YPERTROPITIC ItIIINITIS is a phe Lomenon believed to depend wholly,' pn intumescence, which occurs only :n certain areas provided with erectile tisosue.
Tile c ,n,tant determination of blood ,o the erectile tissues of the turbinate 4/7d:es has. the tendency to carts.e hyper •rr.phic thickening. of the mucosa in thce localities. Several points, how r-r, remain obscure. In some indi viduals intumescence of years' duration (ices not produce hypertrophy, while in (titer cases the latter change sets in rapidly. Still more difficult to under stand is the much greater tendency of the po!,terior end of the lower turbinate to undergo hypertrophy, although the remaining surface of the turbinate bodies is equally inclined to turgescence.
The general practitioner always, and 'WU believe, justly, lays stress upon car diac, pulmonary, hepatic, or renal affec tions which are competent to disturb peripheral circulation and so produce active or passive nasal congestion as fac tors causing nasal turgescence. The use of alcoholic stimulants and tobacco are potent factors., as is exposure incident to the irritation of many peculiar occu pations. But far niore important than these is the fact that in the great ma jority of cases nasal intumescence and hypertrophy are caused by the same pre existing nasal conditions which have been mentioned as tbe cause of acute rhinitis.
Treatment, —The treatment of chronic rhinitis is to-day largely operative, but I must be careful to explain that I use this term even in describing such moder ate forms of treatment as the application of chromic acid or the galvanocautery to hypertrophied tissues. The primary indications in the treatment of chronic rhinitis are to remove obstructions so that nasal breathing, circulation, and drainage will no longer be interfered with. If crests and spurs on the septum are present and by their irritation pro duce intumescent swellings, what is more reasonable than that they should be removed? No single instrument answers for the removal of all forms of enlargement or for correction of deviation of the nasal partition. It is always well to remember
that as little of the mucous surface as possible should be destroyed. The saw is particularly applicable for the removal of enlargements of the cartilaginous sep tum, and, as a rule, there is sufficient thickness to enable the operator to re move enough of the obstructing septum without producing perforation.
It is often difficult to commence the incision with a saw, but this can be facilitated by- turning the patient's head toward the nostril which is to be oper ated upon, thus causing the convexity of the septum to become as prominent as possible. In commencing the saw can be directed almost at right angles to the partition. After the incision has been carried down to the bony sutural line the remainder of the separation may be effected with sharp-cutting nasal scissors and the piece removed with nasal for ceps. It is wise to protect a nasal ulcer ation made by saw and knife with a pow der, like boric acid or iodol, rather than to attempt to prevent sepsis by unsatis factory nasal washings.
If the cutting is properly done com pound stearate of zinc and boric acid will almost always prevent symptoms of sepsis. If the patient shows a rise of temperature and suffers it will be neces sary to commence post-nasal washings with an antiseptic solution. All danger of sepsis is past in three or four days, and then it is better to discontinue pow ders and remove accumulated secretions by irrigating with a post-nasal syringe.
If the septum deviates too slightly for the use of the saw, it will be found use ful to reduce the thickness somewhat by linear applications of chromic acid or trichloracetic acid. Instead of fusing crystals on a probe it is more convenient to add a few drops of water to the crys tals, thus making a saturated solution. Care should be taken not to daub this solution over the general surface, but rather to carefully localize the applica tion.