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lent catarrh. If we trace back the historv of any L.ise of atrophic catarrh, we shall always find the history of the "snotty-nosed child." The period of purulent catarrh, when unaccompanied by proper treatment. lasts from five to twelve years. That of hyperplasia from eight to' ten years before the atrophic Stag in. I have never found a case of atrophic catarrh that I did not believe came from a case of purulent catarrh, through its hyperplastic stage. We may not always be able to trace their history through all the -. yet it is a fact, notwithstanding, that the three must exist. Diagnosis. — An anterior examination of the 1 « ill reveal the presence of more or less greenish-yellow crusts. Thi 'resent an appearance which is absolutely characteristic of atrophic catarrh, differ- ing from th( nd in ulceration and ne< which are mingled with blood, unhealthy pus. and ne- t issue. These crusts are formed from the evap- oration of the water of the thin secretion from the atrophic membrane. If these crusts are not removed but are allowed to remain they become very thick, anil sometimes till up the entire nasal cavity. After re- rain dance slot free maining in contact with the membrane for son* 1 the crusts and membrance, which becomes very offensive. If the ii or come off, and the cavity is thor- oughly cleaned, the odor ceases, while in ozana from tiarge is always offensive; also in syphilitic ozaena. The mucous membrane is January 2, 1S97] MEDICAL RECORD. ulcerated in atrophic catarrh. The appearance of the nasal mucous membrane depends upon the length of time that the atrophic stage has existed. In the early period it is almost normal in appearance ; in the latter periods its membrane rain dance slot presents almost a bloodless appearance and adheres closely to the bone. The bone sometimes appears -shrunken and the nasal cavi- ties appear large and roomy. Treatment. — The first thing in treatment of atro- phic catarrh is to clean the nasal cavities of all crusts and to see that they do not re-form. Without thorough cleanliness nothing can be done to cure atrophic catarrh. ["here seems to be a prevailing opinion among physicians that atrophic catarrh cannot be cured: that all that can be done is to keep the nose free from crusts and give the patient temporary relief. Our books and teachers tell us that this is all that can be done. After a number of years' experience in the treatment of atrophic catarrh I am prepared to say that not only can it be relieved but it can be cured in almost every case It will take long and persistent daily treat- ment, extending over from one to three years. It is not necessary for the physician to make the treatment during all this time. With proper appliances the patient will be able to do most of the work, calling on the physician only once a week or once in two or three weeks. For the first play rain dance slots few weeks the physician should free rain dance slot machine make the treatments. The crusts should not be removed by force. An atomizer should be used with an antiseptic and alka- line solution. Dobell's solution or some of its modi- fications can be used for this purpose. Seller's tablets answer a good purpose, but I prefer the following: B kesorcin \ --. Sodium bicarbonate gr. w. Sodium biborate g Glycerin § i. Aqueous extract of hamamelis J ij. Water enough to make half a pint. This should be warmed and the nose thoroughlv sprayed with it every day. I have a tablet made con- taining five grains of resorcin and two grains each of bicarbonate of sodium and biborate of sodium. ( Ine of these tablets is dissolved in one ounce of water, or, still better, in a saturated solution of hydronaphthol. One of the foregoing solutions should be warmed and the nasal cavities thoroughly sprayed with it at least once rain dance slots free online every day. After the solution has been I horoughly, the parts should be sprayed with warm vaseline containing ten drops of campho-men- thol and five drops of eucalyptol to the ounce. This treatment should be persisted in till all the crusts come away and are prevented from re-forming. Then the patient is ready to play rain dance slot for free commence active treatment. If the case is a mild one and not too far advanced, resor- cin is one of the best app 1 use. The resorcin wash should be used and then the nasal cav- ity thoroughly sprayed with vaseline and resorcin (one per cent.). As resorcin is insoluble in vaseline, it is first dissolved in hot glycerin and then mixed with the vaseline: in some cases thymol is also added in the proportion of five grains to the ounce. This treat- ment will clean the cavities thoroughly, ait as a 'lis infectant, and promote the growth of healthy rain dance slot machine ti In old advanced eases, in which the membrane has atrophied to such an extent as to appear like parch- ment, with little or no secretion, I get better results with judicious use of trichloracetic acid. I know of no remedy in the entire materia medica that is SO useful in the treatment of all nose and throat troubles as trichloracetic acid. Dr. Stein, of Moscow, s.ivs that in solution of 1 to 500-2.000 it will keep all suppurativa - in abeyance for a week. In weak solutions it is one of the best anti- septic remedies that I ever employed, and it also causes stimulation to atrophic membrane to a greater extent than any other application with which I am acquainted. Dr. Stein says: "Weak solutiuns of trichloracetic acid used in the nose in simple atrophic rhinitis for a considerable time sometimes produce such a decided hypertrophy of the turbinated membranes that it may become necessary to cauterize diem in order rain dance slot review to secure free breathing. No other medicine of which I am cognizant produces such a remarkable effect, and thus this agent is particularly applicable in the treatment of ozena. In true ozena I now apply stronger solu- tions than I did at first, i.e., one-half to ten per cent. The odor is not so rain dance slots download quickly nor so thoroughly abol- by any other medicinal agent as by the acid. Here it is certainly a specific." From my use of* trichloracetic acid during the past six years I agree with Dr. Stein in every particular. I keep a number of solutions of the acid on hand, vary- ing from one to fifty per cent. After the nose is thor- oughly cleansed with the resorcin solution, the part is dried with absorbent cotton, and then a two-per-cent. solution is applied on a probe with cotton to the diseased membrane: the strength is increased as the effect becomes less active, spraying afterward with the vaseline and resorcin. We sometimes find a portion of the mucous mem- brane entirely denuded of epithelium and in which the glands are all destroyed, leaving a thin dry layer of membrane covering the bone. In these cases the treatment mentioned will not stimulate the part nor cause new epithelium to cover the atrophic part. In such cases it is necessary to stimulate the edges of the diseased part and cause the mobile leucoevtes to rain dance slot game col-

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