Chronic foul-smelling purulent discharge from the nose, accompanied by the formation of offensive crusts, is almost always the result of an Atrophic Rhinitis which has commenced in early life. Though the atrophy which has widened the nasal passages and caused the destruction of the ciliated epithelium can never be expected to disappear, nevertheless a rigidly conducted plan of continuous cleansing with mild antiseptics will procure freedom from the intolerable fcetor of the patient's breath, of which, however, he is usually himself unconscious from atrophy of the terminal nerves of smell.
In dealing with ozxna the essential point is to remove the thickened secretion upon whose presence the fcetor depends. Every crust should be washed away, and no mucus be allowed to accumulate. As long as secretions are permitted to remain, decomposition speedily sets in, and the diseased surface is never free from irritation. Ilence the necessity for the persistent use of the nasal douche, which consists of a soft rubber tube, with a nosepiece at one end and a lead-sinker at the other. This latter is dropped into a jug of warm water, in which a teaspoonful of common Salt or Bicarbonate of Soda and Borax is dissolved, and after starting the fluid to run siphon-wise through the tube, the jug is elevated as the end of the douche is inserted into one nostril. By keeping the mouth wide open the soft palate is raised and the posterior nares cut off from the mouth and pharynx, and as the water flows in through one nostril it courses round the nasal chambers and flows from the other nostril. At the start of treat ment till the nasal passages have been freed from all old crusts it will be desirable to use the ordinary rubber Higginson's enema apparatus, and any adherent crusts which withstand the strong stream of saline solution must be removed by friction with cotton-wool on a stout probe. The patient soon learns to use the syringe or douche himself, and he should be directed to resort to it at least thrice daily till an impression is made upon the case. Ile should be made to blow forcibly clown each nostril to clear away all septic matter from the Eustachian orifices.
Lack advises after each thorough cleansing of the nasal passages by the syringe that the nose be lightly packed with a strip of Cyanide Gauze about inch wide and i foot in length. This is to be done twice daily and the
packing maintained day and night for several months, after which it may only he resorted to at night.
Most surgeons rest content with thorough cleansing by the Borax and Soda solution followed by the use of a stream of any of the antiseptic solutions to be presently mentioned.
The most efficient cleanser and deodoriser is Peroxide of Hydrogen, swabbed over the diseased membrane by cotton-wool; the brisk effer vescence which follows when the liquid is brought into contact with pus assists greatly in the detachment of crusts and reaches hollows inacces sible to fluids.
After each thorough cleansing the interior of the nose may be smeared over with )iluted Citrinc Ointment or sprayed with an oily solution of r dr. of the strong ointment or I() grs. Menthol dissolved in i oz. Liquid Paraffin.
The following antiseptics in the quantities mentioned may each be dissolved in i pint of tepid water and used as a disinfecting douche after syringing with the alkaline borax solution: Carbolic Acid, i dr.; Liq. Soda: Chlorinate, 2 drs.; Sulphurous Acid, 4 drs.; Permanganate of Potash, 5 grs.; Jeyes' Fluid, 2 drs.; Sanitas, i oz.; Glycerin of Borax, I oz.; Chlorate of Potash,' dr.; Tincture of Iodine M., 4o mins.; Boric Acid, oz.; Perchloride of Mercury, r gr.; Zinc Sulphate, dr.; Zinc Chloride, 5 grs.; Nitrate of Silver, io grs.; Chloral Hydrate, io grs.
Dry insufflation of Iodoform, Alum, Tannoform, Boric Acid, Calomel, Bismuth, Aristol, or any of the iodoform substitutes may be employed when the discharge is excessive, but as a rule antiseptics either in powder or in strong solutions should not be employed, the aim being to keep the diseased membrane moistened so as to prevent the spread of hard crusts, and this is best effected either by packing or the use of oily solutions; hence also astringents are not advisable as a routine. Lowenstein, how ever, uses insufflation of Aristol and claims excellent results. A good method for keeping a moist and antiseptic condition of the nasal membrane is to plug loosely with cotton-wool saturated with equal parts of water and Glycerin of Borax, when for any reason oily solutions applied by the atomiser cannot be tolerated.