=Roughton, B. S. (Lond.), F. R. C. S., Edmund W.—The Diagnosis and
Treatment of Chronic Purulent Nasal Discharges.=—_The Jour. of Lar.,
Rhin. and Otol._, May, 1900.
We ascertain by interrogation, (_a_) if the discharge is purulent or
muco-purulent; (_b_) whether it is unilateral or bilateral; (_c_)
whether it is continuous, intermittent, or influenced by change of
posture; (_d_) if there is offensive smell perceived by the patient or
by others; (_e_) pain is not usually complained of unless there is
obstruction to drainage, and consequently retention of pus under
pressure. Unilateral discharge suggests a foreign body in a child or
sinus involvement in an adult. If it is intermittent or influenced by
position probably originates in a sinus. Subjective fetor suggests
sinusitis; while objective fetor, ozena; and combined subjective and
objective is the rule in syphilitic necrosis. Location of pain is of
very little, if any, use in diagnosis.
_Rhinoscopy._—Attention directed to (_a_) situation of the pus; (_b_)
polypi; (_c_) atrophy of the mucous membrane; (_d_) crusts; (_e_)
ulcerations; (_f_) adenoids; (_g_) nasal obstruction; (_h_) foreign
bodies. Under (_a_) beside usual cleansing of nasal cavities and
reexamination to ascertain situation, he recommends “tamponading,” _i.
e._, by blocking up first one part, then another, with pledgets of wool,
and noticing whence the discharge reappears. (_e_) Ulceration may be
syphilitic, simple, tubercular, or lupoid in origin. “It must not be
forgotten that a perforation” of the septum “may be entirely the work of
a misused finger-nail.” (_g_) The normal mucoid discharge damned up by
nasal obstruction frequently becomes purulent.
Special methods of diagnosis as follows are mentioned:
transillumination; examination of upper teeth; catheterization of the
ostium, maxillares, naso-frontal canal, and outlet of the sphenoidal
sinuses; external examination of antrum and frontal sinuses; exploratory
puncture of the antrum through the inferior meatus, alveolar process, or
canine fossa. Diagnosis of ethmoiditis is principally by exclusion.
Treatment of the accessory sinuses may be summed up under the following
indications: (_a_) removal of the cause; (_b_) evacuation and drainage
of pus; (c) antiseptic irrigation; (d) removal of morbid material, when
present. PALMER.
=Williamson, R. T.—Remarks on the Diagnosis and Prognosis in One Hundred
Cases of Double Optic Neuritis with Headache.=—_Lancet_, May 12, 1900.
The detection of optic neuritis is of the greatest importance in the
diagnosis of cerebral affections. Nevertheless, in certain cases of
double optic neuritis with headache considerable caution is necessary
before coming to a conclusion as to the exact nature of the disease.
Though these two symptoms are present in the majority of cases of brain
tumor and are so frequently due to this cause they are also met with in
other diseases. In some cases of granular kidney, for example, the
patient comes under treatment for headache and failure of vision; and
ophthalmoscopic examination may reveal intense optic neuritis like that
of cerebral tumor (neuritic form of albuminuric retinitis). At first the
symptoms appear to indicate cerebral tumor, but a careful examination of
the urine and cardio-vascular system will clearly reveal the cause.
Limited space does not permit an enumeration of all the causes of double
optic neuritis with headache. The results of the examination of one
hundred cases presenting these two symptoms reveal, however, several
points of interest. Most of these cases have been seen by us conjointly;
some were seen separately, whilst others (in Groups I. to VIII.) were
examined by one of us (R. T. W.) whilst holding the post of medical
registrar at the Manchester Royal Infirmary. For permission to include
the latter amongst our cases we are indebted to the medical board of
that hospital.
With respect to the diagnosis and termination these one hundred cases
may be grouped as follows: