Digital examination and treatment of certain morbid conditions of the nasal chamber ; Age and sex in diseases of the upper respiratory tract / by Harrison Allen.

  • Harrison Allen
Date:
1895
Catalogue details

Licence: Public Domain Mark

Credit: Digital examination and treatment of certain morbid conditions of the nasal chamber ; Age and sex in diseases of the upper respiratory tract / by Harrison Allen. Source: Wellcome Collection.

Provider: This material has been provided by The Royal College of Surgeons of England. The original may be consulted at The Royal College of Surgeons of England.

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    lO chamber from in front revealed a perforating ulcer the size of a cherry. The edges of the ulcer were covered with tenacious crusts and the triangular cartilage was of a deep-red color. The patient acknowledged the syphilitic origin of his affection. Iodide of potassium and bichloride of mercury were ordered inter- nally and Sir Charles Bell’s gargle for the throat. The patient slowly improved. At the end of a month, on April 5, 1887, the progress not being satisfactory, I recommended that the parts within the nostril be explored. I was not surprised when I found both middle turbinated bones were pressed against the septum and each covered with thick vascular mucous membrane. The usual pro- cedure was initiated to separate the parts, and the degenerated mem- brane was removed from the anterior ends of both bones. The bleeding was free, but ceased spontaneously. On June 25, the patient considered himself entirely well. Indeed, he had remained so comfortable that he reported but once or twice from the date of the operation. Five months after the operation the patient reported to .say that the parts had not troubled him since the operation, while the ulcer remained unhealed though no longer covered with tenacious crusts. His complaint was chiefly one of dryness of the throat with a slight laryngeal cough. The patient remained under my care, calling at my ofiice at long intervals through the winter of 1887 and 1888. Remarks.—This case is an illustration of syphilitic pharyngitis and laryngitis complicated by hyperplasia at the anterior ends of both middle turbinated bones which were probably of syphilitic origin, since they were associated with a perforated septal ulcer. It is shown by the course pursued in this case that the removal of diseased tissue in the nostrils and the relief of adventitious pressure was followed by the same, good results as are seen in non-syphilitic patients. At the same time, as might be expected, the procedure had no influence over the general disposition of the pharynx to become again involved under the influence of the constitutional cause. RSsumS.—In Case I it is recognized that a catarrhal state of the nose and throat is maintained by incipient cirrhosis of the liver and gastric catarrh. In Cases II and III the morbid flux was due to obscure states of the general nutrition, and held to be scrofulous in character. Case IV was an instance of the benefit arising from digital examination in secondary syphilis. It is difiicult to determine when a given morbid condition is due to constitutional defects,—that is to say, when they are hereditary or when they are due simply to the results of the impairment of the general vitality from local causes situated elsewhere. In illustration of the group last named, I can recall a m6st instructive case of a lady who, being an invalid from chronic ovarian disease, suffered among other conditions from pseudo-membranous enteritis, and had recurrent nasal hemorrhage from a large septal ulceration. Both of these intensely-obstinate conditions instantly disappeared and never returned after the operation of oophorectomy was performed. The nasal symptoms in this case were catarrhal reflexes, and yet, in i
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