Inflammation of the mucous membrane of the nares sometimes ends in a malignant ulceration, which is characterized by pain, redness, and tume faction, extending to the cartilages, bones, and in teguments of the nose, the ulceration being first confined to the inside of the ala, and afterwards spreading both inwards and outwards, and then re sembling noli me tangere. There is also an in creased discharge of mucus, which soon ichorous and fetid; the breathing is obstructed; the pain is increased by pressure, and on inserting the finger, which also produces slight bleeding. The cartilaginous septum is first destroyed, next the ethmoid bone and vomer, and ultimately all the bones entering into the formation of the nares, ren dering the nose flat and disfigured. This affection, named ozxna, generally follows some syphilitic or scrofulous taint in the constitution, and prevails in the highlands, where yaws and sibbens are com mon. During the inflammation, it ought to be treat ed with the inhalation of steam, and warm anodyne injections into the nares, with fomentations and poultices externally, and with the insertion of small pieces of lint dipt in olive oil; and when the pain has been subdued, cold astringent injections and ointments should be applied, and the muriate of mercury and compound decoction of sarsaparilla administered internally. The patient should be in structed to snuff up into the nares the different in jections used, and bring them round the velum, into and out at the mouth; and he should remain in a warm dry atmosphere.
Epistaxis or hemorrhage from the nares is a more serious disease than is generally supposed, proving fatal even in early life; therefore, in all cases where the bleeding is not arrested by styptics, the naris should be plugged up first at its posterior aperture into the pharynx, which is accomplished by intro ducing a long double canula, with a loop of silver wire along the floor of the nazis, keeping close to the mesial septum, backwards to the pharynx, and downwards behind the velum palati, until the loop is felt or seen in the throat, when it is to be brought forwards by the forceps into the mouth, and then have attached to it a clossil of lint or piece-of sponge, with a ligature, which is to be pulled upwards into the posterior aperture of the nazis, so as to shut it up. The canula should then be removed, but the ligature left hanging out at the anterior aperture, which must be also stuffed with lint.
Polypus is a delicate fleshy tumour, of the shape of a pear, which frequently grows in the nose, either from the mucous membrane investing the bones of the naves being generally attached to the ethmoid bone, or in the antrum maxillare or in the frontal sinus. The mucous membrane appears to take on a diseased action for secreting these bodies, since they grow like fungi, or the shoots from creeping plants. In some individuals, the mucous membrane through out is flocculent and spongy. They are variously arranged and divided by Pott, J. Bell, Ritchey and others. The delicate pale gelatinous polypus and the fleshy one adhere commonly by a small pe dicle; they appear visible in the anterior nares, and can sometimes be felt, and even seen, hanging down behind the velum; and they are not attended with pain, until they press on the contiguous parts, when they produce sneezing, watery eyes, headach, stupor, and difficulty of breathing, and deafness; they destroy the ethmoid bone, the vomer, the walls of the antrum, raise the nasal bones, project the eyes out of their sockets, cause amaurosis, and ulti mately prove fatal. The fleshy polypus is the most
numerous. The firm, hard, dark red polypus, with a broad base, is commonly solitary, and is usually, though not always, attended with pain from the be ginning, and is more frequently reproduced, than the others. Polypi are removed by excision, ex traction, ligature, and caustic. The first is to be preferred whenever it can be accomplished, and should be done by seizing hold of the tumour with the forceps delineated, Fig. 9 of Plate DXV1. and gliding along them, the open limbs of curved blunt pointed scissors, Fig. I I of Plate DXVI. until they reach the pedicle of the polypus, which is then to be cut. if any hemorrhage occur, it is easily stemmed with the nitrate of silver, but if not, the actual cau tery can be used, or the nostril plugged up. The caustic should be applied on the day following, and every succeeding day, until the pedicle is com pletely stunted. But if the polypus has a broad base, or plugs up the anterior naris, the knife Fig. 8, or 12 of Plate DXVI. should be employed. When the polypus hangs back into the pharynx and can not be pulled forwards, it should be noosed by silver wire and a double canula, which are passed as recommended for epistaxis, and the noose carried around the polypus, and elevated as near its root as possible, when the wire is to be tightened. Sil ver wire must not be twisted, as it readily breaks, but turned round one of the rings of the canula daily. If neither scissors, knife, nor ligature can be employed for this polypus, it must be bruised with forceps, Fig. 10 of Plate DXVI; but it ought never to be extracted with the polypus forceps or any other instrument. No pulvis sabinx or any other crrhines should be used.
Polypi or sarcomatous tumours in the antrum max illare burst open the parietes of this cell, and either force their way into the nostril, or forwards towards the cheek, or upwards into the orbit, and even into the cranium, or downwards into the mouth, by ex citing absorption of the bone, or rendering it cari ous; and sometimes they force their way in all these directions at once, giving to the countenance a hor ribly distorted appearance. The alveolar processes become fungous, the teeth drop out, a fetid dis charge flows, the eyes weep, are amaurotic, and even burst, and the patient is rendered wretched to himself, and loathsome to his friends. By the pre sent mode of proceeding to remove this disease, with the exception of one or two cases, all have either died in a few weeks after this operation, or the disease has returned, so that we have proposed the entire removal of the superior maxillary bone. See Lizars's Jnatomical Plates, Part 1X. Occasion ally a fungus excrescence grows from the gums, which is liable to deceive us for that originating within the antrum; but it can be easily removed and prevented from regenerating by the nitrate of cop per or the actual cautery. Other tumours of a firmer consistency originate from the gums, and commonly on the lower maxilla, and ultimately in volve the bone. When early perceived, the teeth should be extracted in their vicinity, and the tu mour, with every portion of the diseased gum or bone, removed. The teeth being like the nails inert, inanimate objects, and in this resembling minerals, are subject only to denudation or des quamation, decay or rottenness, and lastly frac tures. The other diseases usually described as belonging to them properly attack the contiguous textures.