Simple abscesses sometimes occur beneath tl mucous membrane of the nose, especially aft injuries ; and after passing through an ordinary course leave their usual effects in thickening, induration, and unnatural adhesion of the cica trized tissues.
A thickening of the mucous membrane simula ting polypus has been already mentioned. It oc curs especially in scrofulous children and young persons, and presents the same characters, as to its duration and progress, which are observed in the other chronic intlammations to which they are subject, and with one or more of which it is commonly associated. This spongy thickening usually affects at once the whole or a large por tion of the membrane, though, of course, it is most obvious at the folds on the borders of the turbinated bones. It is sometimes attended by superficial ulceration or excoriation of the membrane ; but even without either of these the discharge has usually a purulent character. If it continue long, this chronic inflammation produces not a mere swelling, but a more solid thickening and induration of the membrane sufficient nearly to close the passage through the nose; or if there have been ulceration of the membrane, a part of the passage may be closed by adhesion of the opposite surfaces of the thickened and approximated membranes. Such obstructions are usually situated near the entrance of the nasal ducts, and when the swelling of the membrane which preceded their formation has decreased , they are drawn out, and look like trans verse thin membranes passing across the cavity, just vvithin the nostrils. Such obstructions are particularly apt to occur when, by obliquity of the septum, one of the nasal cavities is unna turally narrow.
Sometimes, from chronic inflammation of the mucous membrane of the nose, substances are produced altogether unlike the discharges com monly seen. Mr. Csar Hawkins, who has paid much attention to these diseases, speaks of " several portions of substance like chalk in consistence, exceedingly fcetid, and in shape exactly like the spongy bones : they were pro bably composed of phosphate, or perhaps car bonate, of lime, with fetid mucus secreted from the upper spongy bones." A similar case, probably, in which a hard concretion was found in a nose, is recorded by Dr. Grandoni.• In another case, Mr. Hawkins saw small bodies, like half-forined cartilage, which had the shape of the superior spongy bone, and which had been occasionally separated during many years; and in another, a very tough and tenacious mucus which was constantly secreted from a soft and relaxed membrane covering a diseased vomer. The exact condition of the membrane in these cases has not been determined ; in one it seemed connected with diseased bone. The secretion of earthy matter from it is perhaps analogous to that which produces the phosphatic incrustations of the diseased mucous membrane of the urinary bladder.
The ulceration of the mucous inembrane of the nose which attends this state of chronic inflammation is usually superficial. Deep and destructive ulcerations (such as give rise to the symptoms of Ozeno) occur, however, under many circumstances; for example, from ne glected injuries, scrofula, syphilis, Sze. Their
effects are often not confined to the membrane, but are propagated either to the skin, through all the intermediate tissues, or to the subjacent cartilage or bone, which then are ilcerated or suffer necrosis secondarily, as, more rarely, they do primarily. The appearances of the ulcers from various causes do not materially differ. They may commence in any part of the nasal cavities; but they are said to be most frequent near the exterior in common or scrofulous ul ceration, and in the more interior parts of the membrane in syphilis. Their first appearance is in the form of a small pustule or collection of matter beneath the membrane; and the ulceration by which this opens exterbally makes progress more or less rapidly, spreading in both extent and depth without any'signs of resistance to its course in the adjacent textures. When such ulcers have exposed the cartilages, these are gradually perforated by the ulcerative process ; they do not suffer necrosis, but in this, and probably in all their morbid changes, they follow the course of the articular cartilages, which they resemble in their structure and in their exemption from being ossified. The sep tum is the part in which the effects of such ulcers are most commonly- seen. Sometimes it is perforated through its centre, and, in these cases, though the aperture he large, the shape of the nose may be unaltered, for the remain ing borders are sufficient for its support. But when a part of these borders is destroyed, de formity is the certain result ; the point of the nose is drawn backwards and downwards when the lower part of the septum is destroyed ; or the rniddle of the bridge falls in, and the, point projects and is turned upwards when the upper part is lost ; or, when the destruction is more general, the nose falls nearly flat below the nasal bones. When the ulceration reaches the bones it may continue to spread through them, destroying them gradually without necrosis ; or, if its progress be rapid, or matter collect beneath the periosteum, so as to expose a large surface of bone, this being depnved of its supply of blood, perishes and gradually ex foliates. Thus, the nasal bones, or lame por tions of the septum, or the turbinated bones, and parts of the palate may be destroyed, arid the most hideous deformities he produced. Sometimes, no doubt, the syphilitic affections of the nose may commence in the bones or cartilages themselves; but, most commonly, they are affected secondarily after being ex posed by the destruction of the mucous mem brane. In the worst cases, the ulceration spreads with a ragged sloup,-hing to the mem branes of the palate, pharynx, and other ad jacent parts, and through them to the bones and other tissues which they cover. The dis ease has its centre of severity in the nose, but the pain around the nasal cavities indicates a simultaneous slighter affection of the adjacent sinuses; sometimes, also, it extends to the membranes and substance of the brain ; and sometimes it passes up the nasal duct and pro duces all the signs of fistula lacrhymalis.