RHINOLITHES
Nasal calculi, are calculous concretions found in the nasal cavity, rather a rare occurrence, but quite a number of cases are on record. They vary very much in size and external appearance; some have been found as large, or larger than a hazel-nut, completely occluding the nostril, but the ordinary size is about that of a melon-seed. In shape they may be ovoidal, globular, or spindle-shaped; rough or smooth on the surface; and of any color, from a yellowish-white, which is the most frequent, to brown or black. They have been found oftener in the inferior meatus, usually on one side, either lying free, attached by a narrow pedicle, or sub-mucoid. The cause for this deposit, or metamorphosis, cannot be accurately determined, but my experience, which is quite insignificant, leads me to infer that a chronic inflammatory condition, particularly with a strumous basis, will be found the predisposing cause, inasmuch as parotid and sub maxillary concretions are usually found in the same patient. I think we find, however, that the concretion may be formed in one of two ways: A vital change, so to speak, in the secretions of the part, without nucleus; or the accidental introduction of a nucleus, such as a piece of bone, a fragment of a tooth, or some extraneous foreign material. The symptoms are very deceptive and inconclusive, and only th e probe, or rhinoscopic examinations can interpret them, when the calculus is beyond the reach of unaided vision. We find much variation in the symptoms, both as to intensity and quality, depending upon the size of the foreign body. There is a feeling of stoppage in the nose, more or less pain, and sometimes evident inflammation, which may extend to the eye or pharynx. The symptoms, in short, much resemble polypus, and indeed these bodies are frequently the nucleus for calcareous deposits. We may add to this account of causation, that GRAEFE considers the gouty diathesis essential, while DURHAM thinks some foreign material must be retained in some part of the nasal cavity. the sub-mucoid variety, I have no doubt, is due to gout or struma, but when the calculi are free, or simply embedded in the mucous membrane, the causes may be more local and chemical, so to speak, than pathological and constitutional. The composition has been found to be, phosphate and carbonate of lime and magnesia, chloride of sodium, and animal matter, as mucus.
The treatment must be both mechanical and medicinal. The calculus must be removed, and the diathesis corrected by proper medication. The operation is not at all times a trifling matter, and before undertaking it works on general surgery must be consulted.
Among the remedies that may be called for, and which must be selected with attention to the tout ensemble of the case, Baryta c., Lycopodium, and Calcarea phosp., are the most prominent. The special indications cannot be given, without going into too much detail, as the constitutional symptoms are of the first importance, the local trouble being of no import. When the calculus is evidently formed around a nucleus, and is not sub-mucoid, removal without subsequent medication, is the sole indication. It is only in the sub-mucoid form that we have a probable morbid process to combat.
OF IOWA, CHICAGO. Author of - The homoeopathic treatment of surgical diseases, Published 1873. Surgical emergencies and accidents, Published 1884. The elements of surgical pathology : with therapeutic hints, Published 1896. Surgical diseases and their homoeopathic therapeutics, Published 1880.