With regard to the bacterial origin of ozmna aside from the possible role of the staphylococcus in infancy, it appears safe to say that, despite the several varieties of organisms identified with the disease by various investigators, all hitherto described play no further riile in the disease than as elements of putre faction or desiccation.
The bacillus of Abel is claimed by its discoverer and by others to be the actual cause of this disease. If a bacillus has been found which can generate the rap idly drying, foetid secretions, the at rophy may be explained by the pressure effects of these tenacious scabs upon the mucosa. It is claimed that the ozvena which is caused by Abel's bacillus may readily extend to the sinuses and there cause suppuration.
Ozmna believed to be caused by an at tenuated bacillus identical with that of Loeffler, but Ivith virulence much less ened; this was found not only on the surface of the mucous membrane and in. the exudate, but beneath it. It prob ably causes a chemical eliang,e in the secretion and a resulting atrophy. Eel fanti and Della Vedova (La Sett. Med., Apr. 4, '96).
In a series of 100 eases, examined with. special reference to the Klebs-LocIller bacillus, 20 Were found having chronic atrophic rhinitis. These bacilli and others Were found in 26 different eases, of which 11 were atrophic.. The presence of the bacilli WIIS attributed to infection, a pathological condition in the nasal chambers providing a suitable soil. Van sant (dour. Amer. Mcd. Assoc., Feb. 27, '07).
The important qurstion of the eti ology of atrophic rhinitis is therefore narrowed clown to a single alternative: It is due purely 1 o a congenital or in , berited condition, or it is dependent upon a pathological process following .1: • I 11,1. \ I/ : purulent ca .. N‘i .1 si.tpicl of nasal gonor 7h..-.1 .1 t- unplication of congenital If suoh a group is recog-nized ; •, L-uld be no possible reason for cast.s of scarlatina in which nt rlinutis co-existed; nor, in fact, tlar condition capable of contribut to the maintolance of this forth of r ,.1.,tis.
Tin: weak point of the staphylococcic tt,•,t1 is the almost complete absence of kast.s cr siatistics to support it. The
lam dicade should witness the solution .1 this problem.
[7.ntkerkandl, in the course of many autopsies on newborn children, failed to iind any congenital anomaly like insuffi cient development ot the turbinated bodies. The hypothesis, therefore, that these bodies. are unable to present suffi vient mucous surface to take up enough moisture to prevent the desiccation of the nasal mucus must be explained on some other ground than congenital de fect But we are naturally forced to admit that if this atrophic condition is not congenital it must be acquired in early childhood as a sequel of a purulent catarrh. CLARENCE C. RICE.] While a certain degree of atrophy may f. How a long-standing chronic rhinitis, true atrophic rhinitis is a disease sui 3ezieris, the nature of which still remains partly in obscurity. Like chronic rhi nitis proper, it appears to be essentially redisposecl to by some abnormalities of •l e ne-al passages, not alone of its os :,rius frame-work, but of its epithelial in:nz, as well.
Treatment. —While atrophied tissues Inn t be replaced by any medical or .r;ical treatment, it is encouraging to r., te that proper remedies can relieve the patients of the distressing local dry r f..=_=. and of the Retid odor they exhale.
Although many drugs have been em ployed in the treatment of atrophic rhinitis, yet they have nearly all been used upon the general principle of ducing what is called by some "stimula tion,- by others "irritation." These two terms, 1 imagine, are alike in kind, fering only in degree. The German school, clinging to the belief that this disease is due to the presence of bacilli, advocate the use of solutions of ride. Koch tells of the great benefit and complete cure in some cases of atrophic rhinitis by the use of a spray of 1 to 4000 mercuric bichloride. Lowenberg always uses antiseptic douches of mercuric chloride (1 to 4000), having first re moved the crusts with warm saline solu tion. Thost applies bichloride of cury in a solution of 1 to 2000 with a camel's hair brush twice a day. Many clinicians have adopted this measure.