ltromoform recommended as a topical ii.plication in atrophic rhinitis after thorough cleansing with hydrogen diox ide. S. Solis-Cohen Oled. NCIVS, July 11, 'Oh.
One of the most valuable agents was ul..ta;ned when the various oil prepara tv.ns came into use. As protectives they are eL rtainlv sedative in their effect, and s.1 allay irritation: as lubricants, they iiromit the formation and retention of abbv crusts; as vehicles for stimulat imz drugs, they hold them in position f ,r a much longer time than when %%atery solutions are employed. Many drm_rs. have been used, in oily solution, in the treatment of atrophic rhinitis where disinfection as well as stimulation ‘%as desired, such iodol, aristol, iodo f min, etc.
In reg.ard to nasal irrigation it is wise unploy the smallest quantity of fluid which will adequately clean the nasal pas.sages, and, except in extreme cases of -nasal oztna, the post-nasal syring.e is an idequate instrument. Sometimes pa tients succeed better in removing the dried scabs when they fir:A spray oil into the nostrils.
There are not many cases in which the nasal douche-cup does not furnish .11tlicient fluid, if the saline solution— and we like Seiler's as well as any—is allowed to remain in the nostrils a few moments in order to separate the drv secretions from their attachments. This is a wiser procedure than using greater force with the fountain-syringe, or blow ir.g. the no:Arils with great intensity.
When the nostrils are cleaned, if the middle turbinated body offers much ob struction or is wedged against the sep tum, it is desirable to make a channel be tween the two, and this can be done by removing the soft structures and perhaps a small part of the bony tissue with scis sors. The snare is hardly a safe instru ment, as it will sometimes remove the entire middle turbinated body; and with the crushing forceps more tissue is fre quently taken away than is expedient.
It is most important to correct the .01anular surface of the mucous mem brane, which frequently presents small ulcerative points where the scabs have been attached. Friction with a stimu lating disinfectant is much better than applications of nitrate of silver or of any other drug.
The use of weak solutions of bichlo ride, or of 50 per cent. of borolyptol or of boroformalin, applied by rubbing the mucous surface with a hard cotton pledget for perhaps half a minute at a time, produces, after a few applications, not only an even surface, but a slippery one, whereas solutions of nitrate of silver nearly always leave the mucous mem brane granular enough to retain the se cretions.
After the washinv, at home and the stimulating friction at the office, the next most important procedure is suit able and constant lubrication with oils. No special advantage is obtained by in corporating the niany drugs which have been mentioned in the oily solutions. Protection and lubrication are to be in sured. The matter of stimulation is a very uncertain factor, and, if great stim ulation is produced by pungent drugs, greater dryness results.
In those cases only where there is a tendency to subacute inflammatory at tacks with discharge of watery secretion should powders be employed. We see this condition in children in which a purulent rhinitis is rapidly assuming an atrophic state. A combination of 75 per cent. of compound stearate of zinc with boric acid and 25 per cent. of pound stearate of zinc with alum is especially useful. This powder should not be used after the discharge has been stopped and congestion controlled, as it tends to produce dryness. In the markedly congestive forms of atrophic rhinitis seen in immoderate smokers and drinkers, this powder is also valuable.
Too much attention cannot be paid to the improvement of the general health, particularly by fresh air and healthful exercise. Ziem ordered his patients to the sea-shore or to the woods for a certain time each day, in order that they might, as he expressed it, "thoroughly ventilate their nostrils." Probably the sea-shore is better for these cases than the mountains.
By far the greater number of eases of nasal purulent discharge appearing as oaentt are referable to affections of the sphenoid and ethmoid sinuses. netor, atrophy, and crust-formation may also be expressions of a number of causes. Hence treatment of ozirna can only be rational when applied to its primary cause. Since these are mostlysphenoidal or ethmoidal, the therapy of oziena must be a surgical one. -Nobel and Lohnberg (Berliner klin. Woch., Mar. 20, 1900).