
I, epithelia of the utricular glands, 2, epi-
thelia of the free endometrial surface. 3,
endothelia of the endometrium, and 4, the
stroma cells will be considered during mi-
tosis.
THK EPITHELIA OF THE UTRICULAR GLANDS
This regeneration, showing a rich mito-
THE CHARLOTTE MEDICAL JOURNAL.
sis, is required after parturition and curet-
tage. The division axis is parallel to the
fixed cell base. The newly formed epithe-
lia cells moves rapidly toward the free sur-
face and covers the surface of the connec-
tive tissue between the glandular remnants.
The newly formed cylindrical epithelia is
apparently shorter than the original.
Amann states that in his vast material
secured in the great clinic of Von Winckel
he never saw the utricular glands closed at
the free surface by excessive proliferation,
Ch.T..
Fig. 3 (J. A. Amann). Fragment of tissue removed from the uterus by the cu-
rette a long time subsequent to an abortion. Dc, decidual cells, and Chz, chorion cells
where blood and fibre masses are separated from each other.
^F
Fig. 4 (J, A. Amann). Decidual uterine m extra uterine gestation, expelled spon-
taneously some days ifter Dr, Amann had removed per abdomen a 7 month living
child. The clearly retained decidual cells enclose no utricular glands, only vessels
2, 3 and 4 indicate the different sizes of the decidual cells.
440
THE CHARLOTTE MEDICAL JOURNAL.
mitosis, of epithelia. It is a pathologic fact
that the adjacent stroma may by compres-
sion obstruct the mouth of the utricular
gland, inducing dilitation. However, this
does not make the mouth of the utricular
gland a solid strand of epithelia by exces-
sive proliferation. In vigorous glandular
epithelial cell proliferation the deficiency of
adjacent stroma, and, perhaps, this is the
method by which a single utricular gland ac-
quires two myometrical or fundal branches
and irregular forms, all opening by one
mouth.
The free surface epithelia of the endome-
trium is regenerated by mitosis from the
remnants of the glandular and surface epi-
thelia. This regeneration mitosis is espe-
cially required after menstruation, curet-
tage, and parturition. The mitosis of the
surface epithelia of the endometrium is more
irregular than that of the utricular glands
epithelia. It shows diascers, regeneration
mitosis, multipolar mitosis, giant mitosis,
with vicula; or perhaps degenerate forma-
Fig. 5 ( J. A. Amann) represents the reg-
ular method of epithelial proliferation, mi-
tosis, in the glandular epithelial of the
uterus. In benign proliferation the surface
area, as a single layer only increases. One
of the epithelia represents a diaster (double
star) which lies parallel to the base of the
epithelial cell. The mitotic nucleus is
larger and forced to a higher level than the
nuclei of the resting epithelia. This is the
form of mitosis that represents the method
in which the glandular epithelia is regen-
erated.
tion in the surface epithelia. The strange
irregularity in mitosis observed in the sur-
face epithelia of the endometrium may be
due to the non-resistence offered to the
growing cells in the direction of the free
surface. In any natural process of the en-
dometrium, which possesses the widest
limits of variation of any mucosa, as par-
turition or menstruation, or even the artifi-
cial process of curettage there is always
some surface epithelia left intact, around