CORYZA. 301 



they penetrate more deeply, and may destroy the perichondriurn and 

 periosteum, and give rise to caries and necrosis of the cartilages and 

 bones of the nose. In the secretion from the ulcer, especially one 

 vvliich has caused a caries, and necrosis of the cartilage and bones, a 

 foul decomposition is almost constantly going on, which produces an 

 extremely bad odor, an occurrence only occasionally observed in the 

 secretion of simple chronic nasal catarrh. 



In other cases, chronic nasal catarrh gives rise to polypous out- 

 growths. According to Rokitansky, " the latter sometimes appear, 

 first, as a diffuse thickening over a large surface of the mucous mem- 

 brane, particularly on the turbinated bones, growing with an uneven 

 surface, and developing wart-like protuberances and fold-like ridges. 

 Sometimes the growths are more circumscribed, assuming a rounded, 

 pedunculated, pyriform shape. They consist of a gelatinous growth 

 from the matrix of connective tissue of the mucous membrane, and 

 from its glands, which frequently degenerates into cysts. Gradually, 

 the material of which the growths are constituted is converted into 

 firm, fibrous tissue. They contract or block up the air-passages, and 

 finally may become visible in the openings of the nostrils." 



SYMPTOMS AND COTJESE. The symptoms of acute nasal catarrh 

 may be presumed to be generally known ; and everybody, probably, 

 having had personal experience of them, they need but very brief no- 

 tice here. The patient first complains of a feeling of dryness and of a 

 more or less complete obstruction in one or both nostrils, which induces 

 a very prejudicial inclination to blow the nose. From time to time, at 

 short intervals, there arises a titillating or prickling sensation within 

 the nostril, which usually precedes the complicated group of reflex 

 symptoms known as sneezing, but which may also occur every now and 

 then without being followed by the sneeze. This dryness of the nos- 

 tril is soon succeeded by a very abundant secretion, a colorless, trans- 

 parent watery liquid, of saltish taste, flowing almost incessantly from 

 the nose, and sometimes producing excoriation of the upper lip. Ac- 

 cording to Donders, the irritating quality of the now strongly-alkaline 

 secretion is due to the quantity of ammonia which it contains, while 

 the proportion of chloride of sodium in it is less than its salt taste 

 would lead one to suppose. 



The senses of smell and taste become perverted, the tone of the 

 voice is nasal. In almost all instances the catarrh extends into the 

 mucous membranes of the frontal sinus, and, if the attack be severe, 

 the patients complain of a feeling of pressure or of distressing pain in 

 the forehead. We can perceive the redness and swelling of the mu- 

 cous membrane as far as the eye is able to reach. In catarrhs of 

 greater intensity, the redness and swelling extend from the mucous 



