Treatment.—A purulent rhinitis due to the gonoCoccus requires careful dis infection by means of Seiler's solution, to which may be added a 10-per-cent. solution of "boroformalin," or boro lyptol. After all secretions have been washed away probably nothing- better may be used than a powder of subnitrate of bismuth and boric acid.
Chronic Rhinitis.
General Considerations.—This seems the best name for this affection; indeed, we can no longer use as a synonym "hypertrophic rhinitis," hypertrophy be ing far from always existing. The same causes may produce in one ease only in creased secretion, in another intumes cence, while in a third the entire mucous and submucous structures may become permanently thickened. Chronic rhi nitis is a complex entity, made up of several clinical conditions which differ widely from one another. Leaving for convenience entirely out of considera tion atrophic rhinitis, which, while it may exceptionally follow the common form of chronic rhinitis, is probably a different malady, we have first to tinguish theoretically-, rather than tically, between chronic catarrhal and chronic purulent rhinitis. The last named affection is rather a symptom of several widely different affections than a distinct disease. A discharge of pure pus from the nose is seen, for instance, in connection with foreign bodies and rhinoliths, with sinus disease, and with any form of ulceration within, the nose (syphilis, glanders, etc.); it also panies post-nasal adenoids in children.
[Griinwald, alluding particularly to nasal suppuration, argues that pus is formed whenever the secretions of ordi nary inflammation cannot find suitable drainage. As a rule, a true purulent dis charge is confined to one side of the nose, because the exciting cause is generally unilateral. A purulent discharge is often fret:A, and, according to Griinwald, very large part of what is termed ozmna is simply fietid suppuration in connec tion with undrained secretions (when, for any reason, there is an impediment to either the forward or backward exit of intranasal secretions), as in ethmoidal or other sinus disease, foreign bodies, syphilitic or other ulceration, etc. It has been claimed that very young children may suffer from chronic suppurative nasal discharge which has been ascribed to the continuation of a nasal gonor rhcea contracted soon after birth or to early inherited syphilis.
Nasal suppuration, then, is an impor tant subject clinically, but does not rep resent a distinct pathological process and has little in common \vith chronic catar rhal rhinitis. CLARENCF. C. RfcE.]
Chronic catarrhal rhinitis is divisible according to the stag,e or degree of the process into simple and hyperlrophic, while the progressive tendency of the disease to lead to the production of tumor-like formations has been charac terized as a terminal stage. Of the so called intranasal neoplasms by far the greater part may be shown to originate in this manner. The papillomatous or mulberry-like growths which are fre quently seen upon the posterior end of the lower turbinate body are merely an advanced stage of hypertrophy peculiar to this locality-, while the poly,Ti so com monly seen in connection with rhinitis affecting the middle turbinated have a more complex origin, but are generally admitted to be dependent upon pre existing inflammation either of the mu cosa of the affected locality or of one or more of the neighboring sinuses.
There is, however, another element to be considered in connection with chronic rhinitis—one which has greatly compli cated the understanding of the disease by: the general practitioner. We refer to the phenomenon of intumescence, which is due to turgescence of the erec tile tissue over the turbinate bodies. This swelling and consequent obstruc tion, for the time being, of the nasal fossao, or rather fossa,—for it is almost invariably- unilateral, although readily alternating from side to side,—is a -feat ure which may occur in health as a pure reflex from a variety of eauses.—sueli as irritating vapors, the menses. sudden exposure to cold, etc., or in an acute coryza or hay fever. lit chronic rhinitis, however, iL plays a highly important part; so. much so that to many general practitioners this intumescence is mis taken for hypertrophy. Intumescence, however, usually involves the anterior aspect of the turbinates, while real hy pertrophy is apt to be posteriorly situ ated: intumescence is practically a uni versal phenomenon, while hypertrophy is hy no means frequent. The gravity i. 1 s Ins in the fact that ...‘ lion& rs -burn :interior under the impression that d(stro)ing hypertrophied tissue, ..1-.1 Litt n.11y Rum\ ing, a permanent in-ttad of cauterizing a compara -‘,1% membrane. Some au ,,.wr :its. such as ingals and .lacnon .1 ana otlurs. probably with a view of re%tntin - this blunder. have divided r. 1(. rhinitis into intumescent and I vi rtr•phic: but. of course, there is to prevent the occurrence of in .Lnee in a nose the seat of hyper lt would be correct, however, slkak f simple intumescence and in t..n.t =..(nce with hypertrophy.