V. Diseases of the Respiratory Passages.


Acute Rhinitis.

Synonyms:—Acute nasal catarrh; acute coryza; cold in the head.

Definition:—An acute inflammation of the Schneiderian membrane, catarrhal in character, and accompanied with intense hyperemia. It may involve also the adjacent sinuses and include all the nasal passages.

Etiology:—The most common cause is exposure to damp and cold and abrupt atmospheric changes. While microorganisms of various kinds may be found present, the real cause of the difficulty is the intense local congestion, caused by the locking up of the secretions of the body. Acute inflammation of these membranes may also be caused by the inhalation of irritating substances, and as the result of other acute disease. All the phenomena in an intensified form are present in la grippe.

Symptomatology:—The first indications are those present in a common "cold." There is lassitude, general muscular aching, with chilliness. There is an elevated temperature, although usually not above 101° F. There is at first a feeling of dryness and stuffiness in the head, with frequent sneezing. A severe frontal headache usually develops, rather abruptly. This is especially severe at the root of the nose, and across the forehead, through the orbits, and including the supraobital structures. Breathing through the nose is obstructed, and later impossible. The catarrhal discharge is at first thin, watery and irritating. Later it becomes copious, very thick, yet clear. In severe protracted cases it may contain pus. The swelling of the mucous membranes, which produces the occlusion, interferes with both taste and smell; the lachrymal ducts may be closed also, causing the tears to flow, or the eustachian tubes may be closed, resulting in more or less temporary deafness. Usually there is extreme aching in the thick muscles, especially those of the back and thighs. The skin is dry, and as the disease progresses, it becomes very hot. The pulse is frequent; there is anorexia, with much thirst; usually the urine is scanty and high colored. In protracted cases the fever may become intermittent, the secretion increases in purulency and becomes fetid and streaked with blood, or free epistaxis may occur. The secretion may be so irritating as to induce excoriation, ulceration, or herpes at the nasal orifices or on the upper lip. The bowels become constipated, the kidneys inactive and all secretions are diminished.

Complications:—Conjunctivitis, pharyngitis, laryngitis, bronchitis or middle ear inflammation, which sometimes progresses to mastoid disease, have followed an acute cold.

Diagnosis:—This depends upon the distressing head symptoms, with the free discharge, but the disease must be differentiated from epidemic la grippe, in which the constitutional symptoms are usually much more severe, and prostration, especially of the nervous system, is not uncommon. A violent and sudden middle-ear inflammation may be taken for nothing but an acute cold, and the real condition be thus overlooked and neglected.

Treatment:—Abortive measures are of great importance and may be successful in most cases. The patient should take a hot foot bath, should drink hot drinks in abundance, being thoroughly wrapped in flannel blankets and profuse perspiration should be induced at the onset of the disease. This may be accomplished by a dose of diaphoretic powder, by an infusion of asclepias or by hot lemonade. Twenty minims of jaborandi may often produce satisfactory results. Other remedies having a specific influence upon this disease are gelsemium, salicylate of sodium and tincture of iron. Gelsemium should be given at the onset of the cold, a full dose of perhaps five minims may be repeated in half an hour. Subsequent doses of two minims of the specific medicine may be given every hour until the symptoms have abated. In many cases the action of the salicylate of sodium in this disease will be surprisingly prompt and satisfactory. Fifteen grains should be given to an adult, dissolved in an ounce of water. This may be repeated twice at two-hour intervals. This will produce marked relief, usually when the remedy may be given every two hours, in five grain doses, for perhaps one day longer. The tincture of iron is indicated in a limited number of cases where there has been feebleness and previous relaxation of the nasal passages. Ten minims in one-fourth of a glass of water, sweetened, may be given every two hours. When the symptoms are not aborted, the indications must be closely studied and carefully met with the proper remedy, the tincture of aconite and specific bryonia will often meet the demand for internal medication satisfactorily. In cases where the secretion is excessive belladonna will be found of service.

The tincture of euphrasia, half a dram in four ounces of water, may be given in teaspoonful doses every hour, where the discharge is thin and watery and where there is considerable lachrymation. This remedy is especially valuable with children, and in the condition known as snuffles in very young infants. Salicylate of sodium may be used for this condition also, by giving frequent dram doses of a solution of five grains in two ounces of water. The inhalation of camphor is valuable in the treatment of an acute cold. The inhalation of the vapor of boiling water, or steam charged with the vapor of eucalyptus, or the compound tincture of benzoin. Or a douche may be used which contains listerine or menthol and soda.

The patient should use care to avoid exposure to cold or draught for several days following an attack of this disorder, as there is an increased susceptibility to cold, which may induce acute inflammation of a serious character in some other organ of the body.

The Eclectic Practice of Medicine with especial reference to the Treatment of Disease, 1910, was written by Finley Ellingwood, M.D.