A clinical text-book of medical diagnosis for physicians and students based on the most recent methods of examination / by Oswald Vierordt.

  • Oswald Vierordt
Date:
1900
Catalogue details

Licence: Public Domain Mark

Credit: A clinical text-book of medical diagnosis for physicians and students based on the most recent methods of examination / by Oswald Vierordt. Source: Wellcome Collection.

Provider: This material has been provided by the Francis A. Countway Library of Medicine, through the Medical Heritage Library. The original may be consulted at the Francis A. Countway Library of Medicine, Harvard Medical School.

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    PART III. SPECIAL DIAGNOSIS. CHAPTER IV. EXAMINATION OF THE RESPIRATORY APPARATUS. EXAMINATION OF THE NOSE AND LARYNX. I. The Nose.—In making a local examination of the nose we employ Inspection and sometimes also Palpation. The inspection is external and internal: we look for asymmetry and other deformities and defects, and then at the shape of the nasal entrance [nostril] ; and also we note the quality of the secretions. Symptomatically, important anomahes of the nose are: uniformly swollen nose; the thickening, however, is most marked at the en- trance (scrofulosis); ^ saddle-nose, caused by syphilitic periostitis, with exfoliation of pieces of bone. The syphilitic coryza (nasal catarrh) of the newly-born is associated with a peculiar snuffling sound.^ As regards the internal inspection, without the aid of instruments we can only examine the entrance into the nose. This only rarely shows characteristic alterations. For the inspection of the deeper parts a reflector and a nasal speculum are necessary. (See the paragraph in the Appendix upon Rhinoscopy.) To the semiology of the affections of the nose belong the following symptoms : fcetor ex ore (ozena, ulcerations); occlusion, with respira- tion through the mouth, with obstruction of the nose or in the nasal cavity; speaking through the nose occurs under the same conditions, but also when there is paralysis of the soft palate. This also occurs when there is an abnormal communication between the mouth and nose (cleft palate). Dilatation and motion of the wings of the nose occurs in dyspnea.^ Lastly, there is nose-bleeding [epistaxis], which is usually without any significance. But it may be caused by some severe local or general affection (tumors, aneurysm, deep ulcers, hemophilia, temporary hemor- rhagic disease). Nose-bleeding may be overlooked if it occur in deep sleep or in stupor (in acute infectious diseases), the blood flowing back- ward into the pharynx, through the esophagus, into the stomach. In this case there may be hematemesis, which may lead to an error in diagnosis. Acute muco-purulent and purulent catarrh of the nose is symp- tomatic in measles, diphtheria, and equinia. Chronic catarrh is a ^ See below. , ^ See below.