Post-nasal »-ashing is necessary where ever the secretions are thick,—that is, composed of mucus and pus,—and also in all stages of atrophic rhinitis. A pint of fluid should not be used if two or three ounces are sufficient to clear the nasal passages. Seiler's tablets, to which may be added a drachm to tbe ounce of boroformalin or borolyptol, are valuable as tbe basis of a solution for these pur poses.
The proper selection of oils and pow ders depends upon the appearance of the mucous surfaces. Powders should not be employed. since they nearly al ways tend to dry on a mucous surface which shows a tendency to atrophy; the oily solutions, on the other hand, are effective. Where the mucous membrane is congested and the secretions thin and watery, nothing is more useful than a powder such as 1 drachm each of boric acid and subnitrate of bismuth, 10 grains of phenacetin, and 5 grains of eucaine.
Briefly, the indications in the treatment of chronic rhinitis are, first, to reduce or remove hypertrophies and swellings, and after that to encourage the return of the nasal passages to their normal condition by proper cleansing, and by protecting the mucous surfaces with a carefully-selected oily solution or with powders. I believe that the benefit to be derived from oily solutions is, first, by reason of the protection they give to mucous surfaces, and, second, by the astringent effect secured through the rapid evaporation of such volatile sub stances as menthol, thymol, and eucalyp tol, and the essential oils.
Atrophic Rhinitis (Dry Catarrh; Foetid Catarrh; Ozama).
This form of rhinitis, though less com mon than the moist and intumescent type just considered, is very frequently seen. Two types of cases should be dis tinguished: First, the true atrophic rhinitis, manifesting itself by the dry and granular appearance of the mucous surface and by the accumulation of dried secretions and scabs, which are seen fill ing the nasal passages. There is atrophy of all turbinated structures, the middle turbinated alone being sometimes ex cepted. Second, pseudo-atrophic rhinitis, a form simulating the former, in which there is a simple dryness of mucous surface and a shrinkage of the erectile structures of the nose and occurring only as an indication of a constitutional condition from any exhausting disease. The dryness and the apparent atrophy here are symptomatic of constitutional debility rather than a clearly-marked nasal affection.
Symptoms.—Atrophic rhinitis is acterized by three leading symptoms, viz.: atrophy of mucosa and bone,
mation of a rapidly-drying secretion, and kutor. With regard to the footor, 4 it does not seem due to the ordinary putrefaction of albuminous substances, but bears a specific character.
Loss of smell is not an infrequent symptom, and in my experience middle ear catarrhs are more frequently associ ated with this form of rhinitis than witb the moist type. Interference with nas.al respiration is caused by the dryness and scabbing, and by the enlargement of the middle turbinated body, which fre quently co-exists.
Study of eighty consecutive eases of oztena shows that disease of the middle or internal ear is a frequent complica tion, occurring in 55 per cent. The middle ear was affected in thirty-eight of the eighty cases and the internal ear in eight, the disease of the former being attributable to closure or irritation of the Eustachian orifice, that of the latter to some constitutional cause, such aa syphilis, tuberculosis, or infectious dis eases which affect alike the nose and the internal ear. Ozcena was found chiefly in young persons, in women more than men; it was usually bilateral, fmtid in 90 per cent. of the eases, often affecting the naso-pharynx, rarely the larynx and trachea,. In a few cases the middle tur binated bodies were hypertrophied or covered with mucous polypi, and in these there was suppuration from the accessory cavities. J. Alorf (Arch. of Otol., No. 4, '94).
The diagnosis of atrophic rhinitis is not difficult even in its earliest stages, where nothing more is present than the conimencement of dryness of the mueous surfaces. But it must be remembered that a condition of dryness of the mu cous surfaces occurs in debilitated per sons, which rapidly tends to self-re covery so soon as the general health is restored. But the common pietnre of grayish. mucous surface in the nostrils too pat-atolls because of atrophied in ferior turbinated bodies, combined with dried secretions attached to all promi nent points in tlie cavities, will readily 37 !.. - d sta, from other forms ' . : • r 1111 ha\ e the moist A.:- of rhinitis inl,:n«1 in the same patient ‘‘ idtiv-tictltttid septum shows a t•,11(1:t ton of the mucous mem - tht narrow nostril, and a dry tondition in the more spacious .-,•: 1,1—t:t. Atrophy seems to have plact in such cases as a result of trphysiological work performed \ the larger of the two anterior cavities.