REFERENCE HANDBOOK OF THE MEDICAL SCIENCES. 
Ox Oall. 
Oztena. 
tion in the depths of the nostrils causing a discharge and 
a bad odor.” 
Both Pliny (first century) and ZEtius (fifth century) 
speak of the therapeutic management of ozaena, the lat- 
ter recommending for its cure insufflations of various 
medicaments, and also the introduction of medicated 
pledgets within the nostrils. 
The treatment instituted by Rufus (second century), 
Rhazes(ninth century), Avicenna (tenth century), Forestus 
(sixteenth century), and others, was, primarily, detergent, 
and, secondarily, directed to drying up the ulcers. 
Actuarius (fourteenth century) seems not to have re- 
garded ulceration as a constant accompaniment of ozaena, 
but calls especial attention to the odor emitted from de- 
composed nasal secretions. 
Alexander Trallianus (sixth century) and Pare (six- 
teenth century) entertained essentially the opinions pro- 
mulgated by Galen at an eai’lier period, while Fabricius ab 
Acquapendente (sixteenth century) and Thomas Mayern 
(seventeenth century) thought syphilis the leading causa 
morbi. 
Reininger (1722) and Giinz attributed ozaena to the pu- 
trefaction of secretions retained in the frontal, ethmoidal, 
sphenoidal, and maxillary sinuses, a theory which has 
been urged more recently by Michel and Rouge. 
Sauvages (1771) was, 1 find, the first to insist upon the 
distinction of ozaena without lesion of the nares (simple, 
true, or idiopathic ozaena) from that attributable to lesions 
of the nasal mucosa, the nasal bones, and cartilages. 
Yalleix (1866) did not attribute ozaena to an ulceration 
of the Schneiderian membrane. 
Cloquet (1830), Trousseau (1835), Cazenave (1835), and 
other older writers, have described the leading clinical 
features of ozsena with a clearness and scientific accuracy 
worthy of admiration. 
Trousseau (1835), Max-Simon (1850), and Cousin (1868) 
divided the disease into symptomatic and constitutional 
ozsena. 
In 1866 Otto Weber maintained that ozsena was simply 
a symptom and not a distinct disease, as many had hitherto 
claimed. 
Niemeyer (1874) thinks there is an ulcerative and a non- 
ulcerative ozsena. 
A very remarkable monograph has recently been pub- 
lished (1886) by W. Moldenhauer, in which the opinions 
and teachings of Gottstein, B. Frankel, Bresgen, and 
others, are warmly assailed. 
Moldenhauer himself, however, makes no attempt to 
explain the pathology of true ozsena, or to add another 
to the many theories already existing relative to this af- 
fection. 
During the past six years interesting articles upon this 
disease have been written by Schrotter, Zaufal, Tillot, 
Zuckerkandl, Michel, B. Frankel, Gottstein, Schaffer, 
Rouge, Cozzoline, Stoerk, Beverley Robinson, Martin, 
Boswortli, Franks, Krause, Massie, Calmettes, Moure, 
Ziem, Clinton Wagner, Woakes, Thornton, Morell Mac- 
kenzie, and others, reference to which is made in my 
bibliography of this subject at the end of the article. 
Etiology.—True ozsena is usually associated with an 
atrophic rhinitis, and occurs most frequently prior to the 
age of thirty, and oftener in the female. 
The disease is common in children, and sometimes ex- 
ists in two or more members of the same family, but 
proof of its contagiousness is wanting. 
Atrophic rhinitis with ozsena is, according to most 
authorities, generally due to the mapifestations of the 
scrofulous or syphilitic diathesis upon the Schneiderian 
mucous membrane. 
The nasal fossse are richly supplied with glands and 
lined with tissues of a highly vascular and cavernous 
structure, thus offering the conditions necessary for the 
localization of either scrofula or syphilis therein. 
The ozaenic subject is one who usually suffers from a 
constitutional weakness, at times ill-defined, which may 
be occasioned by heredity (Frankel, Zaufal, and Bres- 
gen), by hereditary syphilis, by scrofula, or occur as a 
sequel of the eruptive fevers, particularly of scarlatina, 
measles, and small-pox. 
OZ/ENA, from o C,eiv, to stink, or a fish possess- 
ing”afetid odor. Synonyms : Fetid Catarrh, Scrofulous 
Ozama, Fetid Coryza, Strumous Catarrh, Stinknase (Ger.), 
Punaisie (Fr.), Foetor Narium, and Dysodia Narium 
(Lat.). 
Definition.—By true or simple ozaena (rhinitis chron- 
ica atrophicans foetid a), names preferred by the writer, 
is meant an affection limited to the nares, in which there 
is no ulceration or diseased bone, the fetid odor depend- 
ing on changes in the retained secretions! 
The disease, of course, may be modified by diathesis, 
but is not dependent thereon. 
Preliminary Remarks.—The above names are ap- 
plied to a condition of the nares in which a stinking, and, 
to some extent, characteristic odor is exhaled. This odor 
is sui generis, but has been improperly likened to the 
peculiar smell of a mashed bedbug or chintz. 
There exists considerable ambiguity concerning the 
application and exact significance of ozsena, and although 
originating in the earliest period of medicine the word 
has acquired a large and rather indefinite use, even in 
modern times. 
Brochin prefers to describe the condition as an in- 
firmity, not esteeming it a disease proper. 
The term, when unqualified, is quite as indefinite and 
vague to a scientific mind as the generic expressions 
pain, fever, inflammation, or dropsy; all of which phe- 
nomena may owe their existence to diverse causes. 
A mere stench exhaled from the nares may originate 
from disease of the accessory sinuses, from rhinolitlis, 
from the presence of some external foreign body, from 
disease of the osseous or cartilaginous framework, from 
cancer, from lupus, from syphilis, and other causes, but 
the ozsena (stench) is symptomatic only of these disorders. 
Until very recently any affection of the nasal passages 
in which the expired air was fetid was called ozsena ; 
hence, diseases differing widely as to symptoms, course, 
and treatment were included under this rather broad 
category. 
The writer fails to appreciate in what manner limit- 
ing the word ozsena to those fetid diseases of the acces- 
sory sinuses whose prominent symptoms are manifested 
in the nares, can lead to a simplification of the question. 
The retention, then, of this word in medical nomenclat- 
ure is unfortunate, and its use, except as hereafter to be 
indicated, calculated to promote confusion. 
Ozsena is by no means to be classed as a separate and 
distinct disease, but rather as an attendant of several nasal 
affections, particularly atrophic rhinitis. 
The writer further believes that ulceration of the nasal 
mucous membrane rarely, if ever, occurs in true ozsena, 
and he considers the retention and decomposition of nasal 
secretions an essential factor in the production of the 
stench accompanying the affection. 
Clinically, lie is satisfied that the fetidness of the odor 
is proportionate to the length of time the incrustations 
remain in the nasal cavities. 
In the present contribution he will, so far as is consist- 
ent with fact, have respect for the above indicated prop- 
ositions, which are briefly the expression of his indi- 
vidual views concerning this unsettled question. 
Historical.—Well-nigh all ancient writers considered 
ozaena as associated with, and dependent upon, the pres- 
ence of ulcers within the nares. 
Celsus (40 b.c. to 20 a.d.) says, “ The Greeks gave the 
name ozaena to nasal ulcers covered with crusts of a 
stinking odor.” 
Galen (second century) defines ozaena as “an ulcera- 
445 Ozsena. 
Ozsena. 
REFERENCE HANDBOOK OF THE MEDICAL SCIENCES. 
We are struck with the similarity, as to age and gen- 
eral surroundings, of patients suffering with this disease ; 
they are about the age of puberty, the youngest may be 
nine, the oldest is generally not over twenty years of age. 
Adults will invariably trace their disease back to early life. 
The contour of the nose in children suffering with 
ozsena is frequently identical with that of their parents 
(father or mother) who have the same affection. 
M. Mackenzie does not regard the disease as constitu- 
tional in the true sense of the word. He further says 
“ that though scrofula probably produces a certain dis- 
position to catarrh, and renders the affection more in- 
tractable when it does occur, it cannot, in my opinion, 
be said to cause ozsena.” 
Ziem and Schaffer claim that true ozsena may occur 
independently of atrophic rhinitis, and we all well know, 
on the other hand, that atrophic rhinitis is not invariably 
accompanied by ozsena. 
Among Schaffer’s 123 cases of ozsena, 99 were due to 
struma and 20 to syphilis. 
Stoerk maintains that syphilis is the sole cause of ozsena. 
Gottstein says that only two of his twelve cases of ozsena 
appeared to result from scrofula, and none was traceable 
to syphilis. 
The existence of what may be denominated true ozsena, 
as distinguished from the symptomatic variety (depend- 
ent upon caries, necrosis, polypi, deformities, abscess of 
the accessory sinuses, etc.), appears to be established not 
only clinically, but anatomically and etiologically. 
The rhinoscopic and post-mortem examinations made 
by Zaufal, Michel, Hartmann, Gottstein, and other Ger- 
man investigators, have rendered it quite evident that 
the peculiar fetid odor of true ozsena has no dependence 
upon the presence of ulceration in the nares ; that when 
the adherent crusts are removed the pituitary membrane 
is seen to be less vascular than normal, smoother, slightly 
atrophied and inflamed, but above all intact. 
The turbinated bodies do not present the characteristic 
erectile prominence ; the inferior one is of diminutive 
size and is sometimes absent, giving to the nasal cavity 
enormous dimensions. 
Chronic rhinitis, especially of the hypertrophic variety, 
predisposes to the development of atrophic rhinitis, and 
perhaps of a subsequent true ozsena. 
The inhalation of dust and irritating gases, deviations 
of the vomer, and other conditions causing a chronic 
rhinitis, may result in ozsena. 
The exceedingly disagreeable odor of ozsena is thought 
by a few authors to arise from individual idiosyncrasy, 
just as foul perspiration of the axillae, groins, and feet is 
common to some individuals. 
The penetrating perfume emitted from the body of the 
average negro is a striking instance of race idiosyncrasy, 
and exceeds in rare cases the nauseating exhalations of 
ozsena. 
That the nasal mucous membrane in ozsenic patients is 
endowed with the special function of exhaling or secret- 
ing foul odors, the writer does not believe. 
Bosworth very aptly remarks in this connection that 
there is no analogy in the above comparisons, as the 
nasal mucous membrane is not an excretory organ. 
It is the writer’s opinion that the foul odor in true 
ozsena is dependent solely upon the presence of retained 
and decomposing secretions within the nares ; and that if 
these secretions be removed and their further formation 
checked, all fetor disappears. 
To the assertions that ozsenic secretions contain a 
special ferment, and that ozsena is attributable to fatty 
metamorphosis, he attaches slight importance clinically. 
Recently Loewenberg has added an interesting mono- 
graph to the already voluminous literature of this affec- 
tion, and claims to have discovered a special microbe 
(always found as a diplococcus) for ozsena. 
Around this microbe clusters much that is ingenious, 
theoretically, but the practical results of the alleged dis- 
covery as regards the cure of ozsena are as yet nil. 
It has been stated that ozsenic patients never suffer 
from hay fever ; but the writer happens to know of one 
at least who does. 
Anosmia, however, appears to afford complete im- 
munity from hay fever, so far as is now known.* 
Pathology.—The disease, as stated, commences gen- 
erally in early life, and according to Bosworth “ in an 
inflammation which is characterized by a desquamation 
of the epithelium lining of the acinous glands, which re- 
sults in their destruction.” 
In some of Bosworth’s specimens the glands had dis- 
appeared absolutely. The result of this is necessarily 
that the membrane is deprived of its normal supply of 
mucus. That which is secreted being scanty, very soon 
dries upon the surface of the membrane. There is thus 
formed a dry pellicle, which adheres closely, and is re- 
moved with difficulty. Remaining, it soon undergoes 
decomposition, and gives rise to fetor. 
The pellicle of inspissated muco-pus which dries upon 
and adheres to the membrane-, clinging about the con- 
vexity of the turbinated bones, and contracting and dry- 
ing, necessarily exercises pressure and obstructs the cir- 
culation. 
As a result of this, the atrophy of the membrane is still 
more encouraged. As we know, the deep layer of the 
mucous membrane in this region blends with, and really 
forms, the periosteum of the turbinated bones. We can 
easily see, therefore, how, as the result of the process 
continuing through years, there may occur the atrophy 
of the turbinated bone which characterizes the late stages 
of the disease, and which results from impaired nutri- 
tion. 
Zuckerkandl, as quoted by M. Mackenzie, proves that 
not only the soft tissues, but also the bony structure of 
the turbinated bodies become thinner, more elastic, 
flatter, and smaller. 
“ The mucous membrane shrinks and becomes 
wrinkled, the erectile tissue disappears, and the thin, 
pale, shining mucosa looks more like serous than mucous 
membrane. 
“ When the morbid process is far advanced nothing is 
left but thin bands of mucous membrane, occasionally 
perhaps containing some small osseous fragments, the re- 
mains of the spongy bones.” 
Gottstein, as quoted by the same author “finds no de- 
fect other than a certain thinness of the mucous mem- 
brane in cases of ozsena. On microscopic investigation 
the epithelium was found to be normal; beneath this 
was a layer of small round cells mixed with a few spindle- 
shaped cells, and beneath this stratum again was another 
of fibrillar areolar tissue generally lying parallel to the 
surface, the fibrillse being here and there collected into 
bundles in different stages of development. The vessels 
were richly developed and the elastic tunic of the arteries 
thickened. The glandulae were numerous, the gland-cells 
not being recognizable in some places, and the appear- 
ances were those of chronic rhinitis with more or less ad- 
vanced cirrhosis of the mucous membrane and a partly 
infiltrated and atrophied condition of the glandulse.” 
Zaufal thinks the small size of the turbinated bones is 
not due to atrophy, but to arrested development. 
Zuckerkandl, by an examination of two hundred and 
fifty-two skulls, has apparently disapproved Zaufal’s 
views. 
The discharges and crusts of ozsena consist of pus-cor- 
puscles, granular debris, and some epithelium, and are 
usually of an alkaline reaction. 
Krause contends that the mucous cells undergo fatty 
degeneration, and says he has found in the secretion of 
ozsena fatty corpuscles and pigmentary molecules, which 
form a part of the tenacious crusts. 
Quite recently Habermann, of Prague, finds that true 
ozsena consists in an affection of all the glands; first 
there is an accumulation of drops of fat in the glandular 
epithelium, and later a complete degeneration of the epi- 
thelium takes place. 
At a later stage there is inflammatory infiltration of 
the mucous membrane with granular degeneration of the 
infiltrated cells, while at certain points the drops of fat 
already described by Krause are observed. 
* See writer's remarks, Trans. Am. Laryngological Association, 1886. 
446 REFERENCE HANDBOOK OF THE MEDICAL SCIENCES. 
Ozaena. 
Ozaena. 
The osseous structures and venous sinuses alike suffer 
atrophy. 
Moure, of Bordeaux, inclines to the opinion that the 
atrophied turbinated bodies in true ozrena are regenerated 
as the patient advances in age or as the disease diminishes 
in severity under treatment. 
Symptoms.—To the intelligent and frequent perform- 
ance of anterior and posterior rhinoscopy much that is 
accepted at the present day concerning the diagnosis, 
symptomatology, and proper treatment of rhinitis chron- 
ica atrophicans fcetida (true ozsena) is directly attribut- 
. able. 
With the aid of the rliinoscope we are enabled to note 
every change in objective symptoms resulting from treat- 
ment or otherwise, and can readily assure ourselves of 
the special points at which mucous collections are wont 
do lodge, and thus are able to effectually remove the same. 
Rhinoscopy generally demonstrates the presence of 
dried mucus, fetid crusts, and capacious nasal chambers 
dependent upon the smallness or entire absence (1) of the 
inferior turbinated bodies, all of which are briefly the 
salient featui’es of true ozaena. 
The crusts are often found distributed over the entire 
surface of the nares, more commonly, however, moulded 
over the middle turbinated bones, post-nasal orifices, and 
pharyngeal vault. The morbid changes giving rise to 
fetor in true ozaena appear to be confined to the narrower 
portions of the nares, the pharyngeal vault habitually es- 
caping. 
The constitutional symptoms of ozaena, when present, are 
those pertaining to the particular diathesis with which 
ozaena is associat- 
ed, namely, scrof- 
ula, syphilis, or tu- 
berculosis. 
Dyscrasia and 
general systemic 
disturbance, per- 
haps illy defined, 
are nearly constant 
accompaniments of 
ozaena, and if not 
present from the 
incipiency of the 
disease, appear at a 
later stage. 
We have all en- 
countered atrophic 
rhinitis with ozae- 
na in apparently 
healthy children 
and adults, but 
such a state of 
health is exception- 
al and not destined 
to be of long dura- 
tion, for the mere 
inspiration of taint- 
ed air by such a 
patient will finally result in impairment of his general 
health. The facial expression and shape of the nose is 
quite characteristic in many ozsenic patients ; wre have 
the strumous facies, thick lips, prominent cheeks, sub- 
maxillary glandular enlargement, the bridge of the nose 
is depressed near the frontal bone, the anterior nasal ori- 
fices, instead of opening downward, often look outward 
anteriorly. 
The saddle nose is Zaufal’s name for the above state of 
affairs. Fig. 2731 represents the profile of one of my 
ozaenic patients. 
The shape of the nose appears to have had great influ- 
ence with the Emperor Nicholas, of Russia, in selecting 
his famous regiment, “ the Imperial Nosegay.” 
Before the Crimean war he discovered by some means 
that the best fighting and most ferocious men possessed a 
nose which stood straight out from the base of the fore- 
head in the form of a triangle, presenting in front the 
appearance of a double-barrelled pistol. 
This crack regiment of a thousand men was ultimately 
routed by the French, and the defeat was attributed to 
a peculiar sensibility of the nose regiment for garlic, of 
which the Frenchmen are so fond and had eaten, and 
•with the odor of which the atmosphere of the battle-field 
was loaded. 
When charged with cowardice, “ the Imperial Nose- 
gay ” said they could and would face any foe ; but the 
odor of the garlic-eating Frenchmen was too much for 
them. 
Antecedent histoiy frequently affords no clue to the 
existence of diathesis in these patients, and they are often 
entirely ignorant of their nasal affection until those asso- 
ciated with them perceive the stench. It is proper to 
state again at this point that several authorities consider 
ozsena a local disease, entirely independent of diathesis. 
The foul-smelling exhalation occasioned by ozaena is 
the most prominent symptom, and frequently renders the 
patient a burden to himself and an object of avoidance by 
those brought in contact with him. Patients are occa- 
sionally totally unconscious of these foul emanations, for 
the reason that olfactory sensibility is blunted by either 
atrophic changes or the ever-present odor. 
When the discharges are copious and there is the char- 
acteristic incrustation and tenacious adhesion of scabs to 
the nasal membrane and turbinated bodies, the breath be- 
comes particularly offensive, even saturating the air of an 
ordinary room with the foul odor. The writer on several 
occasions has been forced to exclude ozsenic patients from 
Fig. 2732.—Sites generally occupied by the Crusts of True Ozaena, as re- 
vealed by Anterior and Posterior Rhinoscopy. (Writer’s case.) 
his reception-room and treat them at special hours, so ob- 
jectionable was their presence to other patients. 
The crusts are of a greenish or grayish-brown colbr, 
often streaked with blood ; they accumulate in both the 
anterior and posterior nares and the naso-pharynx, causing 
great embarrassment to nasal respiration, and frequently 
occasion nausea and vomiting when the patient makes an 
effort to dislodge them. Frontal and supraorbital pains, 
anorexia, depression of spirits, perverted taste, loss of 
smell, and dulness of the mental faculties are common 
symptoms. 
The olfactory sense may be partially or entirely lost, 
and the disorders of taste resulting therefrom may seri- 
ously interfere with nutrition, by rendering certain foods 
(meats) distasteful. 
M. Martin recognizes, in common with Zaufal, that 
slight functional disorder of the ear, and perhaps otitis, 
may occur as a complication of ozsena, as of other nasal 
affections. According to Loewenberg, the immunity of 
the middle ear in this affection is wellnigh universal. 
Catarrh of the lachrymal canal, epiphora, catarrhal con- 
junctivitis, and weakness of the, eyes are among the com- 
plications of the disease under discussion. 
There is usually considerable irritation and dryness of 
the pharynx, and its membrane is generally either cov- 
ered by a thin pellicle of dessicated secretion, or is of a 
dry, glistening appearance if the crusts have been pre- 
viously detached. 
Fig. 2731.—Profile of a Child of Twelve Years, 
suffering from True Ozsena. (Writer’s case.) 
447 Ozsena. 
Ozsena. 
REFERENCE HANDBOOK OF THE MEDICAL SCIENCES. 
The number and size of the crusts discharged vary 
greatly ; they are not usually larger than an almond- 
shell, and one is usually discharged every few days from 
either nostril. I have known, however, two crusts of 
large size to escape daily from each nostril. 
The velum pendulum palati is almost universally de- 
prived of its normal sensibility, and a posterior rliino- 
scopic exploration can be readily accomplished. 
Such an examination, as before indicated, shows that 
the mucous membranes are everywhere pale, covered 
here and there by inspissated tenacious mucus, and that 
the soft tissues adhere closely to the underlying osseous 
structures, thus giving to the posterior nares an abnor- 
mally large appearance. 
Figs. 2732 and 2733 are drawings made from one of 
my patients suffering with true 
ozaena, and show the points at 
which crusts are usually found, as 
revealed by anterior and posterior 
rhinoscopy. 
The atrophied condition of the 
nasal mucosa and thinness of the 
turbinated bones is also well marked 
in this typical case. 
Diagnosis.—The diagnosis of 
"true ozaena,” i.e., atrophic rhini- 
tis with fetid secretions, is both 
important and devoid of serious 
difficulty, if the modern methods 
at our disposal for exploring the 
nares be utilized. After thoroughly 
cleansing the nostrils of all crusts 
and mucosities by means of a de- 
tergent spray or douche, containing, preferably, Dobell’s 
solution,* a careful anterior and posterior rhinoscopic ex- 
amination is to be made, when, if ulceration, necrosis, 
polypi, foreign bodies, etc., are present, they can hardly 
be overlooked. The general history of our patient, and 
the persistence of fetor in symptomatic ozaena, after free- 
ing the nares of accumulated secretion, must be kept in 
mind. 
Several cases of symptomatic or simulated ozaena, due 
to the presence of plum-stones, cherry-stones, buttons, 
pebbles, etc., have been reported by Holmes, Coote, Til- 
laux, and others. 
The extraction of the foreign body in these cases was 
followed by cessation of the symptomatic ozaena. 
Prognosis.—Cases of true ozaena do not apply for 
treatment until the disease has existed quite a length of 
time, and is well established. Hence a cure is wrought 
with many difficulties, and can only be attained, if at all, 
by a persistent and long-continued therapeutic, hygienic, 
and dietetic regime. The writer firmly believes in the 
occasional curability of true ozaena. 
The prognosis depends greatly upon the state of the 
patient’s general health, his age, occupation, etc. If 
there is a marked scrofulous diathesis, we can materially 
mitigate the severity of the nasal symptoms, as well as 
contribute much toward rendering the ozaenic manifesta- 
tions comparatively endurable, but this is the extent of 
our present ability. 
The disease is obstinate in the extreme, but grows less 
and less apparent as the patient advances in age ; and the 
writer has seen it practically disappear at the age of 
forty. 
While we are unable to achieve brilliant results in al- 
ways curing ozaena, our numerous and efficient palliative 
methods may practically reduce the inconvenience of our 
patient to a' minimum and result in great improvement 
of his general health. Systematic cleansing and disin- 
fection of the nares deprives the inspired air, which is 
otherwise tainted and laden with decomposed effluvia, of 
its toxic influences, thus improving the general health. 
During the writer’s professional experience he has been 
called upon to treat several obstinate and aggravated 
cases of ozaena occurring in young ladies, circulating 
constantly during the season in the captivating social 
festivities of the capital of the nation. The daily dissi- 
pations of these belles were never interrupted, and their 
infirmities, thanks to science, have never been the subjects 
of suspicion. This favorable state of affairs, it is but fair 
to state, was only secured by the most assiduous use of 
detergent and antiseptic medicaments—such assiduity as 
highly sensitive persons would gladly avail themselves 
of to cover their repulsive infirmity. 
Treatment.—The treatment of true ozsena is both 
systemic and local. 
Systemic treatment should consist of tonics and alter- 
atives administered in such manner and at such times as 
to improve the tone of the system and of the assimilative 
functions. For the anaemia attending ozsena, the prepa- 
rations of arsenic, quinine, iodine, or iron, such as the 
tincture of the chloride, the syrup of the phosphates of 
iron, quinine, and strychnine, or bismuth, the mistura 
ferri composita (Griffith's myrrh mixture), or the syrup of 
the iodide, should be employed. Donovan’s, Pearson’s, 
or Fowler’s arsenical solutions, as well as Lugol’s iodine 
solution, are at times required by the exigencies of the 
case. 
The writer has obtained excellent results from gold 
chloride, or gold and sodium chloride, to -j? gr. three 
times daily. Where there is debility, loss of appetite, 
and emaciation, the syrup of the hypophosphites or lac- 
topliosphates of lime, sodium, potassium, or iron, either 
singly or combined, will be of service. Cod-liver oil, 
malt extracts, liydroleine, oleo-chyle, or, above all, a 
palatable preparation containing cod-liver oil, long used 
in the District of Columbia, the formula for which is 
herewith given, may render valuable service. 
Mistura Phosphatica (D. C. P.). 
R. Dilute phosphoric acid f \ jss. 
Yolk of eggs 3 iij. 
Cod-liver oil f 1 viij. 
Glycerine f ? ijss. 
Oil of bitter almond iUxx. 
New England rum f % viij. 
Orange-flower water q. s. 
Reduce the yolk to a smooth paste ; add gradually the 
oils with constant trituration, then add eight fluidounces 
of orange-flower water during brisk agitation. Lastly, 
add the glycerine, rum, phosphoric acid, and enough 
orange-flower water to make the finished emulsion meas- 
ure thirty-two fluidounces. 
Where, in addition to the above symptoms, there is a 
well-defined strumous diathesis and special impiarment 
of the digestive functions, the writer has obtained excel- 
lent results from the following formula, which he de- 
vised some years since, and which is now in general use 
in treating tuberculosis and other wasting diseases : 
Pulvis hypophosphilum cum Pepsino (Morgan). 
R. Calcium hypopliosphite 5 parts. 
Sodium hypopliosphite 5 “ 
Iron hypopliosphite 2 “ 
Manganese hypopliosphite 1 part. 
Pepsin (Boudault’s neutral) 8 parts. 
Milk sugar 4 “ 
M. 
This powder should be finely ground and kept, as well 
as dispensed, in glass. It can be prescribed in bulk, one- 
half teaspoonful (15 grs.) three times daily, stirred in 
cold milk, wine, water, brandy, etc. Lactopeptine, in- 
gluvin, scale pepsin, or Scheffer’s pepsin may be substi- 
tuted in the formula for Boudault’s pepsin. The prep- 
arations of mercury and potassium iodide are indicated 
when this disease is complicated with a syphilitic dia- 
thesis. 
Climate appears to exert little influence on this disease. 
Abundant exercise, proper ventilation, avoidance of ex- 
posure, and perhaps sea-bathing, assist in bringing about 
a favorable termination of the affection. 
Mineral icaters, especially the sulphuretted, according 
to some writers, are beneficial when used either internally 
or locally. 
Fig. 2733.—Posterior Rhi- 
noscopio Image in a Case 
of True Ozsena. (Writer’s 
case.) 
* See correct formula, under Treatment, in this article. 
448 REFERENCE HANDBOOK OF THE MEDICAL SCIENCES. 
Ozsena. 
Ozsena. 
There is urgent need of further investigations upon 
this point. 
Clothing, etc.—The body should be warmly and com- 
fortably clad, and every attention paid to the mainten- 
ance of cleanliness and of perfect action of the cutane- 
ous and renal secretory functions. 
Diet.—A well-regulated and sustaining system of diet, 
having due regard to proper action of the intestinal tract 
and the maintenance of bodily strength, is of first im- 
portance in managing the disease. 
Local Treatment may be carried out by means of 
sprays, vapors, solutions, powders, ointments, medicated 
bougies, or cotton-wool tampons, medicated 
cotton, galvano-cautery, etc., and the objects 
sought to be obtained are : 1, the detachment 
of crusts ; 2, their re- 
moval from the nares ; 3, 
the correction of the fetid 
exhalations ; 4, the 
prevention of crust 
formation, w li i c h 
latter amounts to 
curing the disease. 
Topical applica- 
tions to the nasal 
passages and naso- 
pha r y n x should 
cause no unneces- 
sary irritation of the 
mucous membrane, 
which is, as a rule, more sensitive than that of either the 
pharynx or the larynx. 
They are to be persistently and regularly resorted to 
by the patient, who should be early impressed with their 
necessity and value. Most of the instruments devised 
for applying medicines to the nasal passages can be used 
by the patient on himself, but should not be entrusted to 
him exclusively. 
Sprays may be both of a detergent and remedial nat- 
ure, and afford a safe, complete, and easily applied 
method for the management of true ozsena. They may 
be administered from the hand-ball spray apparatus, from 
the steam atomizer, from the more convenient compressed 
air-sprav machines, or from a Lefferts’ spray producer 
(Fig. 2784). 
Detergent sprays should be of a rather mildly alkaline 
and antiseptic character, and should always be employed 
chlorate, or Condy’s fluid may be used in the place of 
the borax. 
Dobell’s Solution* 
1$. Sodii boratis 3 j. 
Glycerini acidi carbolici (Br. Ph. or 
U. S. Ph., 1870) f 3 ij- 
Sodii bicarbonatis 3 j. 
Aquae tepidae (90° F.) Oss. 
M. 
There are several questionable modifications of the 
above formula, all incorrectly passing under the name 
of Dobell’s solution, and care should be exercised in ob- 
taining a well-made solution. 
Another detergent and antiseptic spray is : 
B. Sodii boratis, 
Sodii carbonatis aa 3 j. 
Liq. sodae chloratae f 3 ss.-f 3 iij. 
Glycerini f 3 vj. 
Aquam ad f § iv. 
M. Sig.—To be used as a spray. 
Collunarium Zinci Boratis Co. (Morgan). 
B. Zinc chloride gr. xx. 
Boric acid gr. xv. 
After dissolving in twelve fluidounces of distilled water 
the solution is to be neutralized with water of ammonia. 
Lastly, add two fluidounces of glycerine, and filter. It can 
be used as a wash or spray, pure or diluted with water. 
Fig. 2734.—Lefferts’ Spray Producer. 
Fig. 2736.—Method of Using the Nasal Douche. (Bosworth.) 
The writer makes daily use of the following formulae 
as cleansing agents in the form of spray or solution : 
I}. Listerine, 
Glycerini boracis aa f 3 ij. 
M. Sig.—To be used in the spray in the proportion of 
one part to seven of water. 
I). Ominico f 3 jss. 
Glycerini boi’acis f f ijss. 
M. Sig.—To be used in the spray in the proportion of 
one part to seven of water. 
5. Thymol gr. j. 
Alcoliolis f 3 j. 
Glycerini f 3 ij. 
Aquam ad f § j. 
M. Sig.—Use as a spray. 
* See Dobell on Winter Cough, etc., 8vo, third edition, 211. London, 
1875. 
Fig. 2735.—a, Siphon nasal douche ; 6, Weber’s nasal douche ; c, barrel 
nasal syringe. 
in the anterior and posterior nares before applications of 
medicine are made to the diseased parts. 
The alkalinity of a spray facilitates the dissolving of 
crusts, and its antiseptic ingredients correct the toxic ef- 
fects of decomposing secretions upon the nares and gen- 
eral health. 
Among the most useful of this class is Dobell’s solution, 
of which the original formula is herewith given, with 
Dobell’s statement that ammonium chloride, potassium 
VOL. v.— 29 
449 Ozrena. 
Oziena. 
REFERENCE HANDBOOK OF THE MEDICAL SCIENCES. 
The infusum picis liquid* (U. S. Ph.) constitutes a 
soothing and highly disinfectant preparation, used either 
as a spray or wash. Acidum carbolicum qxx., or creaso- 
tum ntxx., to aq. calcis Oj., will be found an efficient 
spray or wash. 
Sprays of the following medicaments, in the strength 
indicated to the ounce of water, are recommended either 
as antiseptics, detergents, astringents, or resolvents : Am- 
monium chloride, gr. v.-xxx.; potassium permanganate, 
gr. ij.-v.; potassium chlorate, gr. v.-x.; zinc sulphate, 
gr. j.-x.; zinc sulpho-carbolate, gr. j.-x.; zinc chloride, 
gr. j.-x.; sol. chlorinated soda, Hxx.-f 3 j.; chlorine wa- 
ter, ttlxx. ; creasote, TT[ij.-v.; carbolic acid, TTfij.-v.; bo- 
ric acid, gr. j.-x.; sodium benzoate, gr. iij.-x.; gold 
chloride, gr. j.-v.; gold and sodium chloride, gr. ij.-v.; 
glycerite of borax, f 3 j.-f 3 iij. 
Where a mildly astringent, alkaline, and antiseptic 
spray is indicated the following may be used : 
. Acidi carbolici cryst gr. x. 
Pini canadensis ext. fid f 1 j- 
Glycerini boracis f § iij. 
M. Sig.—One part to seven of water in spray. 
Vapors are occasionally beneficial and must be inhaled 
at a temperature of from 140°-150° F. from a cup Martin- 
dale or Bullock inhaler, or other apparatus, furnished 
with a suitable nasal fitting, into which water and the de- 
sired medicament have been placed. Among the most 
useful of the moist or steam inhalations are: 
If. Creasote lUv.-x. to water Oss. 
Tr. benzoin comp, f 3 ij.-f 3 iij. to water Oss. 
To the above may be appropriately added the vapor 
acidi benzoici; the vapor acidi carbolici; 
the vapor ammonii benzoati; the vapor 
ammonise ; the vapor cubeba?; thewapor 
iodi; the vapor pini sylvestris ; the vapor 
tereben*, and the vapor tliymolis, all of 
the London Throat Hospital Pharmaco- 
poeia. 
• The patient should remain in-doors for 
some time after using these vapors. 
The fumes of nascent ammonium chlo- 
ride may be inspired through the nasal 
passages by the patient from a Kirkwood 
or other inhaler, or forced into the ante- 
rior nares from a Cohen-Lewin inhaler, 
and are beneficial in promoting secretion. 
An excellent method for the administra- 
tion of nascent fumes of ammonium chlo- 
ride is to place the patient in a closed 
room and generate the fumes from sodium 
chloride and sulphuric acid mixed in one 
saucer, and water of ammonia in another 
by its side. 
In this manner a prolonged inhalation 
can be taken with little effort to the pa- 
tient. 
This particular process is, so far as I am 
aware, due to Dr. William M. Mew, U. S. 
Army Chemist, Washington, D. C., and 
has been long and successfully used by 
the writer. 
A simple, inexpensive inhaler may be 
contrived by placing a small piece of 
sponge in a glass tube of one-fourth inch 
bore, and moistening it with a mixture 
composed as follows : 
ff. Creasoti f 3 j. 
Tinct. iodi f 3 vj. 
Chloroformi f 3 j. 
M. Sig.—Ten or more drops on sponge inhaler. 
The above mixture may be inhaled through the nares 
from a sponge attached to an ordinary respirator, which 
may be worn for fifteen minutes morning and evening. 
Solutions are best employed by means of the anterior 
(Fig. 2735) or posterior (Fig. 2737) nasal syringe, the si- 
phon (Fig. 2735), or Weber bottle douche (Fig. 2735), or 
they may he snuffed from the palm of the hand or squeezed 
into the anterior nares from a sponge previously charged 
with the remedy. Some precautions are to be observed 
in the use of these cleansing solutions by means of the 
douche, as they may in rare instances cause ear trouble 
by passing into the Eustachian tube, and even into the 
cavity of the middle ear. 
The principal cause of such an-accident is traceable to 
involuntary swallowing during the use of the douche, or 
to douching with cold water. 
In employing a Weber nasal douche the bottle is ele- 
vated (see Fig. 2736), the nozzle is inserted into the nar- 
Fig. 3738.—Warner’s Catarrhal Douche. 
rowest nostril and pressed firmly, the mouth is held open, 
and the head is bent’forward, when the stream will flow 
out of the opposite nostril if there is no obstruction. 
About twelve ounces of liquid at 90° F. are to be used 
in each nostril, when all crusts and scabs will usually be 
detached and washed out. 
If any crusts remain after this irrigation, they may be 
removed by mopping the nostrils with cotton, and, in- 
deed, by using the forceps for their extraction. 
The barrel syringe (Fig. 2735) can be used for cleans- 
ing the nares from the front, being introduced first into 
one and then into the other nostril, part of the liquid 
escaping by the mouth and part by the nostril it origin- 
ally entered. If, however, the nostril is tightly com- 
pressed around the nozzle of the syringe, the mouth held 
open, and the head bent forward, the liquid may be made 
to escape through the opposite nasal passage. 
The post-nasal catarrh syringe (Fig. 2737), and Warner’s 
catarrhal douche (Fig. 2738), are both almost indispen- 
sable for cleansing the parts by way of the pharynx and 
posterior nares, and in using them the nozzle is inserted 
behind the palate, the head thrown forward, and the in- 
Fig. 3739.—Post-nasal Tube attached to a Bulb-syringe. 
strument discharged through the nasal passages, the fluid 
flowing into a bowl in front of the patient. 
Warner’s douche (Fig. 2738) can be more readily ma- 
nipulated by the patient himself than can the post-nasal 
syringe. 
Systematic applications of solutions to the nasal pas- 
sages in true ozsena, by means of the appliances described, 
will enable us to do much toward improving the general 
health of the patient and curing his local disease. 
The solutions employed in the nasal douche, catarrhal 
douche, post-nasal or barrel syringe, etc., should have a 
temperature of about 90° F., and appended is a list of 
serviceable formulae for such purposes, in the strength 
indicated to one pint of water : Carbolic acid, gr. v.-x.; 
sodium chloride, 3 ss.- 3 j.; sodium carbonate, 3 j.- 3 iij.; 
sodium borate, 3 j.-3 iij.; creasote, utv.-x.; potassium 
permanganate, gr. ij.-x.; calx clilorata, 3 ss. ; liq. sodse 
cliloratae, f 3 ij.-f 3 vj.; zinc sulphate, gr. v.-x.; zinc sul- 
pho-carbolate, gr. v.-xv. 
Fig. 3737.—Post- 
nasal Syringe. 
450 REFERENCE HANDBOOK OF THE MEDICAL SCIENCES. 
Ozsena. 
Ozae na. 
The addition of from one-half to one ounce of glycer- 
ine to the pint in any of the above is to be advised. 
Powders.—Much has been written against the use of 
insufflations into the nares in treating nasal affections, 
but the writer is personally very partial to the employ- 
ment of these preparations in suitable cases. 
Powders should be used only after the diseased parts 
have been thoroughly cleansed and disinfected by the 
physician or patient, and must be evenly applied aud not 
allowed to cake in the sinuosities of the nostrils. 
Some of the powders commonly resorted to are : 
I). Iodoformi 1 part. 
Acidi tannici li part. 
Lycopodii 2 parts. 
M. Sig.—For use in the anterior or posterior (Figs. 2740 
and 2741) nasal powder-blower. 
II. Acidi boracici 1 part. 
Resorcine 1 part. 
Lycopodii 2 parts. 
M. 
R. Iodol 1 part. 
Lycopodii 3 parts. 
M. 
R. Hydrarg. cliloridi mitis 1 part. 
Amyli 2 parts. 
M. 
I). Hydrarg. oxidi rubri 1 part. 
Saccliari albi 30 parts. 
M. 
R. Hydrarg. ammoniati 1 part. 
Sacchari albi 30 parts. 
M. 
R. Acidi salicylici 1 to 3 parts. 
Lycopodii 10 parts. 
M. 
I). Pulvis sanguinarise 1 to 2 parts. 
Lycopodii 2 parts. 
M. 
IJ. Pulvis galangse 1 to 2 parts. 
Lycopodii.... 2 parts. 
M. 
II. Iodoformi 1 to 2 parts. 
Lycopodii 2 parts. 
M. 
These poAvders should be finely ground and kept dry ; 
they are to be applied evenly from an anterior (Fig. 2740). 
tors, the drawing up of mucus and tlie caking of powder 
in the tube w’hen the bulb expands, cannot take place in 
this instrument. 
Again, the instrument is charged with a known quan- 
tity of powder, which is discharged 
into the nares, and not an indefinite 
amount from a powder bottle, as is 
generally the case. 
This powder-blower is furnished 
with a scoop, and the exact amount of powder desired 
can readily be placed in the instrument. A trigger con- 
trols the air-blast, and the at- 
tachments for the anterior and 
posterior nares, ear, larynx, 
etc., are made to screw on, 
thus insuring safety. 
Ointments are frequently of 
great value in treating this dis- 
ease, and are by no means re- 
sorted to as often as they should 
be. 
These preparations can be 
applied by means of a camel’s- 
hair pencil or cotton carrier to 
the nasal passages, and exert a 
soothing disinfectant and cura- 
tive influence. 
Among the ointments worthy 
of mention are: Unguentum 
cadmii iodidi, unguentum liy- 
drargyri ammoniati, unguen- 
tum hydrargyri iodidi rubri, 
unguentum hydrargyri nitratis, 
unguentum iodi, unguentum 
iodoformi, unguentum picis 
liquidse, and unguentum sul- 
phuris, all diluted with cosmo- 
line, vaseline, or simple oint- 
ment to suit the particular case. 
5. AtropiaB gr. ss. 
Iodi gr. iij. 
Acidi carbolici.. gr. iij. 
Petrolati . | j. 
M. Sig.—Apply to nares with 
a brush. 
5. Iodol gr. xv.-xxv. 
Ungt. aq.rosael j. 
M. 
1J. Iodoformi gr. xij. 
Acidi carbolici 
cryst gr. v. 
Iodi gr. iij. 
Petrolati | j. 
M. 
Medicated bougies are occasionally of service in treating 
ozeena, the most useful being buginarium acidi carbolici, 
Fig. 2741.—Posterior Nasal Powder-blower. (From Robinson.) 
Fra. 2740.—Anterior Nasal Powder-blower. (Smith.) 
or a posterior nasal insufflator (Fig. 2741), and preferably 
by the physician, although patients in time become quite 
expert in using these instruments. 
The powder-blower preferred and used exclusively by 
the writer is one of his own design (Fig. 2742), and has 
the advantage of being universal and of being suitable 
for office work or outside practice. In the first instance 
this insufflator can be worked by the office compressed- 
air apparatus, in the latter by the hand bulbs, which run 
an ordinary spray. It will be noticed that the frequent 
and annoying accident which occurs with most insuffla- 
Fig. 2742. — Morgan’s Com- 
pressed Air - scoop Powder- 
blower, showing detachable 
anterior and posterior nasal, 
ear, and laryngeal attach- 
ments. Adapted for use with 
rubber bulbs or with the of- 
fice air-receiver. 
451 Ozacna. 
Pagosa Springs. 
REFERENCE HANDBOOK OF THE MEDICAL SCIENCES. 
buginarium iodoformi, buginarium thymol, etc., of the 
London Throat Hospital Pharmacopoeia. When these 
bougies, which have as their basis gelato-glycerine, are 
introduced into the nostril they gradually dissolve, thus 
bringing the medicament into intimate and prolonged 
contact with the affected mucous membranes. 
Medicated cotton-wools were introduced by Woakes, and 
medicines can by their use in the nares be brought into 
direct and constant contact with the diseased surfaces. 
The gossypium acidi boracici, gossypium iodi, gossy- 
pium iodoformi, etc., are valuable formulae. 
The writer, in using these wools, generally plugs only 
one nostril or a portion of both nostrils at a time. 
Cotton-wool tampons are recommended by Gottstein to 
promote a moderate but constant flow of mucus, thus 
preventing the drying of the mucus, which is the cause 
of the fetid odor. 
A tampon of cotton-wool is introduced into the nasal 
passages by means of a screw (Fig. 2743), and permitted 
to remain therein a few hours every 
day. This treatment is said to be 
very beneficial in special cases, but 
must be persevered in for several 
years. 
The galvano-cautery is recommend- 
ed by a few writers (B. Frankel) as 
exerting a decidedly curative influ- 
ence upon ozama when used cautious- 
ly and over limited areas of the dis- 
eased Schneiderian mucousmembrane 
and submucous tissues. 
The entire nasal membrane should 
be cauterized during this treatment, 
which may consume a month or more 
for its completion. 
The middle and inferior turbinated 
bodies, the roof of the nose, and, 
lastly, the septum should under- 
go cauterization. No complications 
worthy of mention result from such 
applications, and no extensive slough- 
ing need be anticipated. 
These cauterizations certainly tend 
to materially reduce the viscid secre- 
tion and the subsequent formation of 
crusts, by a reparation of the mucous 
membrane. 
’ Harrison Allen appears to rely on 
the galvano-cautery also as a cleans- 
ing agent, and states that if a spiral- 
looped electrode be introduced cold 
into the nares and pressed against the 
crusts, and the electrode is heated, so 
firm an adhesion takes place between 
the heated electrode and the incrusta- 
tions as to permit of their speedy and complete removal. 
He states that when, after the removal of all visible 
crusts, the fetor persists, it is reasonable to infer that the 
palatal depression of the floor of the nose is filled with 
decomposed mucus. 
The electrode, properly curved and introduced, will 
bring away quantities of discharge, which cannot be re- 
moved in any other way, not even by douches, etc. 
Chemical caustics are, in the writer’s opinion, seldom in- 
dicated in the treatment of true ozsena, although silver 
nitrate, chromic, acetic, and nitric acids have been recom- 
mended by a few authors. 
Animal grafting by means of frog’s skin and galvanism 
have recently been used in the treatment of ozsena. 
Bibliography. 
N.B.—To the references bearing an asterisk in the following list the 
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Fig. 2743.— Gottstein’s 
Cotton-wool Tampon. 
A, screw armed with 
wadding-tampon ; B, 
the unarmed screw. 
(Mackenzie.) 
452 Owena. 
Pagosa Springs. 
REFERENCE HANDBOOK OF THE MEDICAL SCIENCES. 
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Ethelbert Carroll Morgan■ 
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