A SIMPLE MODE OF CLEANSING THE NASAL AND 
PIIAKYNGO-NASAL PASSAGES. 
THOMAS F. KUMBOLD, M. ])., St. Louis, Mo. 
[Reprinted from the Chicago Medical Journal and Examiner, May 1877.1 
The greater number of those patients who are afflicted witli 
chronic catarrhal inflammation of the mucous membrane of 
the nasal passages, will require, in the early part of their treat- 
ment, frequent cleansings of these cavities. As the period 
between the applications which the physician gives, is fre- 
quently so long that the membranes become loaded with ac- 
cumulated secretion, the patients must attend, in the interim, 
to the cleansing and to the application of such remedies that 
can be safely intrusted to their care. 
Whenever a collection of muco-purulent secretion is al- 
lowed to remain in the nasal or pharyngo-nasal passages, for a 
length of time, varying from a few hours to a day or more, it 
becomes foetid, and acquires an acrid property; this quality 
is the result of a kind of fermentation, which the heat of the 
parts causes or favors. If such vitiated secretions are allowed 
to remain on the mucous membranes, their acridness will 
aggravate the inflammation. These facts indicate both the 2 
CLEANSING THE NASAL PASSAGES. 
necessity of maintaining the catarrhal surfaces in a clean and 
disinfected condition, and of the patients being instructed as 
to the most effective mode in which this cleansing may he 
done. 
While it is essential to speedy recovery, to have the nasal 
passages maintained in a clean condition, it is also equally 
essential that the means employed in the removal of the se- 
cretions should not cause an irritation that will last beyond a 
few seconds. A sensation of relief should be experienced im- 
mediately succeeding each application. 
The simplest mode of performing the ablution of the 
passages, in question, is by means of inhaling water and air 
from the palm of the hand into the nostrils. This manner 
of cleansing is sufficiently effective, for all patients whose se- 
cretions do not become locked in the nasal cavities by reason 
of their hardness or size. 
It does seem as though it would require but little in- 
structions to enable the patient to successfully perform this 
inhalation, aside from the directions given with regard to the 
ingredients, the strength and the temperature of the solution 
used; but it will be seen from the description of the method 
recommended, that the patient might not adopt it, without be- 
ing so directed. 
During inspiration through the nostrils, the course of the 
greatest volume of the stream of air that enters these cavities, 
is not parallel with the bridge of the nose, nor does it pass 
along the floor of the nasal passages, but nearly between these 
two boundaries, which course is generally at an angle of about 
45° with the plane of the forehead. If we keep in mind, 
that the tendency of the stream of inhaled liquid, is to take 
the same direction that the air does, and that the water, be- 
cause it is heavier than the air, will deviate from this course 
by gravitation, we have only to place the head in certain 
positions, to be enabled to wash or bathe the entire surface of 
these triangular shaped cavities, except the inferior portions 
of the turbinated processes. 
To reach the anterior third of the nasal cavities, the head 
of the patient should be inclined forward to such an extent, 
that the plane of the forehead will be nearly in a horizontal CLEANSING THE NAS SAL PASSAGES. 
3 
position (Fig. 1); then the stream inhaled from the hand, 
FIG. I. 
First position of the head, in which the anterior third of the nasal passages is 
washed by the inhalation of water and air from the palm of the hand. 
will go upward and forward at an angle of 45°. In this 
position of the head, gravitation causes a part of the inhaled 
solution to fall on the most anterior portion of the passages. 
After the inhalation of one or two handsful, the patient 
should blow the nose, to free it of all liquid and loosened se- 
cretions. Continued and hard blowing of the nose should, 
however, be avoided, as this is liable to force mucus up the 
Eustachian tubes, as well-as to aggravate the congestion of the 
inflamed mucous membrane. 
To wash the middle third of the nasal passages, the head 
should be inclined forward until the forehead is placed at an 
angle of 45° with the horizon (Fig. 2), then the greater part 
FIG. II. 
Second position of the head, in which the middle third of the nasal passages is 
washed by the inhalation of water and air. 4 
CLEANSING THE NASAL PASSAGES. 
of the stream of inhaled air and liquid will enter the cavi- 
ties in a vertical direction, striking the superior portion of the 
cavity, but gravitation will divert a part of the fluid forward, 
and a part of it backward, of the vertical line. 
Again the loosened secretions should be blown out. 
In the third position of the head, the forehead should be 
placed in a vertical position (Fig. 3); then the stream of air 
FIG. III. 
Third position of the head, in which the posterior third of the nasal passages is 
washed; and also the upper surface of the soil palate and the posterior wall of the 
pharyngo-nasal cavity. 
and fluid will enter the cavities at an angle of 45° with the 
horizon, going upward and backward. Gravitation, in this 
case, instead of causing it to fall forward, as it did in the first 
position, will cause a part of the solution to pass along the 
floor of the passages, thus washing the remaining third of the 
surfaces. Again all liquids and loosened secretion should he 
blown out. In the flrst and second positions, the inhaled 
liquid will come out of the nostrils in front; but in the last 
position, all of it will come out from the mouth. 
While the head is in the third position (Fig. 3), it is pos- 
sible for the patient to inhale the solution with sufficient force, 
to cause a part of it to strike the posterior wall of the pharyngo- 
nasal cavity: if so, the surface of this cavity, writh that of the 
pharynx and upper surface of the soft palate, will be washed CLEANSING THE NASAL PASSAGES. 
5 
also. In this way, the patient can remove the tenacious 
mucus adhering to these surfaces, which removal cannot be 
accomplished by any other effort he can make, for the reason 
that the mass of accumulated secretion is located above the 
place reached by the movements of the tongue, or soft palate, 
or the force of the breath in hacking or rasping the throat. 
Patients, in their endeavor to remove this adhering mucus, 
usually have severe “coughing spells” in the morning, as they 
turn their efforts to clear the throat* but these efforts do not 
rid the mucous surface of the offending matter; this removal 
is accomplished only when they continue to cough long enough 
to induce gagging efforts, which efforts are accompanied by a 
qualmish condition of the stomach, and a copious flow of free 
mucus; it is this fresh flow of liquid mucus that accomplishes 
the removal of the adhering mass, by washing it away from 
its place of lodgment. The attempt to remove this tenacious 
secretion by the old gargling method, must always fail, be- 
cause this method cannot throw the liquid, employed, to the 
location desired; it can only wash the tonsils, the anterior sur- 
face of the soft palate, the base of the tongue, and a small un- 
important portion of the fauces. 
Those patients who cannot clear their throat with the first 
course of inhalation from the hand, and whose cough is con- 
tinued so long, by the presence of the lodged secretion, that it 
produces a gagging sensation, should lie down in bed for a few 
minutes, as the recumbent position will usually relieve this 
disagreeable symptom. After the sickness of the stomach has 
passed off, and the solution inhaled has loosened the adhering 
mass, they will be enabled to clear the throat by another course 
of inhalation. 
During the last eleven years, I have recommended this 
method to my patients, they have found that it had a very 
beneficial effect, always freeing the nasal and pharyngo-nasal 
passages of the accumulated secretions. 
The number of times that these inhaling operations should 
be repeated, is a matter of some importance. We must keep 
in mind that the nasal passages are not made to receive any 
kind of liquid, and that the lining membranes absorb, to their 
injury, more or less of every fluid that comes in contact with 6 
CLEANSING TUE NASAL PASSAGES. 
them. The reason why the medicated solution is a benefit, is, 
because it acts as a solvent to vitiated secretions that are far 
more deleterious to the mucous membranes, than the effect of 
the absorption of the liquid itself: it follows, therefore, that 
just so soon as the decomposed secretions are removed, the so- 
lution, if continued, will be a means of doing harm. In other 
words, the washing out of these cavities is but a choice be- 
tween two evils, the use of the solution being the lesser. It 
is evident, then, that the sooner the lesser evil is discontinued, 
after the greater evil has been removed, the better it will be 
for the mucous membranes. 
After the surfaces have been made clean, the washing should 
be stopped, even though it produces a pleasing sensation, be- 
cause the absorption of the water causes the membrane to be- 
come swollen, in which condition they are more susceptible to 
the deleterious influence of cold. 
If at any time the inhaled liquid produces a painful sen- 
sation, which lasts beyond one or two seconds, then it should 
be discontinued, even if the passages are not entirely cleansed. 
With such cases, a few partial washings, aided by the local ap- 
plications, made by the physician, will decrease the heat of 
the parts, that is the cause of the hardening of the secretions; 
then the cleansing can he completed without producing the 
least disagreeable effect. 
Patients in whose nostrils or throat dry masses collect, 
should inhale three handsful of the solution immediately on 
getting out of bed in the morning, placing the head in the 
three positions named; this will soften the mass a little; by 
the time they have completed their toilet, they will probably 
be able to cleanse the head by a second course, i. e., with three 
handsful more. During the early treatment of a bad case, 
three or four courses may be required in-the forenoon. 
The solution to be inhaled from the hand is composed ot 
common table salt and water, that is a little warmer than 
blood heat, about one teaspoonful of the former to a pint of 
the latter. Patients will soon learn, from experience, whether 
or not this is the proper strength or temperature, when they 
are informed that water, either without salt, or with too much 
in it, is productive of more or less pain, and that the right CLEANSING THE NASAL PASSAGES. 
7 
quantity (which varies with different individuals) produces a 
pleasant bland sensation; also, that cold water causes a dis- 
agreeable as well as an injurious effect. 
For those cases whose nasal secretions are offensive, five 
grains of salicylic acid should be added to the pint of warm 
salt water. 
1225 Washington Avenue. THE CHICAGO 
§ljeiliral journal ami j||xaimm?r, 
(ESTABLISHED 1844.) 
PUBLISHED BY 
The Medical Press Association. 
all Communications 
to the Assistant Editor. 
Editor: WILLIAM H. BYFORD, A. M., M. D. 
Associate Editors : 
JAMES H. ETHERIDGE, M. D.; NORMAN 
BRIDGE, M.D.; JAS. NEVINS HYDE, A.M., M.D.; 
FERD. C. HOTZ, M. D. 
Assistant Editor: E. FLETCHER INGALS. M. D. 
ISSUED J"E-.