. Physical diagnosis . Fig. —Syphilitic Depression of the Nasal Bones. VI. The Nose. i. Size and Shape.—The enlargement of all the tissues of the noseoccurring in acromegaly has already been mentioned. In myxcedemathe nostrils are sometimes thickened and the whole nose loses itsdelicacy of shape. A red nose is popularly and correctly associated 18 PHYSICAL DIAGNOSIS with alcoholism, but in many cases identical appearances are producedby acne rosacea or by lupus erythematosus, as well as by circulatoryanomalies without any other disease. Falling in of the bridge of the nose may be due to sy
. Physical diagnosis . Fig. —Syphilitic Depression of the Nasal Bones. VI. The Nose. i. Size and Shape.—The enlargement of all the tissues of the noseoccurring in acromegaly has already been mentioned. In myxcedemathe nostrils are sometimes thickened and the whole nose loses itsdelicacy of shape. A red nose is popularly and correctly associated 18 PHYSICAL DIAGNOSIS with alcoholism, but in many cases identical appearances are producedby acne rosacea or by lupus erythematosus, as well as by circulatoryanomalies without any other disease. Falling in of the bridge of the nose may be due to syphilis of thenasal bones, especially when there are scars over the sunken portion,but is sometimes present without any disease. See Fig. 16. The small, narrow nose associated with adenoid growths has alreadybeen mentioned. 2. The nostrils move visibly in many conditions involving dyspnoea(diseases of the heart and lungs, acute infections, etc.), and this is. Fig. 17.—Epithelioma. sometimes useful in suggesting to the physician the possibility ofpneumonia, hitherto unsuspected. Dried blood in the nostrils may beof value as evidence of recent nosebleed. 3. Nosebleed suggests especially trauma, vascular hypertension,infectious fevers (particularly typhoid), and hemorrhagic diseases(purpura, haemophilia, acute leukaemia). 4. A nasal discharge in a young infant (snuffles) suggests hered-itary syphilis. In adults the familiar cold in the head may need abacteriological examination to exclude the possibility of nasal diph-theria or to confirm a diagnosis of influenza. THE HEAD AND FACE 19 5. A small, indolent, long-standing sore on the nose or near thecorner of the eye should always suggest epithelioma (see Fig. 17) andtuberculosis. Microscopic examination may be necessary to determinethe diagnosis. 6. The consideration of local disease within the nose does not fallwithin the scope of this book, but is suggested by local pain, difficultyin brea
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