ACUTE RHINITIS WITH RETEN- 
TION OF SECRETION. 
By C. E. PERKINSYM. D., 
SANDUSKY, OHIO. 
[Reprinted from the Medical and Surgical Reporter, July i6,1892.] ACUTE RHINITIS WITH RETEN- 
TION OE SECRETION-* 
By C. E. PERKINS; M. D., 
SANDUSKY, OHIO. 
Ill taking up a small portion of your 
time, to-day, I desire to call your attention 
to a case which has been very interesting 
as well as somewhat perplexing to me, 
and I hope that the narration of this case 
may bring to your minds similar ones 
which you have met in your experience. 
And if it does, I would like to ask you to 
narrate them for our mutual profit, as in 
trying to find some elucidation of this sub- 
ject, in text books and articles in medical 
journals, I have been greatly disappointed. 
We know that but very few cases, com- 
paratively speaking, of acute catarrhal 
rhinitis are accompanied with symptoms 
of sufficiently severe character to lead 
the patient to consult a physician, but 
*Read before Ohio State Medical Society at 
Cincinnati, May 6th, 1892. 2 
that these do occur in which the diagnosis 
is very difficult and the symptoms severe, 
I think will be shown from the following 
case: 
Miss M. K., aged 30, unmarried, con- 
sulted me on Feb. 9th, this year; her 
family, as well as personal history, was 
negative as to tubercular, rheumatic and 
specific disease; unless we might be in- 
clined to consider an attack of measles (so 
called) occurring in January, '91 as a syphil- 
itic manifestation ; but I cannot do so as 
some four or five other members of the 
family had the same trouble at the same 
time and all recovered without treatment 
of any kind. Up to the commencement 
of this trouble she had been exceptionally 
healthy and robust, having never required 
the services of a physician. 
In the latter part of October last she 
was taken with what she considered an 
ordinary cold. There were the ordinary 
symptoms of acute catarrhal rhinitis, 
viz: malaise, dryness and heat of the nose 
followed by discharge, etc., etc., but she 
had in addition to all these a severe neural- 3 
gia on the right side of the face, which 
persisted for about a month. Early in 
December complete stenosis of the right 
side of the nose developed and the left was 
partially occluded. At this time there 
was a swelling across the nose, frontal and 
nasal pains, and slight epiphora, and there 
was very little running from the nose and 
that of a watery character. About these 
same symptoms continued until just be- 
fore Christmas when she consulted her 
physician. I am quite certain that he con- 
sidered the case one of nasal syphilis, 
for he prescribed mercurial inunctionsand 
insufflated iodoform daily. She continued 
under his care for six weeks. At one time 
in January she had a hoarseness for one 
week. The right nostril continued oc- 
cluded and the left became completely so, 
although he was adopting rigorous anti- 
syphilitic treatment. Not making any 
improvement she consulted me on the 9tb 
of February. I found her weak and anae- 
mic and somewhat emaciated. There was 
complete loss of appetite, and swelling, 
redness, and pains across the nose. 4 
These pains were so severe as to inter- 
fere with sleep; there was complete steno- 
sis of both nasal passages which caused 
the characteristic voice of nasal occlusion. 
This, upon inspection, appeared to be due 
to thickening and infiltration of the turbin- 
ated bodies and septum; they were in con- 
tact about one fourth of an inch from the 
anterior nares. Having benumbed the 
parts with cocaine, I introduced a probe, 
wound with cotton, beyond this point of 
contact and brought out some cheesy mat- 
ter of disagreeable odor. I was unable to 
get a thorough view of the nasal cavities 
at that time so I directed her to return on 
the following day; then I found the (edem- 
atous swelling somewhat subsided and 
saw that there was a polypoid enlarge- 
ment of the middle turbinated bodies 
which acted as a valve to imprison the de- 
composing material. 
This I removed with cold wire snare. 
And thus opened up a regular cavity on 
each side, from which I removed at least 
an ounce of foul-smelling cheesy pus. I 
might add that this accumulation was 5 
above the middle turbinateds so far as I 
could make out. As the parts were thus 
opened, and the discharge was enabled to 
make an exit, it gave rise, by running down 
into the throat, to a very distressing nau- 
sea. This I succeeded in relieving by 
daily removing these secretions and spray- 
ing the nares with a solution of peroxide 
of hydrogen, " Marchand," one to four of 
water, and a mixture, taken internally, of 
pepsin and bismuth; I also prescribed 
champagne. Under this treatment the 
patient soon began to improve. She re- 
gained her appetite, the stenosis was re- 
lieved, foetor stopped, and she began to 
gain in flesh and strength, and on the 4th 
of March I permitted her to go home, some 
ten miles, to report occasionally; she con- 
tinued to improve until the 24th of March, 
when she returned complaining of obstruc- 
tion in the right nasal cavity. Then I re- 
moved the last bit of decomposed mucous, 
which had become very much hardened; 
since which time she has remained well. 
1 examined her on the 26th of April and 
found the nasal cavities as nearly normal 6 
as we are accustomed to see them: there 
was no ulceration, nor was there any per- 
foration of the septum, or anything to sug- 
gest to me that a syphilitic process had 
been going on. 
This case has been a very perplexing one 
to me as far as the diagnosis is concerned. 
I cannot regard it as syphilitic, as the 
effect of antisyphilitic remedies was of no 
avail, but positively hurtful, and the case 
got well without any of the results, such 
as perforation of the septum, exfoliation 
of bone, etc., which we should expect to 
result from such a severe syphilitic mani- 
festation. 
1 am perfectly convinced that it was a 
case where the patient was taken with 
acute catarrhal rhinitis and as a result of 
the swelling of- the mucous membrane, 
the discharge was retained and becoming 
decomposed gave rise to the train of symp- 
toms occurring in the case. There might 
have been implication of some of the ac- 
cessory sinuses, but 1 think that there 
was not to any extent at least. In look- 
ing over the literature of this subject as 7 
far as I have had an opportunity, it is 
surprising how little is to be found. The 
only contribution is from the pen of 
Middlemas Hunt, of Liverpool, which oc- 
curs in the journal of Laryngology, Rhin- 
ology and Otology, page 1, vol. 6; there 
under the head of "Serious Symptoms 
Arising from Retention of Nasal Dis- 
charge," he relates two cases. The first 
was a girl aged 23, who had had the 
trouble for a year with complete stenosis 
of the right nostril. Before coming under 
his care the case had been diagnosed as 
one of malignant disease. He destroyed 
the folds of mucous membrane which held 
the secretion in the nose, and " scooped 
out the putty like material." The case 
resulted in a cure. The second case was 
a widow aged 45. She had about the 
same symptoms except that the neuralgic 
pains were more severe. Her medical at- 
tendant had diagnosed syphilis and had 
salivated her without effect. The same 
foul-smelling cheesy material was found 
in the nasal cavity of the right side. He 
adopted the same treatment except that 8 
he snared the hypertrophied turbinated 
valve, as it were. In his eases owing to 
the length of time the disease had per- 
sisted, the fold which had obstructed the 
exit of the discharge had become almost 
the same as granulation tissue, while in 
mine, from the short length of time, about 
five months, it was mucous membrane in- 
filterated with serum, greatly resembling 
true myxoma. His also differs in being 
unilateral, whereas, mine was on both 
sides. 1 lis conclusion is this, and I quote 
in his own words: "The sequence of 
events, in the above cases seems to be as 
follows: An acute nasal catarrh, extending 
to one of the acessory cavities, most 
probably the frontal sinus, with swelling 
and inflammatory hypertrophy of the 
mucous membrane, leading to gradual 
occlusion of the nostril and retention of 
the discharge, which gradually filled the 
nasal cavity, became inspissated, and, 
through pressure gave rise to pain and de- 
formity. Disease of the antrum is ex- 
cluded by the cessation of all symptoms 
after removal of obstruction." 9 
I wish to say that my patient was well 
before I saw Dr. Hunt's article, but if I 
had seen it sooner it would have been a 
great help to me as well as a relief. And 
now in conclusion, I wish to add that I 
reported this case more because T have 
considered it my duty than for any other 
reason, and I hope it will impress upon 
your minds that cases do occur where 
there may be a foul-smelling cheesy ac- 
cumulation in nasal cavities without 
syphilis or ulceration of the mucous mem- 
brane, notwithstanding what some of our 
best authorities on nose and throat disease 
may hold in their writings.