CORYZA. 303 



general suffering. The swelling of the mucous membrane, however 7 

 creates a permanent narrowing of the nasal passages. 



This disease owes its vulgar name of " snuffles," or " Stockschnup- 

 fen," to the more or less complete closure of one or both halves of 

 the nose, by which inhalation of the air is impeded, and the voice ac 

 quires a nasal tone. The secretion of the diseased mucous membrane 

 is sometimes purely mucous and sometimes muco-purulent, and its 

 quantity varies. It is not always the more profuse and purulent secre- 

 tion which shows the greatest tendency to putrefy. In fact, the so- 

 called " stinknase" " punaisie" ozcena, is sometimes observed where 

 the secretion is so scanty, even in chronic catarrh, that the existence 

 of such catarrh has been overlooked, and it has been asserted that 

 punaisie depends upon a fetid exhalation from the mucous membrane, 

 and not upon the stench from putrid secretion. That the secretion 

 should decompose more readily where the nostrils are unusually con- 

 tracted is not improbable; and an analogous condition may, at all 

 events, be adduced in young children who suffer from intertrigo behind 

 the ears, in whom the secretion from the sore in the narrow cleft be- 

 tween the ear and the head is very apt to putrefy, and to emit a foul 

 odor. If the secretion be copious and purulent, the blackish-green 

 crusts, of stony hardness, above mentioned, frequently form, some of 

 which are expelled by blowing the nose, while others are sucked into 

 the pharynx through the posterior nares, and are then hawked up. In 

 many instances we find the posterior wall of the pharynx covered with 

 similar crusts. Chronic catarrh of the nose is an extremely obstinate 

 disorder, often defying all treatment, and continuing for years, with 

 varying intensity. It is often difficult, or even impossible, to determine 

 whether the malady have led to ulceration and to ozaena, in the nar- 

 rowest sense of the word. The very fact that the fetid odor of the 

 secretion is not pathognomonic of ulceration of the nasal mucous mem- 

 brane, and that it may be present also in simple chronic coryza, has 

 made it necessary for those physicians who include all diseases of the 

 nose, accompanied by an offensive discharge, under the term ozaena, to 

 suppose the existence of two forms of ozaena, an ulcerous and a non- 

 ulcerous form. It is only when the ulcers are situated so low down 

 that we are able to see them by means of suitable dilatation and illu- 

 mination of the nostrils, that a positive diagnosis is possible. Even 

 the superficial ulcers of the nasal mucous membrane, which do not 

 penetrate to the periosteum or perichondrium, are very refractory to 

 treatment. Apart from the constantly-repeated provocations which 

 they suffer upon blowing the nose, the close adhesion of the mucous 

 membrane to the bone or nasal cartilages renders it almost impossible 

 for the edges of the ulcers to approach one another, a condition which 



