Ozoena.

Selected writings of John King.

A perusal of this article, selected as a brief sample of Professor King's text-book material, will readily show why his work on Chronic Diseases—the only American publication of its kind—was so popular with the Eclectic physicians. The completeness of each article, the fascinating presentation of symptoms and causes, and the fullness of treatment made King's Chronic Diseases for years a very popular and much valued work.—Ed. Gleaner.

OZOENA.—Ozoena is a discharge of a more or less profuse character from one or both nostrils, of a puriform or sanious character, and of an exceedingly offensive odor; I have, however, treated several cases of a most fetid, repulsive character, in which there was no appreciable discharge. It is caused by or is rather symptomatic of several abnormal conditions, as chronic inflammation of or ulceration of the lining mucous membrane in the deep-seated cavity of the nose, and is generally accompanied with a discharge; or it may be due to periostitis, ending in suppuration, caries, and necrosis, in a strumous person, or from syphilitic disease of the parts. Cancerous affections in the vicinity of the pants may also give rise to it; or it may originate from a decomposition of retained mucous discharges in the nasal cavity, without ulceration— from any obstacle to a free discharge of the nasal mucus, and occasionally, from a peculiar morbid condition of the system, predisposing it to modifications of the nasal secretion, as met with in other instances, in which, without the existence of inflammation or ulceration, certain offensive odors are evolved from the menstrual fluid, the breath, the perspiration of certain parts, etc. The offensive odor in ozoena usually proceeds from the retention and putrefaction of the nasal discharges; and the disease is more commonly the result of an improperly treated or neglected acute catarrh, occurring in strumous constitutions—the nasal bones being frequently involved in the affection.

Besides the odor, which is sometimes so fetid as to render the patient offensive to himself as well as to those who may be about him, other symptoms may be observed, varying according to the character and location of the disease. When limited to the nostrils or parts in their immediate vicinity, uneasy sensations are apt to be experienced, with a "stuffing up" of the nose, a fetid, yellowish discharge, and sometimes more or less clots, crusts, or fleshy matter will be passed; a dull aching will frequently be complained of, occasionally acute pain, especially just previous to the accumulation of the above mentioned matters, and in some instances there will be more or less epistaxis. If the frontal sinus is affected, in addition to some of the preceding symptoms there will be a constant and more or less severe headache across the affected sinus. In either instance there may be a nauseous taste in the mouth, and not unfrequently the sense of smell is lost or impaired. Often the offensive odor will be the only symptom observed. The disease usually progresses slowly, without being accompanied with acute pain, unless it be of cancerous or malignant origin.

The seat, extent, and nature of the local difficulty may frequently be detected with the aid of the rhinoscope, which will reveal a tumefied, dark red, and velvety appearance of the turbinated bones, sometimes extending to the ethmoidal and superior turbinated bones—the result, sometimes, of periostitis; or ulcers of the nasal fossae, or of the turbinated bones—granulations on the floor of the nostrils, etc., may be observed.

The prognosis of ozoena, as far as the offensive odor is concerned, is as a general rule favorable; but as regards the disease upon which this odor depends, the prognosis must be governed by its character, as to a scrofulous, syphilitic, cancerous, etc., origin, and by the nature and extent of the local inflammation or ulceration.

The treatment of ozoena is constitutional and local. The constitutional measures will depend upon the conditions present; if the patient be anemic, preparations of iron, manganese, nux vomica, etc., will be indicated; if there be a general weakness of the system without anemia, vegetable tonics are indicated, as elixir of cinchona and iron; or a decoction of cinchona, a fluid ounce and a half, dilute nitric acid ten minims; mix; the whole to be taken during the day in doses of half a fluid ounce each, and its use continued daily in this manner for some time; or compound wine of comfrey may be administered. If there be a scrofulous, scorbutic, or syphilitic taint present, the appropriate remedies for such conditions must be prescribed. The diet must be nourishing; moderate exercise in the open air be taken daily; the digestive organs should be kept in as healthy a condition as possible, as any derangement of them will be apt to increase the difficulty; and a proper attention should be paid to the skin and kidneys. The local measures consist in cleansing the nasal cavities from accumulations of putrid and other effete substances, either by ordinary injections into the nasal cavity, or by injections by hydrostatic pressure; and in applying weak, medicinal solutions to the affected parts, by similar means. In many instances ordinary injections will not convey the fluids used to the diseased localities; in such cases, hydrostatic pressure should be used, which will enable the practitioner to reach every part of the internal nasal cavity with the fluids employed. In most cases frequent injections of tepid water, by removing extraneous matters, will effectually remove all offensive smell; other cases will require some disinfecting fluid, as a very dilute solution of carbolic acid; of Labarraque's solution; of pyroligneous acid; of chloride of zinc; of chlorate of potassa, ninety grains to one pint of water, to which may be added hydrochloric acid, one fluid drachm and a half, and in some instances a small quantity of tincture of myrrh; or of permanganate of potassa from two to ten grains to a pint of water. Another good preparation may be made as follows: To a decoction of rhatany root, six fluid ounces, add half a drachm of chloride of lime; rub well together, allow it to stand an hour, strain, and inject half an ounce at a time, repeating it three or four times a day. In addition to their disinfecting influence, some of these agents will likewise exert a very beneficial therapeutical action upon the affected parts.

More especially as remedial applications to the seat of the local difficulty, the following have been employed with more or less success:

1. Tincture of chloride of iron, either diluted or of full strength.
2. Iodine, two grains; iodide of potassium, four grains; glycerine, one fluid ounce: mix.
3. Dilute solution of perchloride of iron.
4. Solution of sulphate of zinc, ten or twenty grains to a pint of water.
5. Solution of nitrate of silver one to three grains to the fluid ounce of water.
6. Solution of tannic acid.

Or decoctions of the following articles, either alone, or in various combinations—golden seal, black cohosh, white Indian hemp, geranium, witch hazel, Solomon's seal, etc. A very useful stimulating nasal injection may be made by adding one fluid ounce of cologne to eight or ten fluid ounces of a solution of common salt, an ounce to a pint. An excellent tonic and astringent injection is composed of an infusion of equal parts of rhatany root, cinchona, and bayberry bark. In most cases, this course persisted in for a few weeks or months will effect a permanent cure.—J. KING, Eclectic Medical Journal, 1865.

The Biographies of King, Howe, and Scudder, 1912, was written by Harvey Wickes Felter, M. D.