SUMMARY Good correlation has been shown between pain scores derived from 4 different rating scales. The correlation was maintained when presentation of the scales was separated by a series of questions and by physical examination. There is good evidence that the 4 scales are measuring the same underlying pain variable as they calibrate well. There is also evidence that an 11 -point (0-10) numerical rating scale performs better than both a 4-point simple descriptive scale or a continuous (visual analogue) scale.

The quantitative anatomy of the bronchi has been studied in sudden deaths in normal subjects, in deaths from status asthmaticus and chronic bronchitis, and in patients with emphysema. In the normal bronchi the observed range of values for the percentage volume of mucous glands was between 7 6 and 16 7. In the status asthmaticus group the mucous gland volume was greatly increased and in no case was there an overlap with the normal subjects. In a previous paper (Dunnill, 1960) the pathological anatomy of the bronchi in asthma was described with special reference to the mucosal changes. The outstanding feature at necropsy was the presence of numerous plugs of mucus in the airways. Histologically, shedding of the ciliated bronchial mucosa cells was prominent, and this was attributed to a transudation of oedema fluid from the submucosa. The loss of the ciliated epithelium, together with interference with the action of the remaining ciliated cells by the oedema fluid, were considered to be the essential factors in the failure of clearance of the bronchial secretions in asthma. The finding of smooth muscle hypertrophy emphasized by Huber and Koessler (1922) was also noted. The present paper is concerned with the quantitative differences in the bronchial wall between normal subjects and those with status asthmaticus, chronic bronchitis, and emphysema. MATERIALS AND METHODSThe bronchi were divided into four groups, and were from (1) normal individuals who had died suddenly, usually a traumatic death, with no previous history of chronic bronchitis; (2) patients who had died in status asthmaticus; (3) patients who had died with a history of chronic airways obstruction with expectoration and who, on pathological examination of their inflated lungs, were found not to have any destructive emphysema-chronic bronchiti^s; (4) patients who had died with chronic airways obstruction and were found at necropsy to have one of the varieties of destructive emphysema.The majority of the lungs were fixed by the formalin steam method of Weibel and Vidone (0961). but in the status asthmaticus lungs, due to the dense bronchial exudate, this was often not possible. and the lungs were fixed by perfusion of the vessels wvith 10% formol saline.Transverse histological sections, 5/1 thick, were taken at three different levels from each bronchus selected (vide infra). Points of bifurcation were avoided. The sections were stained by the Masson trichrome and periodic acid Schiff tethniques, as well as by haematoxylin and eosin. Sections. viewed with a Leitz Ortholux microscope fitted with a x4 objective and a projection mirror, were projected on to a piece of Bristol board with a point-counting grid drawn on it, the points being placed at the angles of equilateral triangles of side 0-6 cm. The details and rationale of the point-counting procedure have been described in previous papers (Dunnill, 1962;Anderson and Dunnill, 1964). Points falling on the bronchial wall were allocated to cartilage, muscle, mucous gland or 'connective tissue'. The latte...

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