A treatise on nasal suppuration, or suupurative diseases of the nose and its accessory sinuses / by Ludwig Grünwald.

  • Grünwald, L. (Ludwig), 1863-1927.
Date:
1900
Catalogue details

Licence: Public Domain Mark

Credit: A treatise on nasal suppuration, or suupurative diseases of the nose and its accessory sinuses / by Ludwig Grünwald. Source: Wellcome Collection.

Provider: This material has been provided by the Harvey Cushing/John Hay Whitney Medical Library at Yale University, through the Medical Heritage Library. The original may be consulted at the Harvey Cushing/John Hay Whitney Medical Library at Yale University.

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    Mucous membrane of the left sphenoidal sinus somewhat cedematous. In both nostrils masses of discoloured foetid secretion, not crusted. Sections of the mucous membrane of the olfactory region show ' almost complete disappearance of the glandular elements,' whilst in the respiratory region acinous glands are visible in considerable numbers. No mention of the naso-pharynx. Now, of these six cases, three, viz.,—Nos. 2, 3, and 4— may be excluded to start with, as the process was one of specific ulceration, having nothing to do with ' true ozaena.' That, however, has not prevented them from being repeatedly quoted and used (without criticism) in the discussion of this question. Where does the secretion come from in the other cases ? In Case i—if one is not biassed by preconceived views— the answer seems clear enough; I, at least, have never yet seen pus from the nasal cavity flow into the accessory sinuses, but always the other way about. The explanation of Cases 5 and 6 is more difficult. Yet it seems to me certain that secretion could not come from parts in which glands were almost or quite absent, and epithelium intact. Secretion must either come from a granulating surface, from which, of course, epithelium is absent, or it must come from a mucous membrane; that is to say, from the secreting parts of it—to wit, the glands. Where glands are absent there is no secretion. Tertiiun non datuv. Thus the ' atrophic ' mucous membrane cannot have fur- nished the secretion. Where else in these two cases it came from I do not know. One cannot attach much importance to the cedematous state of the mucous membrane of one sphenoidal sinus in Case 6. Whether the pus originated in one of the meatus of the nose (as occasionally happens in ozaena), or in one of the recesses of the throat, cannot, in the absence of any report on those regions, be determined, any more than the opposite eventuality can be excluded. The question must remain open, and the two cases prove nothing either for or against the theory of surface suppuration. To proceed :