The diagnosis and treatment of chronic nasal catarrh : three clinical lectures delivered at the College of Physicians and Surgeons, New York / by George Morewood Lefferts.

  • Lefferts, George Morewood, 1846-1920.
Date:
1886
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Licence: Public Domain Mark

Credit: The diagnosis and treatment of chronic nasal catarrh : three clinical lectures delivered at the College of Physicians and Surgeons, New York / by George Morewood Lefferts. Source: Wellcome Collection.

Provider: This material has been provided by The Royal College of Surgeons of England. The original may be consulted at The Royal College of Surgeons of England.

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    early in the disease, before hypertrophy is far advanced, the third form of nasal catarrh develops. This we call atrophic or fetid rhinitis. I have told you that it is by no means as common as the preceding vari- eties. It means this: Remember that in the hypertrophic form we had in the deeper layers of the tissues a deposition of newly developed con-: nective and elastic tissue. This may cause two results: First, by its mere presence and amount, it may press upon, cause atrophy of, and i destruction of function in, the glands and follicles which stud the: mucous membrane. It crowds them to death, so to speak. This may oc- cur, as I have said, early in the disease; if later, as it commonly does, the process of atrophy of the mucous membrane, and especially of the glands, has a different explanation; it is now due to the contraction that takes place in the connective and elastic tissue that has been de- veloped in the hypertrophic form of the disease. The more and more firmly this becomes organized, as time goes on, the more and more completely does it compress and destroy the function of the. secreting glands and follicles, and with them the mucous membrane in which they lie and the submucous structures—atrophy. Even, more, if the process be long continued, the effect of this continued, pressure, aided by the pressure of inspissated secretions or crusts, is exerted upon the turbinated bones themselves. Atrophy, interstitial absorption, is set up in them; they become smaller than normal, and the result is shown in the abnormally large, wide, roomy nasal pas-, sages, covered by a tense, dry, shining mucous membrane, often with hard crusts of mucus covering it. In these cases you can often look directly through the nasal passage back into the pharynx, so wide is it. The symptoms that these pathological changes occasion are not as .« marked as in the hypertrophic form. There is plenty of room through, the nose for the respiratory current to pass, hence there is no obstruc-f-] tion to breathing experienced by the patient. The discharge, instead.i of being profuse, is scanty, and dries into crusts and scales. There is I no interference with the timbre of the voice. The only symptoms, then, are interference with the sense of smell, as a rule, the atiophicu process having extended upwards to the olfactory region, and affected u the terminal fibres of the olfactory nerve, and general uneasy sensa- i tions, sometimes amounting to pain, with excessive irritability an