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Acute Rhinitis Coryza

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ACUTE RHINITIS (CORYZA) attacks children more frequently than adults and, with especial predilection, nurslings. Mechanical, chemical (io dine), and thermal irritants often furnish the cause. Mostly, however, a coryza is infectious in its origin. Among the multitude of pathogenic germs (pneunio-, strepto-, staphylococci, meningococcus intracellularis), which are present, it is often impossible to determine which are causa tive and which are merely present as incidental attendants. Not infre quently, a seemingly simple coryza depends upon infection with true diphtheria bacilli, which quite often appear as a harmless accompani ment of the ordinary coryza in the nursling (Stooss, Bailin, Schaps), but only exceptionally upon gonococci. In infectious diseases coryza very frequently occurs secondarily; as a regular forerunner it is seen in measles, grippe, and influenza. The bacterial nature of a coryza explains without further comment why contagion is of such extraordi nary frequency. According to my observations, the disease may also manifest itself in other members of the family as an angina or bronchitis.

Exposure to cold, no doubt, plays an important role in the produc tion of coryza, and in young infants especially it nmy be held responsi ble with the greatest certainty (careless bathing, taking out in rough weather). The healthy nasal mucous membrane rapidly destroys the majority of the invading germs and harbors only a small number of them in its anterior portion. The beginning cold probably acts in such man ner as to tempormily suspend the bactericidal properties of the nasal mucous membrane, so that the germs which are present, and those re cently introduced by the respired air, may develop undisturbed. Per sonal predisposition is of great significance, and may be of a general or local character. Children suffering from chronic rhinitis and adenoid growths are repeatedly attacked by fresh colds from the most trivial causes; likewise also, anfemic, debilitated individuals. Frequent changes of temperature, cold east winds, unclean, dusty, but especially over heated dry air of the room, act injuriously. I have frequently observed hay-fever in children of four years and upward.

Symptoms and and swelling of the nasal mu cous membrane with copious discharge which, at first, is thin and watery, but later mucopurulent are the well-known symptoms of a simple ca tarrhal rhinitis. In severe infections (diphtheria, scarlet fever) the dis charge is often purulent (rhinitis pundenta). In older children, as in

adults, coryza usually runs a harmless course and rarely leads to serious ffisturbances. On the other hand, in very young infants, particularly during the early months of life, it may become exceedingly menacing. In these cases, the disease at times commences with an elevation of tetn perature as high as 40 °C. (104 °F.). or even convulsions, and may seri ously disturb the nutrition. In consequence of tbe very narrow nasal passages a complete stoppage of the nasal breathing easily occurs, which niay lead to a dangerous asphyxia in the newborn, since they do not know how to breathe through the mouth. Cases are also recorded where the increased fruitless respiratory movements have caused a backward aspiration of the tongue; and threatened suffocation was only averted by drawing it forwards. The impeded or interrupted nasal breathing also constitutes an itnpediment to nursing, and every few rnotnents the tortured infant releases the nipple in order again laboriously to draw some air into its lungs through the mouth. Sleep is also seriously dis turbed, since the infant seeks to relieve its want of air by breathing through nose and mouth alternately. The laborious and overworked breathing causes great fatigue, suffocative attack.s, and may lead to pul monary atelectasis, which together with the inanition resulting from the insufficient ingestion of food, may bring about a fatal termination in the exhausted infant. Even sudden deaths have been recorded in se vere coryza of the newborn (Baginsky) (without bronchiolitis?). In older nurslings also, as well as those of older years, coryza is attended with manifold dangers. At this age, the catarrhal inflammation is apt to extend, and often leads to false croup, bronchitis, and bronchopneu monia. The nasopbaryngeal space and the tonsils quite regularly par ticipate in the catarrh. Sometimes also, the coryza results in an enlarged tonsil. From thence, the intiamtnation is apt to extend to the Eusta chian tubes and the tympanum. Otitis media is an exceedingly frequent complication of coryza in young infants. It may frequently progress unobserved, but may often cause high fever and convulsions, and may lead to rupture of the tympanic membrane, also to mastoiditis. Otitis media is especially favored by adenoid growths.

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