JR ZE3IVE .A IR/ DEC S 
ON 
Nas<)■Pmar y n g e a l Cat arr h. 
by 
-ip., coomes, jvc., id.. 
Demonstrator of Anatomy and Clinical Lecturer on Diseases of Ear, Nose, and Throat in Hospital College Of 
Medicine, Louisville, Ky,; Junior Surgeon to the Louisville Ear and Eye Infirmary; Surgeon 
to Eye and Ear Department of Louisville City Hospital, etc. 
From the American Medical Bi- Weekly, June 8, 1878. 
LOU IS VIL LE, KY.: 
Medical Journal Book and Job Steam Pi biting House, 104 Green Street 
1 8 78. NASO-PHARYNGEAL CATARRH. 
Naso-pharyngeal catarrh is an inflam- 
mation of the mucous membrane lining 
the nose and pharynx, and is always 
produced by one of two causes, viz., an 
excess of ozone in the atmosphere, or 
by contagion. The experiments of 
Schonbein were quite sufficient to prove 
beyond all doubt that epidemics of acute 
rhinitis (or acute catarrh) were pro- 
duced by an agent generated in the at- 
mosphere ; that agent being ozone. 
free from catarrh previous to his mar- 
riage was attacked with the disease soon 
after, when the atmosphere was appar- 
ently free from any influence which 
might produce it; the only cause to be 
found was that of contagion from the 
wife who was suffering from the disease. 
I have frequently met with several 
cases in the same family in which the 
disease attacked each member in suc- 
cession, the time between the attacks 
varying, and evidences pointing to con- 
tagion as the cause. It is said by some 
that the disease occurs more frequently 
among children than adults. I think 
there is no evidence to substantiate these 
declarations; at all events, my experi- 
ence does not enable me to speak posi- 
tively upon this point, but from wbat I 
have seen, I should judge that it occurs 
most frequently between the ages of 
twelve and forty-five years. It is rarely 
met with in extreme old age, and yet no 
age is exempt from it. As a rule, the 
more refined class of people consult the 
physician in the early stages of the dis- 
ease on account of the unpleasantness 
which it necessarily produces, and espe- 
cially the inconvenience while in society. 
Every intelligent observer will agree 
that atmospheric poison is one of the 
prime causes; and therefore a discussion 
as to whether the active agent is ozone 
or a something else, would be out of 
place. 
As to the contagiousness of the dis- 
ease, it does seem that the necessary ele- 
ments for rendering it contagious are 
present in those cases where the dis- 
charge is of a purulent or muco-puru- 
lent character. So far as I have been 
able to ascertain, all attempts to practice 
inoculation have failed; but there is no 
question about the Schneiderian mem- 
brane being susceptible to the infection 
of gonorrhoeal virus. Gonorrhoeal rhi- 
nitis is frequently met with in connec- 
tion with gonorrhoeal ophthalmia; and, 
taking for granted that the pus cell of 
gonorrhoeal virus is in reality the active 
reproductive agent, it is equally proba- 
ble that the pus cell, resulting from an 
inflammation produced by an atmos- 
pheric poison, is equally as contagious 
as that resulting from a gonorrhoeal in- 
flammation under similar circumstances. 
There is another class of individuals 
who are uncouth in their manners, and 
do not seek relief on account of society 
relations, but because the disease has be- 
come intolerable. 
The changes presented by the mem- 
brane lining the naso pharyngeal space 
are numerous and varied. In the acute 
form of catarrh it will be found swollen, 
red, and bathed in an excessive quantity 
of glairy, white mucus, which usually 
affords a copious discharge from the 
Dr, Frankel, of Berlin, says that he 
has known of numerous instances in 
which a husband who had been perfectly NASO-PHARYNGEAL CATARRH. 
nose during the acute attack. The pa- 
tients complain of a tight feeling across 
the nose, and are troubled with frequent 
sneezing, and a “ stuffy sensation,” as 
they term it, a feeling as if the nares 
were plugged with cotton. Nasal res- 
piration is usually interfered with to a 
greater or less extent in most cases of 
catarrh, whether acute or chronic. 
none of the symptoms that are charac- 
teristic of the disease. It has been very 
properly termed a “ proliferous inflam- 
mation ”by Eoosa. There is in reality a 
multiplication of connective-tissue cells, 
which necessarily increase the thickness 
and density of the membrane. The 
sense of smell in these cases is usually 
very much obtunded or entirely absent. 
As the disease advances, the secretions 
are changed and become muco-punilent 
or purulent, and in some instances where 
the disease is chronic the secretions be- 
come inspissated, and occasionally close 
the nares so as to prevent the passage of 
liquids, or obstruct the breathing. In 
other cases the membrane covering the 
turbinated bones, or even that lining 
the whole cavity, becomes dry and 
glazed, looking as though it had been 
varnished. There may or may not be 
an accumulation of inspissated mucus in 
these cases. Where the membrane pre- 
sents a glazed appearance without any 
perceptible or excessive quantity of de- 
posit, haemorrhages are liable to occur, 
which are usually very slight. In nu- 
merous cases eczematous crusts are 
found, the removal of which is usually 
followed by slight haemorrhage or ooz- 
ing of a sero-sanguinolent fluid. 
Destruction of the osseous tissues of 
the nose in casesof simple catarrh rarely, 
if ever occurs. The decomposition of 
secretions is usually the cause of the dis- 
gusting odor that is present in some few 
instances. 
Anosmia may be produced in one of 
two ways in connection with naso-pha- 
ryngeal catarrh, viz., by obstruction due 
to impacted secretions, or by the sensi- 
bility of the terminal filaments of the 
olfactory nerve being obtunded or de- 
stroyed by the disease. 
Ear complications are the most fre- 
quent and serious that occur. In some 
cases there is simply a gradual loss of 
hearing without any pain. In others, 
violent attacks of acute otitis media are set 
up, which end in suppuration, and be- 
come chronic; an occasional one of these 
terminating fatally by producing cere- 
britis or abscess of the brain. The great 
mass of cases of acquired deafness are 
the results of catarrhal disease of the 
nose and pharynx, which extends along 
the course of the Eustachian tube up to 
the drum cavity. The faucial orifice of 
the Eustachian tube very frequently 
becomes inflamed and closes; the result 
of this is an otalgia intensely acute in 
character. The pain in these cases is 
produced by atmospheric pressure from 
without. Frontal headache is present 
in many instances, but I think it is not 
so common as is generally believed. 
In another class of cases, and especially 
in the subacute, there is great relaxation 
of the mucous membrane, and particu- 
larly that portion which lines the phar- 
ynx. There are a few cases that are 
free from deposit or secretion of any 
kind, the surface being slightly moist; 
these are the most stubborn cases met 
with, and yield to treatment very reluc- 
tantly. 
The membrane lining the inferior and 
anterior portions of the space, in many 
instances, is perfectly dry, and resem- 
bles integument more than a mucous 
surface. It has somewhat of a pale- 
pinkish, velvety appearance. This in 
reality should not be classified as a ca- 
tarrhal affection, because it partakes of 
Treatment.—Cleanliness is one of the 
important features in the treatment of 
catarrh of the nose and pharynx. The 
most efficient instruments for the appli- 
cation of local agents are the spray-pro- NASO-PHARYNGEAL CATARRH. 
ducer and catarrhal or post-nasal syr- 
inge, assisted by the occasional use of 
the probe. The douche is inefficient and 
unsafe, under any circumstances, on ac- 
count of its liability to flood the drum 
cavity, an occurrence often attended with 
fatal results. It may terminate in par- 
tial or total loss of the power of audi- 
tion. 
mucous membrane or a very dry phar- 
ynx, from two to ten grains of iodine 
dissolved in one ounce of glj-cerine is 
an excellent application ; where there is 
a demand for disinfectants, the liquor 
sodas chlorinatas is one of the most effi- 
cient. From ten to thirty minims of 
the solution to the ounce of water is 
sufficiently strong. It may be applied 
two or three times a day in the same 
way as other solutions. Hydrate of 
chloral, from five to twenty grains to 
the ounce of water, is also an excellent 
antiseptic, and possesses a peculiar sooth- 
ing property that is very desirable in 
many cases. 
The agents to be used in the treat- 
ment of catarrh are numerous; to men- 
tion them all would be out of place and 
a waste of time. A few well-selected rem - 
edies are sufficient to meet the demand 
in all ordinary cases. Cleansing and 
soothing astringent agents are most fre- 
quently indicated. Among the list of 
cleansing agents, muriate of ammonia 
stands first, bromide of potassium next, 
and then chloride of sodium. All of 
these possess the power of dissolving the 
secretions that accumulate in the nose 
and pharynx; hence in them we find 
our first valuable assistant in cleansing. 
The pain produced by the ammonia and 
potash salts are about the same; that 
produced the potassium salt is of the 
shortest duration. This, however, is to 
be accounted for by the latter being a 
local anaesthetic. In the absence of the 
others, common salt is a very efficient 
cleansing agent. The strength of the 
solutions may be varied from five grains 
to the ounce of water to a saturated 
solution. The strong solutions are very 
painful, and unless finely comminuted 
are only applicable to a certain class of 
cases. As a soothing astringent, I think 
there is nothing to excel a combination 
of carbolic and tannic acids dissolved in 
one part of glycerine and three of water. 
The quantity of either acid may vary 
from one to ten grains to the ounce of 
vehicle. This combination, used with 
the atomizer or post-nasal syringe, pro- 
duces a cooling, pleasant sensation, and 
the patient is comparatively comforta- 
ble for three or four hours. Where there 
is an eczematous condition of the nasal 
In cases where there are specific com- 
plications, the constitutional treatment 
will be governed by the symptoms man- 
ifested in each individual case. In those 
cases where the membrane is much 
thickened and dry, and particularly in 
those cases of proliferous inflammation, 
the iodide of potassium is an important 
adjunct to the local treatment. 
Curability.—There is no reason why 
inflammations of the membrane lining 
the nasal and pharyngeal cavities should 
not be influenced by the application of 
proper medicinal agents, as it is more 
accessible to inspection and medication 
than many of the other raucous surfaces. 
The length of time which is required to 
effect a cure in naso-pharyngeal catarrh 
is necessarily variable, because some 
cases are more violent than others; some 
yield to remedial agents more readily 
than others; and again, others are ag- 
gravated by complications, etc. As the 
disease is very much influenced by at- 
mospheric changes, occasional relapses 
may be expected, which will necessarily 
retard the curative process. 
In conclusion, 1 may say that all 
cases of catarrh of the nose and phar- 
ynx are curable if properly treated, 
and that syphilitic or strumous compli- 
cations always render the cure more 
difficult. 6 
NASO-PHARYNGEAL CATARRH. 
Remarks on the Use of Instruments in the 
Treatment of Uaso-Pharyngeal Catarrh. 
crusts of inspissated mucus. Where the 
secretions are very dry and adherent to 
the membrane, one application of liquid 
by the syringe does not always cleanse 
the surface, and it may be necessary to 
introduce it a number of times to accom- 
plish the desired result. Frequent intro- 
ductions of the instrument at a single 
sitting are often objected toby the patient. 
Children frequently shrink from the use 
of the syringe on account of its having 
to be used through the mouth, but after 
a few applications they usually submit 
without any trouble. 
For the last few years the subject of 
cleansing and medicating the naso-pha- 
ryngcal cavities has attracted considera- 
ble attention on account of the difficul- 
ties and dangers which attend some of 
the processes. There is such conflict of 
opinion about the various methods of 
cleansing and medicating these struc- 
tures that the young practitioner finds 
many difficulties to embarrass him. 
In the application of liquids to the 
naso-pharyngeal space, there is often 
great danger of flooding the drum cav- 
ity. Such an accident is not always fol- 
lowed by grave results; but it is by no 
means desirable to have it occur, as it 
produces alarming symptoms, often dif- 
ficult to manage. 
The question may be asked, is there 
any danger of flooding the drum cavity 
with the catarrhal syringe ? I have 
heard of but two cases; one of these 
was undoubtedly due to the ignorance 
of the physician, who made the patient 
put his tongue out while he injected the 
pharynx. The patient strangled, and 
the result was that both drum cavities 
were filled with liquid, which set up a 
violent acute suppurative otitis media, 
that resulted in perforation of both 
drum membranes. The other was a 
case in which the anterior nares were 
completely closed with inspissated mu- 
cus and prevented escape through the 
proper channel. The prompt use of the 
catheter prevented anything more seri- 
ous than severe pain for a few minutes. 
Of all the methods resorted to for 
cleansing and medicating the nasal cav- 
ities, there is none more popular than 
the douche. It is inefficient for clean- 
sing or medicating the naso-pharyngeal 
space, under any circumstance, and is 
attended with the danger of flooding the 
middle ear. As a rule, intense pain is 
suddenly developed by the accident, fol- 
lowed by violent acute otitis media. This 
is frequently the case despite all the 
efforts to prevent it. 
The acute disease may be arrested or 
pass into the chronic form, leaving the 
patient with perforated drum mem- 
branes, and in many instances, what is 
still worse, creating partial or total deaf- 
ness. Those who are aware of the 
dangers attending the use of the douche 
and still persist, ought to be held strictly 
accountable for any damage resulting 
from it. The catarrhal syringe is an 
invaluable instrument in the treatment 
of many cases of catarrh of the nose 
and pharynx. The cases that are best 
adapted to its use are those that are con- 
fined to the pharynx and lower portion 
of the nose, and those that are free from 
When the nose is in a condition to 
permit the passage of liquid, the instru- 
ment, if properly used, is free from harm 
in every respect. 
It may not be out of place in this con- 
nection to say a word in regard to ma- 
nipulating the syringe. First of all, it 
is necessary to have light sufficient to 
get a fair view of the velum palati and 
fauces. The patient’s head should be 
controlled by one hand and the syringe 
carefully passed in behind the velum 
palati. As soon as the instrument is in 
proper position, it should be emptied 
and withdrawn instantly. The instru- 
ment should never move in the hand, NASO-PHARYNGEAL CATARRH. 
7 
and in order to withdraw it properly, it 
is necessary to invert the hand. If ma- 
nipulated in this manner, there is no 
danger of abrading the surfaces or in- 
flicting pain. 
I claim no invention, because I have 
invented nothing; but I do claim that I 
am the first to make practical use of this 
kind of an instrument for throwing neb- 
ulized liquids into the air passages. The 
amount of pressure used must be gov- 
erned by circumstances. The advan- 
tages of this mode of cleansing and 
medicating are numerous; it economizes 
time and labor; it is manipulated with 
more ease than any other instrument 
used for such purposes. The powerful 
force with which the spray can be 
thrown renders it far superior to any 
form of nebulizer, because the strong 
current of air carries the fluid into every 
recess and insures thorough application. 
The use of atomized liquids is very 
much favored in the treatment of nasal 
catarrh and other affections of the air 
passages, and at present it seems to be 
more strongly advocated by the majority 
of specialists than any other mode. It 
is certainly the most rational plan yet 
proposed. It is the only method of 
cleansing and medicating that can be 
practiced by both patient and doctor. 
This is quite an important point, as it 
is a matter of necessity in the treatment 
of nasal catarrh that the parts be cleansed 
once or more every day; and as there is 
no other instrument that the patient can 
manipulate with safety, it is rendered 
doubly important. 
I do not hesitate to say that of all the 
atomizers placed on the market, none is 
so well adapted to the requirements 
of the patient as Holmes’ Boston Per- 
fumer. Its chief recommendation is its 
simplicity of construction, which ren- 
ders it manageable in the hands of the 
most unskilled. 
Any instrument with which the neb 
ulized liquids may be thrown into the 
nasal cavities will suffice. Hard-rubber 
instruments are used for atomizing 
liquids, but they are not so well adapted 
to the uses of the patient as the Holmes 
instrument. I have recently made use 
of compressed air for the purpose of 
nebulizing fluids, which I think is far 
superior to the hand-instrument in ordi- 
nary use. The instrument for compress- 
ing the air consists of a receiver with a 
capacity for four gallons, with a stop- 
cock at the top and bottom, and a force- 
pump connected with the receiver by a 
piece of rubber hose. Attached to the 
stop-cock at the top of the receiver is a 
piece of hose for attaching the atomizer. 
(See accompanying wood-cut.) 
The degree of comminution that can be 
produced with this instrument gives it 
an advantage over all others, because 
it enables us to use agents that would 
otherwise be exceedingly difficult of ap- 
plication. In those cases where the 
incrustations are adherent to the mem- 
branes, this is the method above all 
others. There are many other minor 
advantages that might be mentioned. 
The complicated structure of the nasal 
cavities necessarily renders the applica- 
tion of any liquid difficult; indeed, so 
difficult is the process that it requires all 8 
NASO-PHARYNGEAL CATARRH. 
the care and skill at the command of the 
physician to accomplish this seemingly 
trivial task. 
the patients were directed by physicians 
to snuff medicated liquid. In two cases 
the liquid used was a solution of the 
chlorate of potash, and in four a solution 
of common salt was used; in the other 
case the composition of the liquid was 
not known. In all these cases the cav- 
ity of the tympanum was very much 
inflamed. In three of them suppura- 
tion occurred, which was followed by 
perforation of the drum membrane. In 
one the destruction of the membrana 
tympani was so great that the per- 
foration never closed. Audition in this 
case and one other was very much im- 
paired. 
Insufflation or Snuffing.—This is prac- 
ticed to a great extent hy all classes, and 
especially while bathing the face. In 
some instances it is done to cleanse the 
nose, and in others to medicate the 
passages. Physicians frequently recom- 
mend their patients to “snuff” salt-wa- 
ter for the purpose of curing catarrh. 
The practice of insufflating liquids is 
certainly an unsafe one, as the drum 
cavity is occasionally flooded by this pro- 
cedure ; and, moreover, the method is 
unsatisfactory, because it is impossible 
to medicate the whole surface of the 
naso-pharyngeal space by insufflation. 
The insufflation of powders is occasion- 
ally very beneficial, especially where the 
disease is confined to the middle and in- 
ferior cavities of the nose. 
From the above it will be seen that 
this is not an accident of rare occur- 
rence, because the practice is a general 
one, and only a few of these cases come 
under the care of the specialist and find 
their way to the press, most of them 
occurring in general practice and looked 
upon as ordinary cases of acute aural 
catarrh. 
I append a brief history of several 
cases that have come within my knowl- 
edge in the last year. In all these cases