Etiology and Pathology.—In the ed . '.. _v of atrophic rhinitis cause and effect s tin to have been hopelessly eon f..i.ndtd. It is an admitted fact that the shape of the nose is peculiar to the .1;:ease—that the nasal fossre are ample old the turbinated bodies small; but t‘hile some authorities regard these tiai.gts as a part of an atrophic involu 7:•.n, others regard them as antedating dista,e and contributing to its pro (:netfon. The fact that the nasal cavities in atrophic rhinitis are lined with squa mous epithelium in place of the colum nar ciliated variety has also appeared to me to influence the development of the disease. However, cumulative evidence -tents to be on the side of the theory of a primary underlying deformity. The recently published essay by Aleissnir, in .vhich many elaborate measurements xere given, appears to prove that the fiat. depressed nose of ozmna is a con- , tributory cause, and not a result of the di,eas.e; and that the epithelial meta- . :.lasia by which pavement-epithelium appears in place of the natural colum- , rar variety is a primary condition, and m.t the result of local disease. A some- what analogous condition may be seen in the coarse skin and epithelial changes which play so prominent a part in calls :ng many cases of acne juvenilis.
It seems beyond dispute that atrophic rhinitis is a disease of the formative period of life, and that in most cases it has its beginning at a very early period, even the first few years of life.
As in all similar affections, the leading question must be to determine whether atrophic rhinitis is actually congenital or acquired through the action of causes operating in infancy.
In 142 cases in private practice SO Were males and 62 females; the youngest was 6 years of age, the oldest SI ; 58 were betw een 25 and 40 years of age, 37 were between 15 and 25, only three m ere under 10, 15 were between 40 and 50, and were between 60 and 65. Of these eases, 55 complained of fcetor, more or less marked. In 47 the sense of smell was impaired, in 20 there was an osmia. In 2S of the eases the hearing was affected. Preceding history of the catarrhal condition before presenting themselves for treatment showed that they had suffered from seven to twenty five years in 72 of the cases, and less than two years in 25. Only 8 of the cases showed signs of tuberculosis, 1 of them being laryngo-pulmonary tubercu losis; in 2 there was distinct scrofulous history; in 5 there was a history of syphilitic infection. J. E. Rhodes (Jour. Amer. Med. Assoc., June 26, '97).
While Lowenberg's observations show ing that the bacillus mueosus was pres ent in all eases of atrophic rhinitis and is its primary etiological factor, it is only responsible for two disagreeable symp toms: fcetor and crusts. Cozzolino (An
nales d'Otol. et de Rhinol., Aug., '99).
A large number of microbes isolated from the nasal discharges of oztuna, and examined as to their pathogenic effect in animals. Fraenkel's diplococcus, strepto cocci, and pyogenie staphylococci, encap sulated, and bacilli were found to be devoid of pathogenic action. Whether inoculated together or separately, they gave rise to no specific disease in the nasal cavities of healthy animals. There is probably some primary anatomical lesion which favors the growth of the various organisms found. De Timani (II Policlinic°, Aug. 15. '99).
The specific cause of ozmna and rill noseleroma has been a bacillus bearing. clo:,e resemblance to the Friedlander bacillus. No biological or morphological difference could be detected on animal experiments and agg,lutination tests. In ozmna and seleroma the Friedlander bacillus merely finds favorable condi tions for active proliferation, but it plays no part in the etiology of either disorders. F. Klemperer and AI. Scheier (Zeit. f. Min. Med., vol. XIV, NOS. 1 and 2. 1902).
An increasing number of experienced clinical observers ascribe atrophic rhi nitis to the action of certain severe dis eases during the first year or two of life, viz.: nasal gonorrlicea and inherited syphilis of an attenuated type. If this school of clinicians is correct in its views, the peculiar changes in the shape of the nose and in its epithelial lining would have to be attributed to the ef fects of one or the other of these dis eases upon the undeveloped tissues of the child.
Gonorrhcea and syphilis have little in common and the coupling together of these affections in the etiology of a given disease may appear to be a forced at tempt to connect disease with vice. As a matter of fact, however, both these affections provide a ready soil for the action of ordinary pyogenic germs. In long-standing urethral gleet it is not the gonococcus, but the staphylococcus, which we encounter. The syphilitic diathesis, whether it be congenital or ac quired, offers special predisposition to suppuration. The two diseases then could contribute to atrophic rhinitis by producing a true purulent catarrh of the nose, which ought to produce far greater ravages than does ordinary catarrhal rhinitis, and produce them much more rapidly. It is quite conceivable that a purulent rhinitis in an infant could in terfere with the onward development of the turbinate bodies and at the same time practically destroy the mucosa.