Coryza.
Coryza is an acute inflammation of the mucous membrane of the nasal chambers. The disease is ordinarily idiopathic, but may be produced by irritative vapors, pollen, or dust. In the idiopathic form the symptoms of coryza are often preceded by malaise, with chilly sensations, and in severe attacks with headache. The attack itself is divided into two stages: that of determination or congestion, and that of exudation. In the first stage the excessive quantity of blood flowing into the arterio-venous network and the capillaries of the nasal mucous membrane distend them and obstruct the nasal chambers.
The symptoms are referable either to such obstruction of nasal respiration—in which group are included oral respiration, sensations of distension, and throbbing in the nose—or to reflexes, such as frontal headache, attacks of sneezing, and dull aching pain in the teeth.
The first stage lasts for a period varying from a few hours to several days, and is followed by the stage of exudation. This is characterized by a free watery or mucoid discharge from the nasal chambers, and by the cessation of the symptoms due directly or indirectly to pressure of the layers of swollen mucous membrane against each other. The discharge at first is watery, and is doubtless composed of transuded liquor sanguinis. It is followed by a mucoid fluid, which in severe or neglected cases may assume a purulent character. In many instances, even in mild cases, the discharge becomes muco-purulent toward recovery. The second stage is associated in children and adults of delicate constitution with excoriations of the nostrils.
Suppuration may take place in nurslings and in old people. It would appear that in coryza, as it exists in the northern countries of Europe, the beginning of the second stage is apt to be marked by free suppuration.
Acute coryza may involve the sinuses of the face, particularly the maxillary sinus. The involvement of the frontal and sphenoidal sinuses, while possible, is infrequent. Pharyngitis, laryngitis, and occasionally acute aural catarrh, often coexist with the disease.
The symptoms of coryza are so distinctive that the diagnosis is easily made. But since any obstructive or catarrhal state of the nose is described by patients as a cold in the head, it is necessary for the medical attendant to distinguish the various diseases so denominated. Acute coryza may be confounded with angiose hypertrophy; with the obstruction to nasal respiration due to deflection of the nasal septum or to an inflamed soft polypus; with catarrhal irritation affecting surfaces which are already enlarged by hyperplasia or which are undergoing atrophy; or with the effects of operative interference in the nose.
In angiose hypertrophy the swollen membranes will contract under a mild current of electricity or by change in the position of the body. Both chambers are rarely involved at the same time. Reflexes are of infrequent occurrence. Obstruction to nasal respiration due to a deflected septum arises from causes which are insignificant and do not affect the constitution. The genuine influenzal or catarrhal element is absent. In an inflamed soft nasal polypus an attempt at inspiration will, as a rule, detect the presence of the growth. In diffuse multiple polypi the case is different. Many persons who are reputed to take cold readily, or who may be said never to be free from cold, are really sufferers from neglected polypi. Persons suffering from atrophic catarrh always speak of an exacerbation of their symptoms as a fresh cold, and describe the disease itself as a cold. The sense of fulness, the throbbing, the heat, and the characteristic discharge of coryza are absent. A fresh cold in atrophic catarrh is an attack of inflammation (often catarrhal in character, it is true) which affects the involved surfaces, but is attended with an increase of plastic exudation and accompanying fetor.
It is a common occurrence for patients who have had a cautery application made or a polypus removed to return after a few days' absence with the report that they have contracted a cold. While the condition may be an attack of acute coryza, the chances are in favor of the symptoms being excited by the manipulation or the reaction from the operation. The symptoms are mild in character.