TREATMENT.—The treatment of coryza is both local and constitutional. The local treatment consists in applications of agents which tend to constrict the vessels of the nasal mucous membrane. In the first rank of such agents may be named cocaine, which in a 2 per cent. or a 4 per cent. solution will often give notable relief by overcoming the sense of obstruction. Individuals will be found in whom the effect is of short duration, and in some persons I found the medicine to have no effect whatever. In more favorable subjects the relief will be acknowledged for a period varying from four to six hours. Next in rank may be named a current of constant electricity (say from six to ten cells) passed through the cheeks. Should neither of the above-named agents be available, inhalations of iodine vapor, a few drops of chloroform rubbed upon the palms and inhaled, or the inhalation of the spirits of ammonia may be recommended. Toward the later stages of the disease detergents and mild astringents are well borne. The constitutional treatment includes the administration of diaphoretics and minute doses of opium, especially in the early stages of the disease. Coryza is commonly self-limited, and by far the larger number of cases do not come under the care of the physician.
Chronic Nasal Catarrh.
Chronic nasal catarrh embraces those more or less persistent affections of the nasal chambers whose symptoms resemble those of acute coryza. The term catarrh is inexact. It is used to include several diseases associated by a single characteristic—namely, the existence of an increased amount of mucous secretion upon the affected membranes.
In order to understand the varieties of nasal catarrh, it is necessary to have clear conceptions of the uses of the nasal chambers. The normal performance of the function of respiration demands that when the mouth is closed the currents of air should pass through the nose. These currents, however, do not sweep over the entire nasal surfaces, but are confined to those portions which answer to the inferior meatus and the space bounded within by the septum, without by the median surface of the inferior turbinated bone, and above by the under surface of the middle turbinated bone. In the lower mammals this space is separated posteriorly by a transverse bony lamina which effectively excludes the upper portion of the nasal chambers from the tract just named. Anteriorly, at the termination of the inferior meatus and the middle turbinated bone, the tract is in freer communication with the upper spaces. The passage thus briefly defined may be called the respiratory tract, and when it remains patulous no serious interference with nasal respiration can occur.
The transverse diameters of the tract are subject to frequent changes, owing to the erectile character of the mucous membrane in its walls. But as long as the surfaces do not touch one another obstruction cannot exist. The passage, even when narrowed to a chink or line intervening between the median and lateral walls of the tract or between the floor and the roof of the inferior meatus, is sufficient evidence that there is room for the transit of the currents of air. The membranes themselves are subject to changes in form which are dependent upon the degree of development of their erectile tissue.
There is doubtless a disposition on the part of the erectile tissue to grow in the direction of the least resistance, and thus to occupy, by a process of compensative hypertrophy, the spaces left as the result of variations or defects in development in the bones composing the framework of the nasal chambers. The greater development of the erectile tissue may in this way be found on the side answering to the larger respiratory tract, which may therefore be more apt to suffer from changes in the conditions of nasal breathing than the chamber having the smaller tract. The erectile tissue acts as a monitor to the throat and lungs by presenting warm surfaces over which the air passes, thereby having the temperature raised before it enters the throat and lungs. It also acts by occluding the chamber, and thus aids in shutting out irritant vapors and dust. The lower animals possess a higher degree of development of the tissue at the point where the adducted ala presses against the septum. This point answers to the position of the organ of Jacobson. With man, the locality of the adduction corresponds to the junction of the premaxillary with the maxillary portion of the nasal chambers, and is often the seat of a delicate band of mucus extending across from the inferior turbinated bone to the septum.
That portion of the nasal chamber above the respiratory tract may be called the olfactory tract. It does not appear to be involved in the diseases under consideration, or, if it is, no clinical signs or symptoms are presented with which the author is acquainted. It will therefore receive no attention in this article.
For convenience the varieties of chronic catarrh may be classified as follows:
FIRST VARIETY—that dependent on defective nasal respiration.
This variety is caused by—