Octavius Sturges
1864 The Lancet  
601 ganate of potash. This agent had done me such excellent service in removing the fetor of the mouth in cases of typhus fever, that I was induced to apply it for the removal of the fetor of ozæna, and with the most striking and immediate success. A solution of from one grain to ten grains in a pint of water is a good proportion, according to the severity of the case. The solution tastes alkaline, and acts as a feeble escbarotic upon healthy, and particularly upon vascular or erythematous,
more » ... r erythematous, parts. When the margin of the nostril; is excoriated, the permanganate colotirs the excoriated part brownish; but the effect of this is rather beneficial than otherwise, as the excoriated and coloured part dries easily, and after the shedding of the faint brownish pellicle, appears healthy. Mode of applying these and other fluids to the nose by means of the apparatus.-The fluid, of the proper composition and temperature, is filled into the glass vessel, which is lowered for that purpose. All air in the india-rubber tube is now replaced by fluid, the escape of the air upwards being facilitated by gentle manipulation. The glass vessel is raised and fixed in the position which will give the desired pressure. A little fluid is now allowed to escape from the nozzle, to make sure that all air is expt lied. The patient (or healthy person, if it is only desired to show the physiological experiment) is seated in front of a basin, with his head and face slightly bent over it, the apparatus standing by his side. He is told to breathe through his mouth exclusiveiy, and to abstain from swallowing. The nozzle, previously selected as of proper size, and connected with the apparatus and filled as described, is now inserted into one of the nostrils, and held there by the patient's hand of the same side. The little stop cock is now opened, and af-ler a few seconds a continuous and rapid stream of fluid is seen to flow from the opnosite nostril into the basin below. Persons who have control over themselves wilt always bear the experiment as here described; but young persons, nervous females, and children become confused, begin to cry, or to swallow and breathe through the nose. In such cases the level of the fluid in the glass should be very little above the level of the introitus into the external ear, so that the fluid runs very slowly, or only drops out of the free nostril. The hand of the operator should be upon the india-rubber tube, to close it by compression the moment he sees bubbles come through the nostril, or perceives that the patient swallows or becomes confused. It is always well to let the fluid pass at first under slight pressure, in order to allow sordes within the nose to be loosened and crusts of dried matter to be softened. When this has been effected, it is useful suddenly to raise the glass vessel, and produce a rapid stream, which will then scour the impurities away. In some cases I have done this repeatedly with success. The loosening of crusts and lumps of inspissated mucus is always attended with some irritation, and also with retardation and diminution of the current of fluid. The sudden increase of the pressure is the surest means of causing the least inconvenience to the patient, and effecting in the quickest manner the purpose of the operator. It is also well to reverse the current now and then, as sordes are much better detached in that manner. If only one nostril is diseased, or the principal seat of the disease, I allow the fluid to enter by the opposite side, and to leave by the affected nostril. 1 then change the current, and, filling the affected nostril, allow the current to leave by the healthy one. Thus half a dozen or a dozen changes niav be usefully instituted. This reverse has sometimes the effect of throwing large lumps of inspissated mucus and pus upon the upper side of the soft palate ; and as they are too large to be carried round the septum narium into and through the nasal canal by which the fluid leaves, they are taken into the pharynx, and immediately ejected by the patient through the mouth. This presence of lumps upon the soft palate is, therefore, sometimes a cause of a sudden interruption of the operation. After the removal of these lumps, the operation may be continued as before. It is really surprising what an amount of sordes will sometimes be removed from the nose by thif rinsing process. Anyone who has seen it ouce wiil easily conceive the manner in which, by means of these consrant accumulations, nasal diseases become chronic, incurable, and lead to fearful suffering and death. The shape of the bisin. in which the fluid which leaves the nose is received, is a matter of some importance. A common washhand.basin will suffice in many cases in which the patients are not disturbed by the splattering of the fluid as it falls into the accumulating fluid in the basin. The splattering can be mostly avoided hy so placing the patient's head that the current from his nostril runs along the side of tha basin. But there remains the objection that the sordes, mucus, and dirty fluid are constantly before the patient's eyes. All these evils can be avoided by using a washhand basin provided with a funnel shaped tin cover, similar in construction to, but larger in size than, a common spittoon. It is still better to use a high cylindrical vessel of white china-say a large jug of a capacity of from one to two gallons-for the reception of the fluid from the nostril, as the funnel shaped top can be made more inclined, thus ensuring a quieter flow of the water. For the consulting room it is most convenient to have the washhand basin sunk into the stand, with a tube leading from the loweah point into a hidden receptacle. If it is desired to collect any of the crusts and secretions for microscopical examination, the aperture in the basin may be plugged, so long as the rinsing process continues. But even this I find unnecessary when the bottom of the basin is not too rapidly inclined, but rather flat. The mucous and inspissated discharges then adhere to the basin, the current from the nostril being insufficient to carry them down into the tube, and can be inspected, or removed with a forceps into a little white china dish and further examined. The inspection of these discharges is of some importance in a diagnostic point of view; for the nature and amount of the epithelium which they contain show us the special part of the nasal cavity from which they come. The upper regions of the nasal cavity are covered by a cylindrical epithelium, which mostly shows two or three layers of cells upon each other. The lower reginns of the nasal cavity are lined with a ciliated cylindrical epithelium, the action of which removes particles of dust and fluid towards the nares. When the discharges are purulent, they consist of pus-corpuscles only, with hardly any admixture of cylindrical epithelium. This characterizes chronic ulcerations. When chronic ulcerations become extended, the pus is mixed with cylindrical epithelium which is thus being shed. When the affection of the nose is quite recent, no pus, but only cylindric epithelia. are perceived in the secretion. In cases of old follicular ozsena. the crusts have on their soft surface a villous appearance, being condensed mucus, indicating in some slight manner the distribution, size, and shape of the I mucous follicles of the Schneiderian membrane. In cases of ' ulceration with rapid loss of substance, as in specific disease, elements of the deeper tissues, particularly fibrous structures, can be perceived in the discharges. When the nasal cavity is the seat of villous or other descriptions of ulcerated cancer, the elements of these tumours are found in the blackish-brown, thick, and extremely fetid discharges. l , (To be concluded.)
doi:10.1016/s0140-6736(02)68944-5 fatcat:oog22vtq6fegzfl3wpyuqoslxu