In the great majority of cases, if not in all, the bacteriological diagnosis is the only safe one, and all cases should be considered as diphtheria until the con trary has been proved by cultural meth ods. In the meantime isolation and dis infeetion should be insisted upon. AI. P. Ravenel (Med. News, May 25, '95).
Twenty-three cases of fibrino-thinitis, of which eight, or a little more than one third, revealed no diphtheria bacilli. I). B. Kyle (N. Y. Med. Jour., July 6, '95).
One hundred and twenty cases of croupous rhinitis or membranous rhinitis reported in various papers collected. In fifty of them there appears to have been a bacteriological examination, and in sixty-five a positive result as far as Klebs-Loeffier's bacillus. J. T. Campbell (Ann. Otol., Rhin., and Lan, Aug., '97).
it is a rare affection, and the rbinolo gist has but few opportunities to study it.
It has been thought that the gouty, rheumatic condition is a factor in produc ing it. Differential diagnosis will always have to be made between it and nasal diphtheria. In addition to microscopical aid perhaps these differential points are the most marked: Nasal diphtheria oc curs in children, croupous rhinitis usu ally in adults. The exudate in nasal diphtheria is more yellow in color, is soft, friable, coming away in small pieces, whereas the cast found in croup ous rhinitis may be removed entire, and is whiter and firmer. A bleeding sur face will be found beneath the diph theritic membrane, but not in the pa tient suffering fi,lom croupous rhinitis. In two out of five cases of croupous rhinitis which I have seen the patients had no constitutional disturbance and were about all the time. The disease does not last more than four or five days. During the first two there is a strong tendency to reformation of the membrane when it is removed. As has 1. • ery nitwit re • 111 Nolo h sometimes follows 74.• .1' the g,.11‘dnoenittery, or which e.: - Jr. or the point of the puncture • zi.r.okli the anterior pillar of the (It an attack of peritonsil Treatment.—The course of this I mitvd to a few days. Internal inav be administered if there .)ing. acute nasal disturbance. IL•11,1111 of the disease will not be siort.oni I' bv the removal of the mem-. bv overwashing The removal d secretions by irrigation and insulllation of a boric-acid powder, t \%hieli may be added a few g-rains of pondered alum. are usually sufficient.
Iz is wise to isolate the patient and to burn the cloths which receive the nasal in croupous rliinitis iron exercises pe culiar influence in controlling the fibri 1.ons exudates. Mercurial preparations also exert a decided curative effect upon the disease, especially in children, and pref,renee should be given to the mild chloride. giving a child six years of age 1 grain every four hours, or oftener. The calomel treatment should be thoroughly te.ted in the early stages of the attack in children, but if no decided ameliora tion of symptoms are noticed by the end of thp second day, then the iron treatment should be sub4ituted. Bulson ,Columbus Med. Jour., Oct. I, '95).
Purulent Rhinitis.—This is known to 1.e due in individual eases to the gono t-rwctis. streptococcus (scarlatina), and th.-, special erysipelas-foceus and prob ably also to other bacilli. It is purulent from the .start, and the symptoms wit nr.....ed in an ordinary catarrhal eoryza ai.F.unie a more violent character. This type is extremely rare in adults, and is probably far from unusual in very young children; but definite data are lacking cpon this point.
The appearance of the nasal passages is similar to that seen in acute coryza, with these differences: whereas in the latter the secretion is a watery serum, in the former it is a thin, yellow pus which has not the adhesive quality so markedly as has the pus which has its origin in the accessory cavities.
A differential diagnosis must be made between this form of rhinitis and the many cases in which there is abundant muco-puralent secretion—sometimes al most entirely purulent because of de fective posterior drainage, as in children with adenoids or in adults with polypi. A purulent secretion symptomatic of dis ease of the accessory sinuses is, as a rule, unilateral, and but little difficulty is ex perienced in tracing the secretion to the special locality affected. The nature of a unilateral purulent discharge caused by a foreign body, or a specific ulcera tion. or occurring during one of the eruptive diseases is readily recognized.