A Novel System of Operating 
for the Correction of the 
Deflected Septum 
By Means of an Electric Motor, Nasal Drills 
and an Original Spray-Producing Device 
WITH ILLUSTRATIVE CASES 
BY 
WILLIAM CHAPMAN JARVIS, M.D. 
Professor of Laryngology and Diseases of the Nose and Throat in the New 
York University Medical College, Consulting Laryngologist to 
the Outdoor Department of Bellevue Hospital 
Reprinted from The MEDICAL RECORD, April 9, 1887 
NEW YORK 
TROW’S PRINTING AND BOOKBINDING CO. 
20i—213 East Twelfth Street 
1887 A Novel System of Operating for the Cor- 
rection of the Deflected Septum1 
By means of an Electric Motor, Nasal Drills, 
and an Original Spray-Producing Device. 
WITH ILLUSTRATIVE CASES. 
WILLIAM CHAPMAN JARVIS, M.D., 
PROFESSOR 0F LARYNGOLOGY AND DISEASES OF THE NOSE AND THROAT IN THE 
NEW YORK UNIVERSITY MEDICAL COLLEGE, CONSULTING LARYNGOLOGIST TO 
THE OUTDOOR DEPARTMENT OF BELLEVUE HOSPITAL. 
Reprinted from The Medical Record, April 9, 1887. 
Despite the numerous methods which have been ad- 
vanced by laryngologists for the correction of malformed 
or displaced septa, no single procedure or device has 
evidently been invented which can justly claim the right 
of universal applicability for the successful treatment 
of the conditions met with in this deformity. _ Rather 
than view this as an indication of inefficiency or irresolu- 
tion, I would, on the contrary, profiting from the common 
experience of the past, interpret the formidable array of 
instruments as a commendable effort to successfully cope 
with the various contingencies which may be met with in 
the treatment of the deflected septum. It is even diffi- 
cult to imagine a single instrument possessing the com- 
bined property of cutting with facility and precision the 
• Presented at the New York Academy of Medicine (Laryngological Section ) 
March 23, 1887. 2 
hardest bone or softest membrane. This, nevertheless, 
would be required of an instrument designed for the suc- 
cessful treatment of deflected septa, composed, as they 
may be, of hypertrophied mucous membrane, dense, elas- 
tic cartilage, or compact bone. 
Several devices have been already brought forward by 
me for curing the deflected septum, which, judging from 
their liberal acceptance in print and practice, have more 
than survived the usual surprise provoked by the presen- 
tation of therapeutic novelties. Ido not desire this ad- 
dition to my septum armamentarium, namely, the electric 
motor and novel system of drilling, to be interpreted as 
an expression of dissatisfaction with earlier procedures, 
but rather as an intention to make these operations more 
effective. Indeed, I rarely if ever complete an opera- 
tion upon the septum by means of the electric drill alone, 
for the reason that my delicate punches, cartilage-scis- 
sors, and bone-forceps afford valuable assistance for the 
removal of adherent tissue debris, in the form of shreds of 
mucous membrane or cartilaginous and osseous asper ties. 
A sufficient experience with the common treadle sur- 
gical engine, and particularly with an improved form of 
this apparatus, invented and used by me during an ex- 
tended period for intra-nasal operations, has convinced 
me that the natural dread occasioned by the sight of the 
cumbersome and rapidly revolving noisy machinery con- 
stitutes a menace to the usefulness of the nasal drill. 
This sometimes serious objection, though mostly of a 
psychical nature, is effectively overcome by the employ- 
ment of the electric motor, concealed in its narrow shell 
suspended in mid-air, but few patients possessing an idea 
of the great power conveyed by the quiet, mysterious 
movements of this apparently insignificant mechanism. 
My earliest results with the electric motor, in opera- 
tions upon the septum, were obtained by means of a very 
ingenious dental instrument, devised by the late Dr. 
Robert Arthur, of Baltimore, and for the use of which 1 
am indebted to my friend Dr. George Arthur, U. S. N. Fig. i. 4 
This little instrument, used by me not quite two years 
ago, was constructed to combine the greatest amount of 
working power with the smallest bulk, inasmuch as the 
drills and magnet were held in the hand, after the man- 
ner ot a pen-handle, the mandril and drill-chuck being a 
direct extension of the armature. The efficiency of this 
motor is dependent upon the great number of its revolu- 
tions, that is, the acquired momentum, and it satisfac- 
torily serves the purpose for which it was intended, 
namely, drilling the teeth. Although I succeeded in cut- 
ting away the dense structures entering into the formation 
of extensive deviations of the septum, the frequent retar- 
dation of the drill’s revolutions when unusual pressure 
was exercised, gave rise to inconvenient delay in acquir- 
ing fresh momentum. For this reason I was compelled 
to abandon the employment of Arthur’s hand-motor and 
turn to bulky but more powerful devices of the kind to 
accomplish my purpose. I nevertheless believe that the 
application of direct power, in accordance with the prin- 
ciple of Arthur’s motor or Robert’s electric osteotome, is 
the most rational, inasmuch as the loss of power through 
friction is reduced to a minimum. 
The weight of electric motors possessing great rotatory 
inertia renders the employment of a cable and inde- 
pendent hand-piece necessary. The first motor of this 
pattern, seen by me several years ago, was one known as 
the Hussey motor. Being intended for dental purposes, 
it was operated by means of a flexible cable, the weight 
of the instrument being supported by a cord attached to 
the ceiling. I experimented with one of Hussey’s larger 
motors, but was disappointed in the instrument. Dr. 
Seiler drew my attention to the Griscom motor several 
years ago, and I embraced an opportunity to study its 
action for an extended period, but was not perfectly sat- 
isfied with the instrument. To Dr. Carl Seiler, I believe, 
is due the credit of first calling the attention of the medi- 
cal profession to the utility of the electric motor in intra- 
nasal surgery. 5 
The experience just described led me to discover and 
utilize the powerful but compact C and C electric motor. 
Inasmuch as this instrument has proved in my hands the 
desideratum sought for, I shall give it exclusive attention, 
only referring to other motors for purposes of comparison. 
This electric motor is shown in Fig. i, together with the 
accessory operating appliances. The axle-shaft can be 
discerned projecting from the centre of the motor-box. 
By simply unscrewing the face-place the component parts 
of the motor can be readily reached and examined. The 
armature, of the ring type, is wound continuously, wire of 
trapezoidal section being used. The commutator brushes 
are so arranged that no injury can arise from reversing 
the motion of the armature. The commutator segments, 
seventeen in number, are placed in a circular manner, 
being separated by an interval of only one-sixteenth of 
an inch. This close arrangement of the segments secures 
uninterrupted and great power without sacrificing speed. 
Hence there is absolutely no dead-point, a prevalent ob- 
jection with electric motors, and the common annoyance 
of laboriously adjusting the armature at intervals during 
an operation is, by this device, relegated to the incon- 
veniences of the past. 
The counter-electromotive force generated by the 
motor running at 1,800 turns a minute, with an 18-am- 
pere current in the field, is 5 volts. The revolutions 
can be carried as high as 2,000 to the minute. Its ex- 
treme capacity equals power. The dimensions 
of the instrument are X 5 X 3 inches, and weight 12 
pounds. 
A single quantity-cell supplies sufficient electromotive 
force for any ordinary nasal operation ; two of these 
cells furnish an excess of power, even in operations in- 
cluding the densest portion of the vomer. To facilitate 
the attachment of the flexible shaft, I have had con- 
structed a nretallic sleeve which slips over the journal- 
box of the motor. Within this sleeve is an angular rod, 
soldered to the flexible cable, which slips in a groove 6 
cut into the centre of the axle of the armature. The 
free movement of this rod within the groove favors the 
flexion of the cable, and permits the shafting to be 
quickly attached or withdrawn. The electric motor can 
be used either attached to a convenient table or sus- 
pended by wires from the ceiling. 
The wires running from the battery are interrupted 
before reaching the motor and arranged upon a foot- 
board. The convenient cut-off thus formed is simply 
composed of a sheet of spring brass, which the pressure 
of the operator’s foot brings in contact with a button, 
through which the electric current is conducted to the 
motor. This device, I have been recently informed, has 
been likewise invented by Mr. Griscom. Although it is 
possible by this arrangement to instantly cut off the cur- 
rent, if desired, the sudden interruption of the electric 
flow is not really required, inasmuch as the easy with- 
drawal of the small nasal drills, even while running at 
full speed, is a very simple procedure. 
After experimenting with several kinds of batteries, I 
have finally settled upon a modification of Bunsen’s cells, 
a plunge and a gravity battery, as the most convenient. 
My improved plunge battery is so arranged that a 
succession of cells can be automatically thrown into the 
circuit by simply raising the lid of the box which sup- 
ports the elements, sliding it along a rod, which serves 
as a hinge, and allowing the cover to descend, when the 
plates dip into the fluid, bringing themselves by their sub- 
mergence into connection with the preceding cell. By 
reversing this procedure the plates are removed from the 
cells, being finally received into drip-cups, where they 
remain until used again. 
The automatic connection of several cells by this ar- 
rangement obviously facilitates prompt action, and saves 
time, trouble, and complications likely to occur in the 
adjustment of key-boards and switches. If desired this 
battery can, by a slight change in the connections, be 
converted from a series of cells into one giving the effects 7 
of a single cell, and therefore appropriate for running 
low-tension motors. By another arrangement I am en- 
abled to utilize the current from a stationary gravity 
galvano-cautery battery. 
The employment of small nasal drills, already referred 
to, I desire to lay particular stress upon, as constituting 
a desirable digression from the routine course heretofore 
pursued, of resorting to large and cumbersome devices 
of the kind in operations upon the nose. To facilitate 
the practice of keeping the parts operated upon con- 
stantly in view, the dimensions of the drill must neces- 
sarily be made small. When large drills are employed, 
the ingenious shielded multiple knife of Dr. Goodwillie, 
for example, so effectively employed by him, a view of 
the field of operation is rendered difficult or impossible, 
and the operator is compelled to rely upon his acquired 
tactus eruditus, to the exclusion of his sense of sight. 
The long practice required to attain the necessary 
tactile proficiency to operate with precision, though blind 
to the exact behavior of the drill, it seems to me, must 
seriously interfere with the extensive adoption of large 
nasal drills in general practice. Furthermore, surgeons 
will naturally hesitate to permit keen-edged cutting in- 
struments to rapidly revolve out of sight in close contigu- 
ity to the brain, beneath the frail plate of the ethmoid. 
The extreme narrowness of the superior meatus makes it 
impossible to satisfactorily employ shielded drills in this 
region. 
Although keeping for convenience a number of nasaj 
drills of different shapes and dimensions, I shall largely 
confine myself to the description of two of these, namely, 
my rasp drill and nasal plane. The rasp drill (Fig. 3) is 
virtually a hollow file, the teeth of which have been made 
to project, in the form of diminutive knife-points, for the 
distance of one-sixteenth of an inch above the circum- 
ference of the tube. These pyramidal teeth are cut at 
intervals of one-eighth of an inch along the circumference 
of the steel tube, and their relation to each other is so ad- 8 
justed that a simple rotation of the instrument produces 
an incision resembling that made by the cut of a con- 
tinuous knife-edge. 
A vent-hole, cut at the distance of an inch from the tip 
of the drill, permits the detritus to escape and thus pre- 
vents clogging of the steel teeth, an objection met .with 
in many cutting devices of the kind, and at the same 
time frees the parts from the tissue debris which is apt 
Fig. 2. 
to accumulate and obscure the field of operation. The 
extremity of the drill may be capped by a crown-knife, 
to prevent the eroded tissues from escaping into the nos- 
tril, and at the same time furnish an effective direct drill. 
These little tubular drills are capable of cutting through 
the densest cartilaginous or osseous structures found in 
the nostril, with great rapidity and perfect precision. 
Fig. 3. 
Several forms of these nasal drills are constructed, the 
difference depending upon the length of the teeth.1 
In the tubular scissors or nasal plane (Fig. 2) 1 have 
Utilized a cutting device which has been already em- 
ployed in other parts of the body in various forms and 
for different purposes. It consists of a small cylinder 
within which rotates a delicate tube, the end of which can 
1 An ingenious application oFthe trephine, shown to me by Dr. H. Cu' tis, and 
employed by him in conjunction*with an electric motor, deserves especial mention. 
The removal, by this small drill, of the mucous membrane over the deflected sep- 
tum I do not deem an objection to its use in cases where the vomer is the seat of 
the deflection, since the preservation of the pituitary membrane to facilitate rapid 
healing at this remote point, can hardly compensate for the time and labor required 
to attain the object. I shall therefore promptly add this useful instrument to my 
operative armamentarium. 9 
be discerned through the fenestra as shown in the figure. 
The inner tube,, it will be observed, is set with a row of 
fine teeth. These teeth, if deemed desirable, can be dis- 
pensed with. 
A useful feature of these drills will be recognized in 
the property they possess of removing bone and cartilage 
of the deflected septum without injury to the overlying 
mucous membrane. It is obvious that the preservation 
of the pituitary membrane in its entirety and integrity 
affords protection to the wound, and hastens the restora- 
tion of the injured tissues to their proper functions. It 
will often be found convenient to separate the mucous 
membrane and temporarily secure it to the roof of the 
nostril by means of cotton pledgets before cutting away 
the subjacent bone or cartilage. 
The hand-piece employed by me (Fig. i) as a drill- 
holder, invented by Mr. Weber, has the great advantage 
of clutching the drills after the manner of a powerful 
chuck. A right-angled adjustable gearing device can be 
made by means of a sleeve to slip over the top of the 
hand-piece. The right angle will be found useful for 
keeping the drill’s point constantly in view while operat- 
ing in the deeper portions of the nasal cavity. It is 
larger and more powerfully constructed than those 
usually employed by dentists. A useful addition to the 
hand piece will be observed in the illustration (Fig. i) 
in the shape of an adjustable spray-producing device, in- 
vented by me to facilitate the practice of keeping the 
drill in sight. It accomplishes this result by showering 
the wounded tissues with cleansing fluids, or by means 
of the air-douche alone, while the drill is in full action. 
The force of the compressed air, charged with moisture, 
impinges upon the cut and bleeding tissues, whipping 
the blood-clots far beyond the field of operation. In 
obtaining this result I have found it necessary to branch 
off from the usual methods adopted for projecting sprays, 
on account of the obstruction that would be ordered by 
the fluid receptacle. The change consists in an extraor- dinary lengthening of the fluid conduit. This was ac- 
complished by means of a fine rubber tubing, two or 
three feet in length, beginning in the spray lube and 
ending in the fluid receptacle. The air and fluid tubes 
are joined together for almost their entire length. An 
adjustable cut-off slipping over the head of the hand- 
piece enables the operator to regulate the spray at pleas- 
ure. The spray-tube proper is attached to a ring which 
revolves around the drum of the right angle. This ar- 
rangement renders it possible to direct the spray in any de- 
sired location about the drill. I employ the same device 
to produce and keep up rhi'golene or cocaine anaesthesia. 
I shall conclude with a brief description of two illus- 
trative cases, selected from a number of the kind, as 
good examples of the results obtained by the employ- 
ment of the electric motor and drills. The first case, a 
broker’s clerk, aged twenty, referred to me by a patient 
upon whom I had successfully operated, consulted me in 
October, 1885. The patient proved to be an habitual 
mouth-breather, and did not remember ever having 
breathed freely through the nostrils. He was often de- 
prived of needed rest by being awakened during the 
night with a parched throat. The accumulation of thick- 
ened mucus in his nostrils was a source of constant an- 
noyance. He also complained of tinnitus aurium. 
Examination.—An inspection of the anterior nares 
showed pronounced distortion of the septum in the shape 
of an extensive general deflection of the triangular car- 
tilage to the left, also a localized deviation of the co- 
lumna to the right, as shown in Fig, 4, taken from a life- 
sketch. The displaced cartilage pressed firmly against 
the inferior turbinated tissues in the left nostril, pro- 
ducing complete occlusion on this side. 
The right nostril, though only partially obstructed by 
a localized deviation of the septum, associated with an 
inferior turbinated hypertrophy, possessed very little res 
piratory value. Without entering into the details re- 
corded in my case-book, I will simply state that the 11 
careful employment of the electric motor and drills, in 
conjunction with my stellate punch, cartilage, and bone- 
trimming forceps, resulted in the satisfactory correction 
of the deformity, the complete restoration of nasal res- 
piration, and normal nasal drainage, and the consequent 
disappearance of all the annoying symptoms. 
Fig, 5, drawn from a life-sketch, taken five months 
Fig. 4. 
Fig. 5. 
subsequent to the operation, shows the appearance of 
the parts after complete healing had occurred. 
The next case I shall present is that of a druggist, 
aged twenty-seven, who consulted me February 17, 1887, 
in search of relief from a difficulty in breathing. The 
left nostril was permanently stenosed, and the right one, 
though partially free, would become periodically ob- 
structed, and was a source of constant annoyance. 
Examination.—Anterior rhinoscopic inspection de- 
monstrated the existence of an extensive osseo-cartilagi- 12 
nous deflection of the septum to the left, extending as 
far back as the middle of the vomer. The patient did 
not manifest the slightest dread in submitting to an oper- 
ation in which the electric drills were employed. The 
osseous and cartilaginous tissue was first cut away with 
the rasp drill, and subsequently smoothed down by means 
of the revolving nasal plane. Forty minutes were con- 
sumed in cutting a large opening from the anterior free 
edge of the deviated tissue, the columna, to the post- 
nasal opening, about the middle of the vomer. This 
time included intervals of rest required for spraying the 
parts with cocaine and noting the progress of the oper- 
ation. The loss of blood was unusually scanty. One 
month after the operation the wounded septum had com- 
pletely healed, leaving a large interspace between it and 
the lateral nasal wall for the entire length of the nostril. 
The patient stated that the great cause of his suffering, 
the difficulty in breathing, had entirely disappeared— 
nasal respiration being as perfect in the night-time as 
during the day. 
I cannot conclude my paper without acknowledging 
the courtesy extended to me by Mr. W. F. Ford, while 
bringing my mechanical experiments to a successful is- 
sue, and I might add that any or all of the devices de- 
scribed by me can be obtained from Hazard & Hazard, 
of New York,