NOSE. 



739 



usually affects at once the whole or a large por- 

 tion of the membrane, though, of course, it is 

 most obvious at the folds on the borders of the 

 turbinated bones. It is sometimes attended 

 by superficial ulceration or excoriation of the 

 membrane ; but even without either of these 

 the discharge has usually a purulent character. 

 If it continue long, this chronic inflammation 

 produces not a mere swelling, but a more solid 

 thickening and induration of the membrane 

 sufficient nearly to close the passage through 

 the nose ; or if there have been ulceration of the 

 membrane, a part of the passage may be closed 

 by adhesion of the opposite surfaces of the 

 thickened and approximated membranes. Such 

 obstructions are usually situated near the entrance 

 of the nasal ducts, and when the swelling of the 

 membrane which preceded their formation has 

 decreased, they are drawn out, and look like trans- 

 verse thin membranes passing across the cavity, 

 just within the nostrils. Such obstructions are 

 particularly apt to occur when, by obliquity of 

 the septum, one of the nasal cavities is unna- 

 turally narrow. 



Sometimes, from chronic inflammation of the 

 mucous membrane of the nose, substances are 

 produced altogether unlike the discharges com- 

 monly seen. Mr. Cassar Hawkins, who has 

 paid much attention to these diseases, speaks of 

 " several portions of substance like chalk in 

 consistence, exceedingly foetid, and in shape 

 exactly like the spongy bones : they were pro- 

 bably composed of phosphate, or perhaps car- 

 bonate, of lime, with fetid mucus secreted 

 from the upper spongy bones." A similar case, 

 probably, in which a hard concretion was found 

 in a nose, is recorded by Dr. Grandoni.* In 

 another case, Mr. Hawkins saw small bodies, 

 like half-formed cartilage, which had the shape 

 of the superior spongy bone, and which had 

 been occasionally separated during many years ; 

 and in another, a very tough and tenacious 

 mucus which was constantly secreted from a 

 soft and relaxed membrane covering a diseased 

 vomer. The exact condition of the membrane 

 in these cases has not been determined ; in one 

 it seemed connected with diseased bone. The 

 secretion of earthy matter from it is perhaps 

 analogous to that which produces the phosphatic 

 incrustations of the diseased mucous membrane 

 of the urinary bladder. 



The ulceration of the mucous membrane of 

 the nose which attends this state of chronic 

 inflammation is usually superficial. Deep and 

 destructive ulcerations (such as give rise to the 

 symptoms of Oz&na) occur, however, under 

 many circumstances ; for example, from ne- 

 glected injuries, scrofula, syphilis, &c. Their 

 effects are often not confined to the membrane, 

 but are propagated either to the skin, through 

 all the intermediate tissues, or to the subjacent 

 cartilage or bone, which then are ulcerated or 

 suffer necrosis secondarily, as, more rarely, they 

 do primarily. The appearances of the ulcers 

 from various causes do not materially differ. 

 They may commence in any part of the nasal 

 cavities ; but they are said to be most frequent 



* Annali Universal! di Medicina, Ottobre, 1840. 



near the exterior in common or scrofulous ul- 

 ceration, and in the more interior parts of the 

 membrane in syphilis. Their first appearance 

 is in the form of a small pustule or collection 

 of matter beneath the membrane; and the 

 ulceration by which this opens externally makes 

 progress more or less rapidly, spreading in 

 both extent and depth without any signs of 

 resistance to its course in the adjacent textures. 

 When such ulcers have exposed the cartilages, 

 these are gradually perforated by the ulcerative 

 process; they do not suffer necrosis, but in 

 this, and probably in all their morbid changes, 

 they follow the course of the articular cartilages, 

 which they resemble in their structure and in 

 their exemption from being ossified. The sep- 

 tum is the part in which the effects of such 

 ulcers are most commonly seen. Sometimes 

 it is perforated through its centre, and, in these 

 cases, though the aperture be large, the shape 

 of the nose may be unaltered, for the remain- 

 ing borders are sufficient for its support. But 

 when a part of these borders is destroyed, de- 

 formity is the certain result ; the point of the 

 nose is drawn backwards and downwards when 

 the lower part of the septum is destroyed ; or 

 the middle of the bridge falls in, and the point 

 projects and is turned upwards when the upper 

 part is lost ; or, when the destruction is more 

 general, the nose falls nearly fiat below the 

 nasal bones. When the ulceration reaches the 

 bones it may continue to spread through them, 

 destroying them gradually without necrosis; 

 or, if its progress be rapid, or matter collect 

 beneath the periosteum, so as to expose a large 

 surface of bone, this being deprived of its 

 supply of blood, perishes and gradually ex- 

 foliates. Thus, the nasal bones, or large por- 

 tions of the septum, or the turbinated bones, 

 and parts of the palate may be destroyed, and 

 the most hideous deformities be produced. 

 Sometimes, no doubt, the syphilitic affections 

 of the nose may commence in the bones or 

 cartilages themselves; but, most commonly, 

 they are affected secondarily after being ex- 

 posed by the destruction of the mucous mem- 

 brane. In the worst cases, the ulceration 

 spreads with a ragged sloughing to the mem- 

 branes of the palate, pharynx, and other ad- 

 jacent parts, and through them to the bones 

 and other tissues which they cover. The dis- 

 ease has its centre of severity in the nose, but 

 the pain around the nasal cavities indicates a 

 simultaneous slighter affection of the adjacent 

 sinuses; sometimes, also, it extends to the 

 membranes and substance of the brain ; and 

 sometimes it passes up the nasal duct and pro- 

 duces all the signs of fistula lacrhymalis. 



Polypi. The mucous membrane of the nose 

 is more subject than any other part to the 

 growth of polypi, which may occur in either 

 one or both of the nasal fossae, or in the cavi- 

 ties adjacent to the nose. Those which grow 

 in the fossse, and which alone will be con- 

 sidered here, are of several kinds, and, though 

 the lines of distinction cannot be clearly drawn 

 between them, are commonly arranged as 

 vesicular, gelatinous, fibrous, and malignant 

 polypi. 



3 B 2 



