By the term rhinitis librinosa or pseudomembranacea is desig nated an affection of the nose which appears as an ordinary coryza with scanty mucopurulent discharge, but in which fibrinous membranes are expelled in a surprising manner, a process which may be repeated from. time to time. Very often only one nostril is affected, so that the obstruction is not very great. Withal, the general condition remains undisturbed, and fever is absent, or there may be at the most a subfeb rile temperature. The subniaxillary glands are not enlarged, or only slightly so. The pharynx remains free, or a slight catarrhal condition may be present. The disease often is subacute or chronic, entirely be nign, attd is not infrequently seen in older children. Formerly, the disease was regarded as entirely harmless, strepto- and staphylococci being found in the discharge. Later, however, in some cases, virulent diph theria bacilli were demonstrated to be present in the discharge and in the membranes. It is quite evident, therefore, that it is frequently only an attenuated form of diphtheria, against which one must always be on guard since serious infections may follow in its wake (Gerber aml Podack). In private practice it is always proper to regard rhinitis fibrinosa as diphtheria, as long as a careful examination has not demonstrated the absence of diphtheria bacilli. The treatment consists in the adnunis tration of antidiplitheria serum and nffld irrigations. Insufflation of iodol is also recommended.
Diagnosis.—The diagnosis is usually readily made and does not require the use of a speculum. It is sometimes difficult at first to decide whether the appearance of a rhinitis is primary or whether it is the pro dromal symptom of an infectious disease (influenza, whooping-cough, nieasles). In cases where the discharge is unilateral, purulent and bloody', a foreign body is usually present. A very purulent rhinitis in the newborn may be of a gonorrhceal nature. Of the highest impor tance is the differentiation of a simple rhinitis from nasal diphtheria, on the timely recognition of which the life of the patient often depends. Nasal diphtheria usually begins as a violent coryza and, even after careful examination with a speculum, often no formation of membrane can be distinguished, which is usually found in the posterior part of the nose in the direction of the Dares. One must bear in mind that primary nasal diphtheria is comparatively frequent in young children, and that diphtheria is particularly apt to appear in this form during the early months of life. Every case of rhinitis attended by lever, excessive puru lent discharge, and markedly disturbed general health, is suspicious of diphtheria, and requires a bacterial examination.
In cases of serious illness and well-founded suspicions, a serum in jection should be made without awaiting the result of the bacteriologi cal examination, which, owing to the almost invariable presence of the pseudodiphtheria bacilli, is not always promptly disposed of. Rhinitis pseudomembranacea progresses in the same manner, but much more harmlessly than nasal diphtheria.
The prognosis in simple rhinitis is good. Only in the newborn is there a direct menace to life; but older infants may also perish from a subsequent otitis and bronchitis, especially those suffering from malnutrition with disturbed digestion.
Prophylaxis consists in judicious hygiene and judicious methods of hardening. Association with persons afflicted with catarrh and sore throat should be avoided, likewise the use in common of the pocket handkerchief. Special treatment of coryza is necessary only during infancy. Nasal douches and injections are to be strictly avoided, since they are irrita ting and may easily cause an otitis media. In older children it is suffi cient to remove all external injurious matters and to refrain from tiolent blowing of the nose. The free volatilization of the oil of turpentine in the vicinity of the patient is advantageous. An ointment of lanolin (bryolin, etc.) is the best protection against excoriation of the nasal ori fices and the upper lip from the discharge. Infants suffering from a severe coryza should be kept in the room and, if feverish, in bed. Care should be taken to have the air of the room sufficiently moist during the season when the rooms are heated. During the acute stage considera ble precaution must be exercised regarding the bath (a warm room, etc.). This bad better be omitted in cases where the nursing is unrelia ble. Frequently. the discharge or dried crusts may be removed by rneans of a pledget of absorbent cotton, w-hile the sneezing thus pro duced often promotes the discharge of the secretion. The instillation of a few drops of lukewarm and sterilized olive oil containing 1-2 per cent. menthol is of benefit, also an aqueous solution of cocaine 1-2 per cent., of which 1-2 drops are instilled several times daily in each nostril with the head resting obliquely. Lately, Bailin advocates the intro duction of pledgets of cotton saturated with a 1:1000 solution of adrena lin for 2-3 minutes several times a day. Ten to twenty drops of oleum pini pumilionis dropped on a piece of flannel, close to the head of the patient will often act beneficially. In cases of increased difficulty of swallowing, nourishment may be given with a spoon, and in emergency by means of the feeding tube. In a desperate ease of a four weeks old infant, Heineman successfully performed tracheotomy. Older children may be allowed to inhale or be insufflated with small quantities (as much as will go on the point of a penknife) of finely powdered boric acid or borax containing 2 per cent. cocaine.
lIcematama and perichondritis are mostly frequently seen during childhood. the cause mostly depending upon a blow or a fall on the nose. A hmmatoma of the cartilaginous portion of the septum results, and this strips the perichondrium from the cartilage which is often fissured or necrotic. Usually, the lfiematoma becomes infected and leads to peri chondritis and hypertrophy of the perichondrium and the mucosa. Interference with respiration usually occurs several days after the in jury, and this leads the patient to seek medical advice.
On raising the tip of the nose a dark red, smooth su•elling is at once seen on the anterior portion of the septum. It is usually bilateral, easily compressible with a probe, and not very painful. Since the septum is usually necrotic or perforated at some point the fluid contents of the swelling may frequently be moved about with the finger. Often the abscess ruptures spontaneously, or ultimately it may be emptied by a deep incision into the mucous membrane previously cocainized.