REPORT ON 
RHINOLOGY: 
The Treatment of Nasal and Pharyngo-Nasal Catarrh. 
B Y 
J. ADDISON STUCKY, M. D. 
LEXINGTON, KY„ 
Surgeon to St. Joseph’s Hospital, Member Kentucky State Medical So- 
ciety, Vice President American Rhinological Society. 
Reprinted from the CINCINNATI MEDICAL AND DENTAL JOURNAL of 
October, 1886. 
LEXINGTON, KY., 
ACME PRINTING COMPANY, 
NO. 9 CHEAPSIDE. 
1886. REPORT ON RHINQLOGY:* 
The Treatment of Nasal and Pharyngo-Nasal Catarrh. 
BY J. ADDISON STUCKY, M. D. 
LEXINGTON, KY„ 
Surgeon to St. Joseph’s Hospital, Member Kentucky State Medical So- 
ciety, Vice President American Rhinological Society. 
Repiinted from the CINCINNATI MEDICAL AND DENTAL JOURNAL of 
October, 1886. 
Until a very few years ago, diseases of the naso- 
pharyngeal cavities were so little thought of, that 
they were scarcely noticed by any of the authors of 
our best text-books. But now, the literature on the 
subject is voluminous; and it seems that the idea is 
just beginning to dawn upon the minds of the pro- 
fession that disease of these cavities is the most pro- 
lific cause of trouble in the tympanic, pharyngeal and 
laryngeal cavities, the lachrymal duct and canal, and 
the conjunctiva. Facial neuralgia, occipital and 
frontal ache, and impairment of the function of the 
digestive apparatus and nervous system are also fre- 
"Read before Kentucky State Medical Society, at Winchester, June, 1886. 2 
quently due to it—I might enumerate many symptoms, 
reflex in their nature, due to the same cause, but think 
I have mentioned enough to at least awaken some 
interest in this subject. 
I was glad that this Society decided at its last 
meeting to place rhinology on an equal footing with 
laryngology, otology and ophthalmology, and it is 
with no little degree of embarrassment that I present 
this, the first report on the subject. It is not my in- 
tention to weary you with a history of rhinology, nor 
to give a detailed report of its progress during the 
year that is past. The medical journals all over the 
land have had so much to say on the subject, that, to 
do this would be consuming too much valuable time. 
Taking for granted that most of you, at least, have 
familiarized yourselves with this, I propose briefly to 
consider: 
(1) The best method of treating disease of the 
nasal and pharyngo-nasal cavities. 
(2) To mention those remedial agents that have 
given me best results in the treatment of several dif- 
ferent forms of this disease. 
At the last meeting of the American Laryngo- 
logieal Association, I)r. J. Solis Cohen says: “The 
two great principles in the treatment of naso-pharyn- 
geal catarrh were, first, to keep the parts clean, so as 
to let them have a chance to get well of themselves; 
and second, to take care of the patient’s general 
health.” He deprecates the free (and frequently in- 
discriminate) use of the knife, drill and cautery, and 
says: “I have relieved, in many instances permanent- 
ly, by mild measures, cases in all respects equally 
severe with those so often treated by ruder methods.” 
This has been my experience, and it is the mild, non- 
i rrit a ting treatment that I advocate. 3 
To Dr. Cohen’s first maxim, “Keep the parts 
clean,” I would add, protected and lubricated; if this 
is doim, and the patient’s general hsalth eared for, the 
majority of eases of chronic nasal catarrh will get 
well. The impairment of the general health (conse- 
quent lowering of the vital forces and involvement of 
the vaso-motor system) in a large number of cases of 
this disease, is not, in my opinion, the cause of the 
disease, but vice versa. But it is more to the local 
treatment than the constitutional that I desire to call 
your attention. 
In cleansing or medicating the nasal cavities, the 
method and remedies should be non-irritating, reach- 
ing every portion of the diseased surface. 
“A method that requires the irritation of the 
healthy parts to free the diseased surface must do in- 
jury to the healthy surface, and the injury thus done 
to the one is much greater than the benefit done to 
the other, for the healthy membrane will take on in- 
flammation much faster than the diseased portion will 
resume its normal condition.” 
The questions that then present themselves are: 
(1) What is the non-irritating remedy? 
(2) How is it to be used? 
To the first I answer, vaseline, in the form of a 
spray, as applied by Rumbold’s method. This remedy 
is well known to every practitioner, hence needs no 
description or eulogy. That it is non-irritating, 
soothing and protecting to an inflamed and diseased 
surface, I venture to say, none will deny. In my 
opinion it is the sine qua non in diseases of the respi- 
ratory tract. Used in the manner that I shall pres- 
ently describe, it fulfills, in a great majority of cases, 
the indications pointed out by the eminent laryngolo- 
gist and author referred to, in that it can be made to 4 
“thoroughly cleanse the parts,” and lubricate and pro- 
tect them. I am aware that many eminent in the 
profession contend that vaseline is not absorbable. I 
believe that it is; but this cannot be determined by 
its use in the pharyngo-nasal cavities, but when used 
on the general surface, as in scarlet fever, or in the 
external auditory meatus, we know from experience 
that it is absorbed. If it is not absorbed it would 
act wholly by its physical properties, but its effects in 
curing are too great and marked to result from a 
physical cause alone. That it possesses medicinal 
properties in no small degree l am well satisfied. 
These properties I believe to be anti-septic. It acts 
also as a physical agent by coating the membrane, 
thus preventing the absorption of moisture and gases, 
and the contact of dust and other irritants. 
Having obtained a non-irritating remedy, we 
must use a non-irritating method of applying it to the 
diseased part. In June, 1866, Dr. T. F. Rumbold 
designed and used a set of instruments—spray pro- 
ducers—which fulfilled in every respect this last re- 
quirement. The instruments are made so as to spray 
the entire pharyngo-nasal and larvngo-tracheal space, 
and “as the diseased surface is not touched by the in- 
strument, but only impinged upon by the air and liquid, 
and the remedy used is non-irritating, it follows that 
it is operated upon in the mildest manner possible. 
These instruments combine with efficacious cleansing 
and medicating, a thoroughness and mildness that is 
unequalled by any other method” (Rumbold). 
To accomplish these results, the instrument must 
be made to throw a stream (spray) that is required to 
make an application to each portion of the diseased 
surface. To accomplish this, I have found that three 
spray producers are enough to meet these requirements. 5 
Figs. 1 and 2. illustrate the instruments and 
method of applying the spray, 
Spray Producers for making Local Applications to the Nasal and 
Pharyngo-Nasal Cavities, the Fauces and the Tonsils. 
No. 1 treats the tonsils and the fauces; No. 2 the anterior nares; 
No. 3 the posterior wall of the pharyngo-nasal oavity; No. 4 its su- 
perior surface, and by slight rotation its lateral walls, and No. 5 
throws the spray into the posterior nasal openings (Rumbold) . 
(1) One that throws a horizontal stream, for 
treating the pharynx, tonsils and anterior nares. 
(2) One that throws a stream vertically, for 
treating the superior portion and arched boundary of 
FIG. 1. 6 
the pharvngo-nasal cavity, or vault of the pharynx, 
(3) One that throws a stream upwards and di- 
rectly forwards, at an angle of forty-five degrees, 
treating the posterior nares, edges and sides of the 
turbinated processes, and septum nasi. 
I know of no method equal to this; and I have 
given the post-nasal syringe, douche, powders and 
swab an impartial trial, and conclude that, this is the 
only method by which we can thoroughly, midly and 
effectually treat these tissues. 
fig. 2. 
In cases of simple chronic catarrh (rhinitis), 
where the secretions are not very abundant or tena- 
cious, I find that thoroughly spraying the pharyngo- 
nasal cavity, posterior and anterior nares with warm 
vaseline, is usually sufficient to bring about a cure in 
two or three weeks. Compressed air, ten to fifteen 7 
pounds to the square inch, is used to produce the 
spray. This is usually sufficient to thoroughly cleanse 
and remove the unnatural secretion; and by lubrica- 
ting and _protecting the parts, nature is given an op- 
portunity to effect the cure, If the case is one of 
long standing and the muco-purulent secretion is very 
tenacious and difficult to remove, on account of the 
membrane being very much swollen, I use the follow- 
ing solution with good results: 
R. Sodium chlor 
Acid boric, aa .... gr. v, 
Sol. cocaine mur., per cent., 5 i. M, 
This is warmed and sprayed into the anterior and 
posterior nares, and dissolves the tenacious secretion 
and causes “a contraction of the succulent tissues” so 
that the patient is able to thoroughly cleanse the nose 
bv blowing it. After this cleansing is accomplished, 
applications by means of the spray producer, of warm 
vaseline with small amount of pinus canadensis or 
glycerole of tannin completes the treatment. This 
should be done once daily for a week, then every 
other day for ten days, then once or twice a week 
until the cure is completed. Care should be exercised 
iu using the astringent. If the application causes 
pain, lessen the quantity or discontinue it, and use 
plain vaseline until the excessive irritability is over- 
come. 
HypertorphIc Catarrh (Rhinitis), 
The sequel of chronic catarrh, is by far the most an- 
noying variety of nasal catarrh. It is this that gives 
rise to a greater number of reflex symptoms and se- 
quehe, some of which are frontal and occipital ache, 
facial neuralgia, dyspepsia, melancholia, hay fever, 
coryza, lachrymation, ciliary neuralgia, conjunctivitis, 
tinnitus aurum, otitis, nasal obstruction, mouth 8 
breathing, impairment of the senses of smell, sight, 
taste and hearing. 
If the mucous membrane is hypertrophied, the 
treatment is essentially surgical, and consists in the 
destruction and removal of the obstruction. Local 
applications to genuine hypertrophied tissue, in my 
hands, has been palliative only, and unsatisfactory. 
If there is simple swelling or turgescence of the mem- 
brane, we can accomplish a great deal by soothing 
antiphlogistic treatment, such as I have already men- 
tioned. In removing the hypertrophied tissue I have 
succeeded best with chromic and acetic acid and the 
Jarvis snare.* 
In destroying or removing large hypertrophies, 
I use my concealed applicator—a description of which 
most of you have seen—or the Jarvis snare. Where 
the hyperthropy is small or covering the septum nasi, 
I use, with excellent results, the chromic acid appli- 
cator, designed by I)r. Chas. Sajous. In using chloro- 
acetic acid, especially in the posterior nares, Dr. Sajous 
furnishes us with a very ingenious and excellent ap- 
plicator. It consists of two flat probes, shaped like 
Bosworth’s in close apposition, their surfaces being so 
flattened as to render their contact perfect. One of 
the probes is fastened to the handle, and is furnished 
with a number of shallow holes, a distance of a half 
inch along the inner surface of its extremity, so that 
a drop of acid will be retained when the other probe 
is placed over it. The latter having free longitudinal 
motion, can be moved freely along the other, by means 
of a finger-lever, thus uncovering the acid-covered 
surface. Their broad ends being of silver, the acid 
does not affect them. 
From one to six applications are necessary to 
hypertrophy of post-turbinated process; from one to 9 
three applications, an hyperthropy of ant. turbinated. 
Applications of chromic or acetic acid should not be 
made oftener than once or twice a week. In the in- 
terim, daily applications of carbolized vaseline (1 gr. 
to 1 oz,), by means of spray producers, should be 
made. This plan of treatment has given me satisfac- 
tory results, and the cicatrix is smaller than when the 
galvano-caustic is used. 
I rarely use cocaine to the parts, before applying 
the acid, except in eases of marked hyperaesthesia 
The pain caused by the acid is instantly relieved by 
the alkaline, one-half per cent, solution of cocaine to 
which reference has been made. From six to ten 
weeks is the time usually required to successfully 
treat this disease, and even then the patient, unless 
very robust, should have a week or two of treatment 
every spring and fall for a year or two. 
Atrophic Catarrh, (Rhinitis), 
is the sequel of hypertrophic rhinitis, and is character- 
ized by abnormal patency of tbe nasal chambers, a 
sensation of dryness in the nostril and pharyngeal 
vault, strenuous efforts being made to relieve this 
by blowing the nose. The sense of smell is obtunded 
or lost. The symptom which causes the most annoy- 
ance to the patient is the impure character of the 
breath Thin scaly crusts of a greenish gray color, 
sometimes tinged with blood, are discharged through 
the nostrils, or hawked out of the throat. As the 
disease advances, these crusts become much thicker, 
and are discharged in the shape of flakes which pre- 
sent at times, a perfect cast of the surface which they covered. These scabs adhere tenaciously to the site of 
their formation, and are frequently reitioved with dit- 
ficulty. The diminished vitality of the membrane, 
its deficient blood supply, and the absence of the lu- 
bricating glands, are obstacles which are overcome 
with difficulty, and require time and patience to influ- 
ence. (Sajous,) 
Resorcine, five grains, to vaseline, one ounce, 
sprayed into the anterior and posterior nares, has af- 
forded me excellent results. If the secretion is very 
abundant and hard to remove, b to 10 gtt. of boro- 
glyceride, added to resorcine and vascaline, softens 
the crusts, stimulates the mucous membrane, thus aid- 
ing in the cleansing of the cavities. 
If there is an unpleasant odor to the breath, due 
to the decomposition of the crusts of mucous in the 
cavities, it is immediately destroyed by the application 
of resorcine. I use it in the strength of five to ten 
grains to the ounce (by volume) of vaseline. “It is 
an antiseptic and a stimulant, and, in view of its 
greater solubility, its almost imperceptible odor, its 
less toxicant and irritant properties, it is superior to 
carbolic acid in the treatment of this disease.” 
If the crusts cannot be removed by the means of 
the spray, our next best method is the cotton covered 
nasal probe, with which each crust should be careful- 
ly wiped off*, after which a thirty or forty per cent, 
solution of glacial acetic acid is applied to the sup- 
purative area. This checks the suppurative process. 
The patient should use daily, or thrice daily if tin; 
secretion is very abundant and the crusts form rapid- 
ly, a mild, stimulating akaline solution. The follow- 11 
ing modification of Dobell’s solution is the one 1 usu- 
ally prescribe: 
K Sod* bi carb, 
Sod* bi bor aa 3ss, 
Listerine 3). 
Aquffi destil. §v, 
M. Ft. sol. 
This is to be used with the atomizer. The magic 
atomizer, No. 25, is the best instrument for the pur- 
pose I have seen. The atomized fluid can be thrown 
into the anterior and posterior nares. As the secre- 
tion lessens in quantity and becomes thinner, the 
cleansing solution (an atomizer) should not be used so 
frequently. 
It is gratifying to be able to report that the pro- 
fession is rapidly discarding the harsh methods of 
treating diseases of the nasal cavities; laying aside 
the post-nasal syringe, swab and douche, and is adopt- 
ing the mild and non-irritating method. Having 
had both methods used on mvself, and having used 
the method which I now advocate for six years, and 
carefullv noted the results, I am thoroughly con- 
vinced that this is the best now shown, and the most 
rational. 
In conclusion, I desire to emphasize the three in- 
dications', or objects, of the local treatment of diseases 
of the nasal and pharyngeal cavities: 
First, non-irritation; 
Second, thorough cleansing of the diseased sur- 
face, with sufficient force to remove the morbid secre- 
tion; 
Third, medication and protection of diseased tis- 
sue without irritation of healthy tissue. 
Thus far I have only spoken of local treatment; 12 
constitutional and hygienic treatment are not to be 
neglected, as nine-tenths of the cases of chronic dis- 
ease of the nose or throat not only require local meas- 
ures, but also the most careful constitutional and 
hygienic treatment. 
The bowl of each spray-producer contains about 1 drachm—this is to be 
two-thirds filled with vasaline. and heated over a spirit lamp, or the oper- 
ating lamp, until the vasaline is melted—then it can be easily converted 
into a spray with light pressure,