NOSE. 
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 
_ obstructionsare 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. Cesar Hawkins, who has 
paid much attention to these diseases, speaks of 
“ several portions of substance like chalk in 
‘consistence, exceedingly fotid, 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, 
bably, in which a hard concretion was found 
™m 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 
_ inerustations 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 Ozena) 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 Universali di Medicina, Ottobre, 1840. 
739 
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 flat 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 fosse, or in the cavi- 
ties adjacent to the nose. Those which grow 
in the fosse, 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. 
3B 2 
