350 ON CATARRH. 



a very good substitute in the absence of the other two salts. Of course all 

 these these things are to be kept in view in prescribing for cases of Catarrh. 

 I have taken this typical form of chronic Catarrh as it presents itself for 

 treatment, for obvious reasons. 



After cleansing the passages with the posterior nasal syringe, which is 

 an invaluable instrument, any instrument which has power to atomize or 

 reduce fluid to the finest possible state of division may be used, and in that 

 way you can medicate the whole of the nasal passages. Any instrument 

 which has that power may be used for the purpose of medicating the naso- 

 pharyngeal space and the little crypts in the nasal passages. I am in the 

 habit of using, in preference to other instruments, what is known as 

 "Holmes' Boston Perfumer." It has a metallic tip, and if properly cleansed^ 

 will not get out of order for a long time. It is the most serviceable instru- 

 ment that I know of for the purpose of medicating the passage after cleans- 

 ing with the posterior nasal syringe. A solution of the bromide of potassium, 

 as a general thing, is the best, say from ten to forty grains of the salt to an 

 ounce of water, and in proportion to the strength of the solution, the inter- 

 val should be great ; if the forty-grain solution be preferred, it should not 

 be used more frequently than twice in one day — once in twelve hours. If 

 the w^eaker solution be preferred — and that should depend upon the quan- 

 tity of secretion — if the secretion is going on rapidly, if there is a large 

 amount of matter secreted, the weaker solution applied frequently is the 

 preferable method. 



jSTow, after the disease has lasted some time, and the discharge somewhat 

 dried up, as it were, leaving still an inflamed surface — preter -naturally dry, 

 without any disposition to throw off its secretion — a solution of iodine and 

 glycerine answers the purpose best. That is to be used, also, with the atom- 

 izer ; to be preceded by the posterior nasal syringe loaded with some sort of 

 cleansing fluid, to remove any of the inflammatory matters collected in any 

 of the crypts or cavities of the nasal passages, or any where in the naso- 

 pharyngeal space. 



By the use of the speculum, introduced into the interior nares, and a 

 strong light reflected from a concave mirror, the nasal fossae may be ex- 

 plored, except in those cases where there is great swelling in the covering" 

 of the superior turbinated bones. It is precisely in this locality that catarrhs 

 are likely to linger, and likely, always, to escape observation ; and when you 

 think the patient entirely relieved you find, to your surprise, that destruction 

 of the bone has been going on — the superior turbinated bone perishing. 



The iodine solution may vary from half a grain to five grains to the 

 ounce ; the five-grain solution being applicable to syphilitic subjects only. 

 And there must always be a distinction between syphilitic ozaena and ordi- 

 nary Catarrh ; the ordinary Catarrh in the otherwise healthy subject never 

 gives rise to any very offensive discharge. The decomposition of mucus may 

 be very readily recognized by its odor, so may the destructive changes 

 which take place in the osseous tissues, and in the other tissues of the body 



