(REPRINT.) 
THE MEDICAL HERALD. 
SAINT JOSEPH, MO. 
DANIEL MORTON, IVI. D., Editor. 
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Volume X. 
Number 1. 
JANUARY, 1891. 
j SZ.on'yea^in5Advance. 
ORIGINAL 
Horn a General Ppaetitionep Olay 
fitPophic Rhinitis. 
By HANAU W. LOEB, A. M., M. D., St. Louis, Mo. 
Lecturer on Diseases of the Nose and Throat, Marion-Sims College of Medicine; 
Attending Surgeon Nose and Throat Department, Grand 
Avenue Free Dispensary. 
Read before the Medical Society of the Missouri Valley, Kansas City, Mo., December 18,1890. 
From the time when the Chinese Emperor, Iloang-ty, four thousand five 
hundred years ago, first described specific ozoena until the present day, the 
treatment of chronic atrophic rhinitis has been, more or less, the bug-bear of 
the general practitioner of medicine. True, the modernizing influence of 
thorough-going reason has shorn the disease of much of its mystifying ele- 
ments, still, to many, even in this enlightened day, it remains a book sealed 
with the superstition of the past, and bound tightly by the cords of enforced 
destiny. 
Notwithstanding the great amount of literature which has resulted from 
the pains-taking study of this disease, the vast majority of doctors are indiffer- 
ent, some perhaps ignorant, as to its proper treatment. Some do not believe 
that an iota of benefit can result from treatment of any kind; others declare 
that they have no desire to treat it; still others, by temporizing, hold their 
patients day in and day out, in the vain hope that some kindly providence 
may relieve doctor or patient. Amid all this array of indifference, disinclination 
and lack of knowledge or its application, is it strange that the poor sufferer 
should, read with, a shudder, the advertisements which deal out his symptoms. CIIRONIC ATROPHIC RHINITIS: Loeb. 
so exactly, and which alarm him by unnecessary enunciation of dangers which 
never occur? Is it to be wondered at that his mind becomes filled with vis- 
ions of consumption—visions which, by reason of their indistinctness, magnify 
the evils thus portrayed? Is it remarkable that he should swallow with avidity 
such unwholesome morsels as this: “ The microbe of catarrh, in your sleep, 
crawls down your throat, and, coming in contact with your lungs, produces 
consumption?” Is it further a matter of wonder that the poor, bewildered 
mortal, whose fears have now changed his nose into a mountain of woe, ready 
to boil and to seethe with the fury of evil spirits, should seek his family physi- 
cian, and, receiving the unsatisfactory advice, which in many cases he will get, 
is it strange, say I, that he should place his tender organ of facial ornamenta- 
tion into the hands of a quack ? I think not. From a popular standpoint, at 
any rate, the charlatan who boasts loudly of his cures, and who points out the 
evils that may result, knows far more than the dilly-dallying doctor. Here 
lies the trouble, doctors imagine the nose beyond their ken, too far removed 
for their comprehension; in fact, many do not hesitate to say so. Why, bless 
you! those same doctors would never admit a lack of knowledge in the treat- 
ment of a cervicitis or an endometritis, and yet the organs concerned in these 
latter diseases are far more difficult to examine than the nose. 
Thoughts such as these are calculated to make a specialist ponder, and to 
seek some plan of benefit. That some good may come from a tacit and clear 
statement of the treatment of this disease, I am assured ; and that the general 
practitioner will, by the application of a few general rules, be able to benefit 
almost all of these cases, I am still more assured. I have seen this very thing 
exemplified in my own students in the Marion-Sims College of Medicine, to 
whom I have assigned cases for treatment in the clinic, with results highly 
satisfactory. What students are thus enabled to do, I feel certain that the 
great body of our upright, conscientious and earnest practitioners of medicine 
can do far better. 
Many means have been devised, and many remedies have been suggested, 
for the treatment of this very refractory disease, but as its theoretical con- 
sideration forms no part of the subject of this paper, they are placed aside. 
Therefore, the radical treatment of the disease requiring, as it does, an exten- 
sive knowledge and technique, will not receive attention. That the disease is 
ever entirely cured is still a controvertible question. Reports have been made 
of cures by cauterization with chromic acid, and the galvano-cautery, and by 
galvanism of the nasal mucous membrane. 
The condition can be ameliorated! Not only this, but every practitioner 
who possesses an intelligent conception, may become the high-priest of this 
benediction. 
From the nature of the disease, the vitiated secretion and scab-formation 
which go with it, one can easily understand that two features of treatment are 
indicated, viz., cleanliness and stimulation ; cleanliness so that there can be no 
irritation from the presence of scabs, and for the thorough application of medi- 
cines and stimulation to counteract the passive inflammation, and to cause the 
blood more nearly to approximate the normal. 
Now, cleanliness does not mean the promiscuous douching or spraying of 
the nose—by no means. The most persistent care must be taken to remove 
every scab and particle of abnormal discharge. Granted; but how can this 
be done by the general practitioner? Easily enough. Ilis armamentarium 
nasale need not be very extensive. A lamp, a student’s lamp being prefer- 
able, a head mirror, a nose speculum, a small cotton applicator (a knitting CHRONIC ATROPHIC RHINITIS: Loeb. 
needle with one end roughened will answer), constituting an equipment not 
elegant, but sufficient. The cost, exclusive of the lamp, is little enough, being 
less than $4.00. Cotton, absorbent or borated, should be on hand, as well as 
plenty of the old-time Dobell’s solution, or the following modification, which I 
like better: 
Sodii Bicarbonatis 
Sodii Biboratis aa 5U 
Listerine or Katharmon §ss 
Aquae q. s. ad gviij 
M. Sig. Nose wash. 
To the list I would perhaps add some sort of atomizer or post-nasal 
syringe, costing in either case not more than $1.25. However, one could get 
along without either of these. The nose should be first sprayed out with the 
solution whose formula I have just given (better warmed), or by means of the 
post-nasal syringe the cavities can be washed out from behind. Understand, 
however, even this does not constitute the cleansing of the nose, for after this 
has been done, the work really begins. The light being reflected into the 
nose, held open my means of a speculum (Knight’s modification of Duplay’s 
preferred), the probe, to which a pledget of cotton is attached, is made to dis- 
lodge and to remove each scab or portion of discharge which is presented to 
the view. Any one can do this, for any one can see the scabs, and can with 
ease remove what he sees. This accomplished, the nose is clean, and the first 
essential part of treatment has been applied, 
For the stimulative plan cf treatment, various drugs have been recom- 
mended, out of which I select menthol, thymol and eucalyptol as having been 
most efficacious in my hands. I have used menthol more frequently than any 
of these agents, and have been so \vell pleased with its action that I should be 
unwilling to exchange it for an}7 othtr remedy. The following is the customary 
formula: 
1$; Menthol gr x. 
Liquid Albolene §j 
M. Sig. Spray for the nose. 
The amount of menthol may be increased to gr. xx or even 5* to the ounce 
This, or thymol, gr. x to §i liquid albolene, or eucalyptol gtt. x to §i liquid 
albolene, should be well sprayed into the nose, first directing the patient to 
breathe through his open mouth, thereby shutting off the oro-pharynx and 
causing the spray to pass out of the other nostril. The first sensation is that 
of warmth, and no little itching is frequently occasioned ; but this is soon suc- 
ceeded by a feeling of coolness and comfort in the nose which is gratifying to 
the patient. While the menthol, thymol and eucalyptol have a stimulative 
effect, the liquid albolene is not void of benefit, It takes the place of vaseline 
of quondam fame, without having the inconvenient features of the latter. By 
means of the spray, the oily albolene is thrown over a large portion of the 
mucous membrane, and by bathing it with an oily film, aids not a little in its 
improvement. This cleansing out and treatment of the nose should be done 
uvery day, if possible, for some little time; later, the intervals may be length- 
ened. It is useless to attempt any permanent or even transitory improvement, 
for that matter, by treating the nose twice a week, or less; three times a week 
is seldom sufficient at the outset. 
Nor is this all there is in the treatment. The patient should be directed 
to clean his nose three or four times daily, by snuffing up Dobell’s Solution, or 
the modification which I have given, and thereafter to use a spray of menthol, CHRONIC ATROPHIC RHINITIS; Loeb. 
thymol, or eucalyptol and albolene. A special sort of atomizer must be used, 
from the fact that all atomizers do not act with oily solutions. Each patient 
must provid himself with one, and use it three or four times daily. The Cod- 
man & Shurtleff, No. 356, or the Brooklyn Throat Hospital Atomizer will 
answer. The latter is better for the doctor, in that having three nozzles it 
may be used for the nose, pharynx or larynx. 
Of late I have been using a new atomizer, lately designed and manufactured 
by the A. M. Leslie (Surgical Instrument Company of St. Louis, the Acme 
Vaseline Atomizer ; in fact, I now prefer it to any other kind. It has the ad- 
vantage of simplicity and cleanliness. Though intended as a vaseline atomizer, 
it can be used to the greatest satisfaction for the spraying of liquid albolene. 
I would again urge that, whatever the form of the atomizer, it should be 
used systematically, thoroughly and regularly. It is surprising how much 
better the patient will become under this sort of treatment; the excessive 
scabby discharge ceases, the odor disappears, the hawking diminishes, and the 
patient’s mind turns to other thoughts than an untimely death from the fancied 
change of catarrh into consumption. Not only this: the relief is so decided 
and rapid in its occurrence, that the patient becomes a friend and patron whose 
good word will reflect credit and money to the doctor who is so fortunate as to 
have applied this mode of treatment. 
It is well to state one danger which may occur, not only from this form of 
treatment, but in any case where douching is used: I refer, of course, to the 
otitis media, catarrhal or suppurative. Where there is the slightest tendency 
to this disease one must be guarded, and must avoid the douche, and some- 
times the spray. In such cases, the only recourse is to remove the scabs as 
well as possible by means of a probe and pledget of cotton. 
Very naturally there are other plans of treatment which are not to be 
despised. I desire to make no reflection whatever upon any other method. 
This I do say, however, the method which I have detailed is one which must 
commend itself to every one. It is simple in its application, scientific in its 
procedure, and sufficiently easy in detail as to be within the range of every 
practitioner of medicine. 
I turn now to the title of my paper: “ How a General Practitioner May 
Treat Chronic Atrophic Rhinitis.” I feel that I have answered the question 
in so tangible a manner that its acceptance and adoption by the general prac- 
titioner is a matter of choice, and not one of long-considering deliberation. 
The question narrows itself down to this : Will you treat these simple cases in 
this simple manner, to the credit of yourselves and to the benefit of yourselves, 
or will you with less pride, less reason and less professional honor, allow those 
who have placed their well-being in your hands to go on day by day without, 
any relief, subsequently to fall into the unscrupulous hands of some catarrh 
nincompoop? I believe you will adopt the former course. 
3148 Locust Street.