DISEASES OF THE NOSE. 
DISEASES OF THE PHARYNX. 
BY 
J. M.D., 
OF PHILADELPHIA, 
PRESIDENT OP THE AMERICAN LARYNGOLOGICAL ASSOCIATION; LECTURER ON LARYNGOSCOPY AND 
DISEASES OF THE THROAT AND CHEST IN JEFFERSON MEDICAL COLLEGE; PHYSICIAN TO 
THE JEFFERSON MEDICAL COLLEGE HOSPITAL AND TO THE GERMAN 
HOSPITAL OF PHILADELPHIA. DISEASES OF THE NOSE. 
259 
DISEASES OF THE NOSE. 
BIBLIOGRAPHY. 
Maxwell, G. Troup: Muriated Tincture of Iron a Cure for Nasal Polypi. Phila. 
Med. Times, Apl. 17th, 1875.—Adams, Wm. : On the Treatment of Broken Nose 
by Forcible Straightening and Mechanical Retentive Apparatus. Brit. Med. 
Joum., Oct. 2d, 1875.—Michel, Carl: Die Krankheiten der Nasenhohle und des 
Nasenraclienraumes. Berlin, 1876.—Stoerk, Carl: Klinik der Krankheiten der 
Nase und des Rachens. Stuttgart, 1876.—Casabianca: On Thickening of the Sep- 
tum of the Nasal Fossae Simulating Malignant Tumor. Journ. de med. et de 
cliir. prat., Nov., 1876; London Med. Record, Feb. 15th, 1877.—Robinson, 
Beverley: Remarks on Hypertrophy of Turbinated Corpora Cavernosa. Am. 
Jour. Med. Sci., Apl., 1877.—Vaja, von: Sarcoma of the Nose in a Syphilitic Sub- 
ject. Wien. med. Presse, March 18th, 1877; N. Y. Med. Jour., July, 1877.— 
Mackenzie, Morell: Lectures on Diseases of the Nose. The Lancet, July 28th, 
Aug. 25tli, Nov. 10th, 1877.—Hartmann, A.: The Treatment of Nasal Catarrh. 
Deutsche med. Wocli., Nov. 16th, 1877.—Jordan, Furneaux: The General Utility 
of Sponges as Surgical Dressings. Brit. Med. Jour., Mch. 30th, 1878.—Hartmann> 
A.: Ueber Ozoena. Deutsche Med. Wocli., Nov. 13th, 1878.—Gottstein: Ueber 
Ozcena und eiije einfache Behandlungsmethode derselben. Berlin, klin. Wocli., 
No. 37, 1878.—Schuster and Sanger: On Syphilitic Disease of the Nose. Viertel- 
jahrschrift fur Dermatologie und Syphilis, Bd. IV., H. 1 and 2; London Med. 
Record, Apl. 15th, 1878.—Riedel: Tuberculose der Scheidenwand. Deutsche Zeit- 
sclirift fiir Chirurgie, 1878.—Cohen, J. Solis: Destruction of an Exostosis in the 
Nasal Passage by Means of the Burr of the Dental Engine. Med. and Surg. 
Reporter, Phila., July 13th, 1878.—Porter, Wm. : On Post-Nasal Catarrh. Illi- 
nois Med. Recorder, 1878.—Voltolini, Rudolph: Die Rliinoskopie und Pha- 
ryngoskopie. Breslau, 1879.—Seiler, Carl: Handbook of Diagnosis and Treatment 
of Diseases of the Throat and Nasal Passages. Phila., 1879.—Cohen, J. Solis: 
Diseases of the Throat and Nasal Passages. 2d Ed., New York, 1879.—Harrison, 
Reginald: Note on the Treatment of Mucous Polypus of the Nose. Brit. Med. 
Journ., Nov. 15th, 1879.—Miller, A. G.: The Treatment of Mucous Polypus of the 
Nose. Ibicl., Dec. 13th, 1879.—Hartmann, A.: Operationen zur Nasenpolypen. 
Schmidt’s Jahrb., Bd. 183, No. 3, 1879.—Spear, J. M.: New Method of Plugging the 
Posterior Nares. Med. and Surg. Reporter, Phila., Nov., 1879.—Allen, Harrison: 
Errors of Conformation of the Nasal Chambers, Studied in Relation to the Cause of 
Nasal Disease and Irregularity of the Teeth. Phila. Med. Times, No. 314, 1879.— 
Goodwillie, D. H.: Extirpation of the Bones of the Nose and Mouth by the Use 
of the Surgical Engine. The Medical Record, N. Y., 1879.—Shurly, E. L.: The 
Galvano-Cautery as a Therapeutic Measure in Chronic Nasal and Naso-Pharyngeal 
Catarrh. St. Louis Med. and Surg. Jour., 1879.—Goodwillie, D. H.: Hindrance 
to the Respiration by Disease in the Nose. Canada Medical Record, Dec., 1879.— 
Allen, Harrison: On a new Method of Treating Chronic Nasal Catarrh. Am. 
Jour. Med. Sci., Jan., 1880.—Thudichum: Treatment and Complications of Nasal 
Polypi. The Lancet, Feb. 21st, 1880; Same Author on Polypus and other Morbid 
Growths in the Nose, their Radical Treatment by the Electro-Caustic Method, 260 
DISEASES OF THE NOSE. 
and their Connection with Asthma, ibid., Apl. 17th, 1880.—Thornton, W. Pugin: 
Treatment of Ozoena. Brit. Med. Jour., Mch. 27th, 1880.—Hamilton: The Surgical 
Treatment of Epistaxis. Brit. Med. Jour., May 8th, 1880.—Wagner, Clinton: A 
Case of Acute Idiopathic Perichondritis of the Nasal Septum, Tei'minating in 
Abscess. Archives of Laryngology, N. Y., Mch., 1880. 
STEYOSIS. 
In re-writing his article on stenosis of the nasal passages, Dr. 
B. Fraenkel alludes to cases such as are related by Jacoby (Arch. /. 
Ohrenh., neue Folge, 6, p. 124), in which stenosis of the osseous frame- 
work of the nasal passages has produced such complete obstruction to 
nasal respiration as to prevent sleep, even under the influence of medica- 
ments; and has thus been the immediate cause of marasmus and death. 
CORYZA. 
A writer in the Practitioner (Jan., 1875) has suggestedthe prevention 
of attacks of coryza from draughts of cold air, by wearing cotton-wool in 
the ears during exposure. 
Dr. Rudolpho Rudolphi states (Gaz. med. Ital. Lomb., Jan., 1879) 
that an acute attack of coryza is often relieved in the course of half an 
hour, by slowly swallowing the saliva secreted while chewing a few dried 
leaves of Eucalyptus globulus. Some reports of this treatment, however, 
warn against depressing effects of the remedy, even though it stop the 
cold. 
Dr. Hartmann recommends compression of the air in the nasal cavities 
by means of the Politzer air-douche, which drives the secretions out from 
the adjacent sinuses, and relieves the pains and disagreeable sensations. 
To prevent any undesirable effects on the middle ear, it is suggested 
that the external auditory canals be closed by the fingers during the pro- 
cess, to prevent too forcible pressure upon the drum membrane. 
The writer may state in this connection that he has sometimes found 
considerable relief to follow an artificial evaporation of the serous fluids 
in those cases of acute catarrh which go by the name of “ snuffles,” and 
in the acute coryza attacks attendant upon some cases of bronchial asthma, 
by forcing a current of air through the nasal passages from the ordinary 
rubber ball and tube, such as is used to propel liquids in spray. The 
patient carries the little apparatus about him, and retires from time to 
time to use it as needed. 
Porter recommends first relieving the irritation, and then promoting 
resolution. The patient inhales, several times a day, from a warm, dry 
goblet, twenty drops of a mixture composed of one drachm of iodine, and 
ten grains of iodide of potassium, in half an ounce each of ether and 
chloroform; the vapor from which often gives quick relief. Then he 
administers five or more grains of carbonate of ammonium every third 
hour, usually in combination with squill. DISEASES OF TIIE NOSE. 
261 
CHRONIC CATARRH. 
It has become quite common of late years to treat the hypertrophied 
membrane of the middle and lower turbinated bones in chronic nasal 
catarrh by the galvano-cautery and galvano-caustic loop, as long ago 
recommended by Voltolini. The loop is used in preference to the cautery 
whenever it is possible to ensnare a portion of the exuberant tissue; and 
the cautery in cases where this is impracticable. The eschars left by the 
process are allowed to fall off before the operation is repeated. Cutting 
these tissues, where practicable, by the cold loop, as long ago advised by 
the writer, is likewise coming into considerable use. It is more easy of 
execution than the use of the galvano-caustic loop, but has the disadvan- 
tage of producing hemorrhage, so that the electric method is often actually 
more time-saving in the long run. It is remarkable, in many instances, 
how these manipulations are tolerated without causing excessive pain. 
Occasionally the operations are practically painless. At times they are 
intensely painful. When there are no means of securing freedom of nasal 
respiration without the sacrifice of tissue, these procedures are perfectly 
justifiable. Indeed, they are sometimes essential pre-requisites to the 
cure of the catarrh. 
Gottstcin recommends the simple occlusion of the nasal passages by 
wad-tampon, retained for twenty-four hours in either nasal passage 
alternately. This prevents desiccation of the secretions, and diminishes 
fetor by keeping them fluid and thus retarding their decomposition. 
Thornton has published a record of six cases of ozaena successfully 
treated by a nasal spray, applied cold with the hand-ball apparatus, at 
first daily, and then at longer intervals; and composed of one drachm 
each of carbonate and biborate of sodium, from half a drachm to two 
drachms of the chlorinated soda liquor, one ounce of glycerine, and suf- 
ficient water to make an eight-ounce mixture. 
Evidence is accumulating in favor of the use of iodoform as a local 
application to diseased conditions of the nasal and naso-pharyngeal mucous 
membrane, whether ulcerated or not. This remedy is applied in powder, 
in solution in ether or chloroform, rubbed up with petroleum ointment, 
and in various other combinations. 
Dr. Allen makes some pertinent suggestions as to the anatomical1 
construction of the nasal chambers favoring the development of catarrh, 
when obstructions interfere with the efficiency of their respiratory func- 
tions. lie places great importance upon the necessity of local surgical 
interference in overcoming these obstructions or removing them; and has 
adopted a series of devices for carrying out his procedures in the different 
portions of the passages; all of which is lucidly described and illustrated 
in his article. 
In syphilitic manifestations, Schuster and Sanger use the curette or 
scraping spoon to remove the diseased tissue from the nasal cavity, and 
thus arrest its progress by contiguity. 262 
DISEASES OF THE HOSE. 
XASAL POLYPUS. 
A novelty in treatment is extolled by Mr. Reginald Harrison. This 
consists in puncture from the anterior nares by the acupuncture needle, 
or by Southey’s trocar, to drain away the serum. This is followed daily, 
for some time, by thoroughly injecting a solution of carbolic acid and 
gl}Tcerine. Dr. Miller, after evacuation by acupuncture, applies rectified 
spirit in spray, which diminishes the size of the tumor; in many instances, 
he reports, the polypi have shrivelled up and disappeared altogether. 
Dr. Thudichum, who has long used the galvano-caustic snare in the 
removal of nasal polypi, again calls prominent attention to the great 
value of the procedure, as verified by more than three hundred personal 
cases. 
Dr. G. Troup Maxwell recommends the plan first adopted by Dr. J. H. 
Reeder, of Laron, 111. {Chicago Med. Jour., Sept., 1859), consisting in 
injecting into the passage a drachm of the tincture of the chloride of iron, 
with an equal part of water; and kept in contact with the parts for a few 
seconds by bending the head backward. The procedure is repeated daily. 
The mucous polypi soon slough, it is said, and are then discharged. 
The treatment occupies from three to eight days. 
EP1STAXIS. 
Mr. Hamilton advises the following procedure in arrest of epis- 
taxis: “Saturate a piece of linen material, about three feet long and 
one inch wide, in some astringent;—tea, alum-water, or preferably gallic 
acid and glycerine. This strip should be regarded as consisting of three 
parts, each intended for its own special position in the nasal passage. 
The end of the first portion should be grasped in the dressing forceps 
and passed along the floor of the passsage and packed into the posterior 
naris until its presence can he distinctly felt by the finger-tip passed 
around the soft palate. The second portion should be gradually pressed 
into the roof of the nasal cavity; while the anterior naris should be filled 
with the remaining third. Thus every part is thoroughly tamponed. 
The plug should be left in situ until carried away by the natural secre- 
tion of the mucous membrane; any part protruding from the nostril 
being readily cut off with scissors.” 
Dr. Spears suggests as an appliance for carrying a tampon to the pos- 
terior naris the use of a flexible gold chain, a short strand of metallic 
cylindrical beads, or bird-shot compressed upon a cord ; the object being 
that the weight of the appliance shall carry it along the floor of the nasal 
passage into the pharynx, whence it is drawn into the mouth for the pur- 
pose of attaching the tampon in the usual manner. 
Mr. Furneaux Jordan contends that an ordinary uterine sponge-tent, 
passed along the floor of the nose, expands into all the cavities of the 
organ and occludes them effectually. DISEASES OF THE HOSE. 
263 
DISEASES OF TIIE SEPTUM. 
Thickenings of the septum of the nose are occasionally mistaken for 
tumors and exostoses, deceiving even experienced surgeons into per- 
forming unnecessary operations. 
Access to intra-nasal osteomas and exostoses is sometimes practicable 
with the burr and drill of the surgical engine, sufficiently to avoid the 
necessity for external incisions upon the facial portion of the organ, as 
exemplified in a case under the writer’s care, the mucous membrane and 
periosteum being first turned off and then replaced after the growth has 
been ground down. Care is necessary during the manipulation to provide 
for a stream of water to be kept playing upon the instrument, to keep down 
the heat from the friction and to wash away the detritus. 
Dr. Clinton Wagner has described a rare case of acute idiopathic peri- 
chondritis of the nasal septum, terminating in abscess with profuse sup- 
puration. 
DEFORMITIES. 
Dr. Weir's method of relieving the deformity of a broken nose consists 
in an improvement on Mr. Wm. Adams' (London) method of refracture and 
reposition. His article is illustrated by photographs of two successful cases; 
one in the practice of Dr. Little. He performs an osteoplastic operation. 
Packard's bevelled incision is made not more than from one-eighth to 
one-quarter of an inch in length, over the greatest convexity of the bony 
deformity and parallel to the free border of the nose, so as to strike, as 
near as may be, the naso-maxillary junction. Then, by the introduc- 
tion of a very narrow chisel through this small opening, he cuts through 
the bone with a few strokes of the mallet. If the tilting action of the 
imbedded chisel proves insufficient to loosen the other side of the nose, 
it is only necessary for him to chisel that side also, through the same and 
only incision. The parts are retained in position by compress and plas- 
ter, aided by the use of a nose-truss—a modification of that of Adams. 
In deformity of the cartilaginous septum impeding respiration, Dr. 
Qoodicillie reports success by cutting out the offending portion by means 
of a pair of gouge forceps, one blade of which is armed with a strong cir- 
cular knife. 
Riedel reports two cases of tuberculosis of the septum narium; one of 
ulceration of twenty-seven years’ standing in a male fifty-three years of 
age, and the other of ulceration of eighteen months’ standing in a female 
fifty-five years of age. Age and duration are opposed to the hypothesis,, 
though the inference was based on microscopic investigations. 264 
DISEASES OE THE PHARYNX. 
DISEASES OF THE PHARYNX. 
BIBLIOGRAPHY. 
Founts, David: On the Use of the Actual Cautery in Pharyngeal Disease. 
Brit. Med. Jour., Sep. 22d, 1877.—Osler: On Miliary Tuberculosis of the Pharynx. 
Canada Med. and Surg. Jour., 1877.—Browne, Lennox-. The Throat and its 
Diseases. London, 1878.—Cohen, J. Solis: Diseases of the Throat and Nasal Pas- 
sages. 2d Ed., N. Y., 1879.—James, Prosser: Sore Throat. 4thEd., London, 1879. 
Seiler, Carl: Handbook of Diagnosis and Treatment of Diseases of the Throat 
and Nasal Passages. Phila., 1879.—Mackenzie, Morell: Diphtheria, its Nature 
and Treatment, Varieties and Local Expressions. London, 1879.—Letzerich: 
Ueber Natron benzoicum. • Berlin, klin. Woch., No. 1, 1879.—Stuart, John A. 
Erskine: Note on Sulphur Prsecipitatum as a Topical Application in Diphtheria. 
The Practitioner, London, Oct., 1879.—Burrall, F. A.: Diphtheria and Benzoate 
of Soda. The Medical Record, N. Y., 1879.—Hoffman, L.: Ueber die therapeu- 
tische Wirkung des Natron benzoicum. Berlin, klin. Woch., XVI., 1879.— 
Krokzak, F.: Vorliiufige Mittheilung fiber Natron benzoicum Inhalationen am 
Krankenbette. Wien. med. Presse, 1879.—Dabney, W. C.: The Topical Uses of 
Ergot. Am. Jour. Med. Sci., July, 1879.—Quinart: Massage of the Tonsils. Arch, 
med. Beiges; N. Y. Med. Jour., Aug., 1879.—Mackenzie, Morell: A Manual of 
Diseases of the Throat and Nose. Vol. I., Diseases of the Pharynx, Larynx, and 
Trachea, London, 1880.—Kien. A.: De la diphtherie; etude patliogenique et 
therapeutique, en particulier de son traitement par le benzoate de soude. Gaz. 
medicale. Strasbourg, 1880.—Jacobson, Nathan: Diagnosis and Treatment of 
Diphtheria. The Medical Record, N. Y., Mch. 20th, 1880.—Billington, C. E.: 
Forty Attested Cases of Diphtheria; with Remarks on Diagnosis and Treatment. 
Ibid., Mch. 27th, 1880.—Robinson, Beverley: An Unusual Case of Extensive 
Phagedenic Ulceration of the Fauces, without Obvious Efficient Cause. Archives 
of Laryngology, N. Y., June, 1880. Cady, C. B.: Benzoate of Sodium in Pneu- 
monia (reporting successes in diphtheria). The Medical Record, N. Y., July 
3d, 1880. 
HYPERTROPHIED TONSILS. 
Quinart describes a method of treating hypertrophy of the tonsils, in 
which he has been quite successful. “He covers his index-finger with alum, 
introduces it into the mouth, and brings it to bear directly on the tonsil, 
which is manipulated, with gradually increasing force, over as great an 
extent of its surface as can be reached. The operation is at first painful 
and disagreeable, but the discomfort is readily allayed by an emollient 
gargle. After a few repetitions it ceases to be painful, and the patients 
readily learn to practise it themselves.” 
FOLLICULAR PHARYNGITIS. 
The opinion is gaining ground that actual destruction of the groups DISEASES OF TIIE PHARYNX. 
265 
of enlarged follicles, whose existence gives the name to this affection, is 
absolutely essential to a cure of the disease. 
Quite a number of practitioners, on both sides of the Atlantic, engaged 
in the special treatment of throat affections, express a decided preference 
for the incandescent galvano-cautery, with which one or more of the 
offending groups are destroyed daily or at longer intervals, until the 
pharynx has been cleared. Dr. Foulis occasionally prefers, and uses 
almost exclusively in his clinical practice, the tapering bulb of the ordi- 
nary potential cautery, at a dull red or even a black heat. Dr. Lennox 
Browne does not find it necessary to destroy the nodules themselves to 
effect their obliteration. He simply cuts off their blood supply, by de- 
stroying the continuity of the enlarged blood-vessels surrounding them, 
using the galvano-caustic point for the purpose, and trusts to their sub- 
sequent shrinking from want of nutritive fluids. 
Dabney extols the free application of ergot, twice daily. He employs 
a solution of Squibb’s solid extract, or ergotine, as it is sometimes called, 
composed of twenty grains of the extract, one fluid drachm of tincture 
of iodine, and seven fluid drachms of glycerine. 
Dr. Morell Mackenzie makes great distinction between the hypertro- 
phic and the exudative forms of follicular pharyngitis, and regulates his 
treatment of the disease accordingly. When the hypertrophic form exists 
alone, no remedy is considered by him so productive of good results as 
London paste, carefully applied to each elevation; not more than two or 
three being touched on the same day, for fear of exiting too great an 
amount of collateral inflammation. In the exudative form, his practice 
is first to scrape the mucous membrane with the curette, wherever the 
white spots of exudation appear; and having thus cleared the secretion 
away, to carefully apply a pointed stick of nitrate of silver to each spot 
which discharges an abnormal secretion. 
In applying nitrate of silver to the pharynx and other accessible parts 
of the throat, the writer has of late years used with great success a simple 
device of his own which is safe in application, economical of material, 
and protective to adjacent tissues. The caustic is inclosed in a wooden 
sheath, in fact, the sheath of an ordinary lead-pencil, like which it is 
sharpened to a point as required. It can be held in contact with the 
tissues for several seconds, without breakage, or smearing of contingous 
surfaces, and is thus rendered effective as a caustic in destroying the 
offending nodules. It is more easily managed than either London paste 
or any form of potential cautery. 
Stoerck denies the follicular character of these groups of nodules, and 
declares them to be simply circumscribed masses of swollen epithelial 
cells demoded of their exterior squamous layer. He removes them bodily 
with gouge-forceps. Others scrape them off with the curette. 
It is the writer’s conviction that this destructive treatment is requisite 
only when it is evident that the nodules excite cough by direct or reflex 
action, or absolutely keep up the special annoyance or irritation for which 
the sufferer seeks relief. Many individuals present these enlargements 266 
DISEASES OF THE PHARYNX. 
on examination, without ever having been conscious of even uneasy sen- 
sations in the throat. The promiscuous use of the galvano-cautery, 
gouge-forceps, and the like, seems liable to do injury, unless the proper 
cases are carefully selected by experienced practitioners. 
THBERCHLOSIS OF THE PHARYNX. 
Miliary Tuberculosis of the Pharynx, now that it is sought 
for, is being now and then reported. Osier has reported a case of chronic 
phthisis in which miliary tuberculosis existed in the pharynx as well as 
in the lungs. Numerous small, firm granulations, which, on examina- 
tion, proved to be miliary tubercles, were scattered over the posterior and 
lateral walls of the pharynx. There was no involvement of the larynx, 
and no ulceration. 
DIPHTHERIA. 
No new light has been thrown upon the question of the identity of 
croup with diphtheria. 
As regards treatment of diphtheria, Mr. Stuart has recently reiterated 
his encomiums on the topical use of precipitated sulphur, which he now 
prefers to use rubbed up with a little water and applied with a swab to 
the desired spot, as easier, safer, and more accurate than any other 
method. 
Dr. Billington reasserts his great success with the half-hourly or still 
more frequent use of teaspoonful doses of a mixture of two scruples of 
chlorate of potassium in half an ounce of glycerine and two and a half 
ounces of lime-water. This he frequently, though not invariably, alter- 
nates with equal doses of a mixture of one drachm of the tincture of the 
chloride of iron in an ounce each of glycerine and water. Meanwhile, he 
sprays the throat frequently with a mixture of ten minims of carbolic 
acid in four ounces of lime-water. The throat and nasal passages are 
kept thoroughly cleansed by frequent and efficient syringing with weak, 
tepid solutions of table-salt. 
Great claims of success with benzoate of sodium, in large doses, have 
been advanced by Letzericli, attributed to asserted arrest in the development 
of the diphtheritic bacteria. These claims have received a certain amount 
of support from a number of writers, but the weight of rendered evidence 
is as yet undecisive, to say the least, and a good deal is unfavorable. The 
formula used by Letzericli consists of five grammes of pure benzoate of 
sodium, dissolved in forty grammes each of distilled water and peppermint 
water, to which are added ten grammes of syrup of orange-peel. To infants 
less than one year old, two teaspoonfuls of this are given every hour; to 
children from one to three years of age, a tablespoonful, the amount of 
benzoate of soda in the mixture being increased from five to seven or eight 
grammes; for children from three to seven years old, the proportion of 
the drug is increased to from eight to ten grammes; for those over seven, DISEASES OE THE PHARYNX. 
267 
to from ten to fifteen grammes; and for adults, the proportion is from 
fifteen to twenty-five grammes. The fafse membranes are dusted with 
the powder of benzoate of sodium, blowm through a quill or other tube, 
two or three times daily in light cases, and every three hours in severe 
ones. It is also administered in gargles, a five-per-cent solution being 
sufficient for older children. 
For removing false membranes bodily from the larynx, when required, 
Mackenzie recommends an ingenious special device of his own, consisting 
in a squirrel-hair brush, the hairs of which are directed upwards. Its 
advantage for the purpose over the usual form of brush is apparent.