WITH COMPLIMENTS OF THE AUTHOR. 
THE INFLUENCE OF DISEASES 
OF THE 
NOSE AND NASO-PHARYNX 
ON OTHER PARTS OF THE BODY. 
By W. SCHEPPEGRELL. A. M. D., 
Assistant Surgeon to Eye, Ear, Nose and Throat Hospital, etc.. 
New Orleans, La. 
Reprinted from the August, 18Q4, number oj the New Orleans Medical and Surgical Journal. 
L. GRAHAM It SON, LTD., 44-40 BARONNE ST., NEW ORLEANS THE INFLUENCE OF DISEASES 
OF THE 
NOSE AND NASO-PHARYNX 
ON OTHER PARTS OF THE BODY.* 
By W. SCHEPPEGRELL, A. M„ M. D., 
Assistant Surgeon to Eye, Ear, Nose and Throat Hospital, etc., 
New Orleans, La. 
Reprinted from the August, 18Q4, number op the New Orleans Medical and Surgical Journal. 
In bringing to your attention the influence of diseases of 
the nose and naso-pharynx on other parts of the body I will 
present a subject which has received much consideration from 
rhinologists for many years. While deprecating the opinion 
of extremists who believe that almost all diseases originate 
from the nose, and, still more, of many practitioners who ap- 
pear to think that no disease can originate from this organ, I 
will endeavor to present certain facts on this subject, which will 
enable us to judge in what affections it is our duty to examine 
the nose and naso-pharynx with a view of benefiting our patient. 
The influence of pathological conditions in the nose and 
naso-pharynx may be either direct or indirect (reflex). In 
the former the causative association with other diseases is 
usually well defined; in reflex disturbances, however, the etio- 
logical relationship is not so clear, and can only be substan- 
tiated by the oft repeated clinical experience of many observers► 
i. The organ most frequently affected by diseased condi- 
tions of the nose and naso-pharynx is the ear. The openings 
of the Eustachian tubes in the naso-pharynx make the ears 
especially liable to pathological processes from this source, 
whether due directly to the extension of the disease or to any 
* Read betore the Louisiana State Medical Society, May 30, .1894. 2 
condition that interferes with the function of ventilation of the 
middle ear. 
With a view of showing the relationship between aural 
and nasal disease, Swinburn1 gives a list of 1000 cases of ca- 
tarrhal and purulent inflammations of the middle ear. In these 
cases there were present, either as an associate or causative 
condition, some disease of the nose or naso-pharynx in 914 
cases. The causative or accompanying affections that were 
found were the various forms of rhinitis (771), post-nasal 
adenoids and enlarged tonsils (59), polypi (8), and deformi- 
ties of the septum (76). 
Turnbull2 calls especial attention to the injurious influence 
of enlarged pharyngeal tonsils on the ears, and Good- 
willie* shows the etiological influence of catarrhal conditions 
of the nose and naso-pharynv on deafness. Sexton,4 in his 
work on “ The Ear and its Diseases,” states that the origin 
and continuance of aural disease are due to or intimately asso- 
ciated with catarrhal inflammation of the upper air-passages in 
the greater number of instances. 
While scarlet fever, measles, diphtheria, meningitis, lues 
and other diseases frequently play a role as the causative factor 
of ear disease, still the consensus of opinion, based on oft 
■observed facts, shows that the most common cause lies in the 
nose and naso-pharynx. 
A very frequent cause of ear disease in children is the 
enlargement of the pharyngeal tonsil. While I concur with the 
opinion of Massei5 and would deprecate indiscriminate aden- 
otomy on all children in whom this tonsil is somewhat en- 
larged, still, where the hyperplasia interferes with tree nasal 
breathing, or sets up congestion of the surrounding mucous 
membrane, it is undoubtedly our duty to remove it, especially 
if it has already caused injury to the middle ear. 
The causal influence of nasal and post-nasal disease on 
the ears is so well recognized that I will not detain you by 
giving a history of cases to substantiate what I have said, but 
will now proceed to point out to you the association of diseases 
of the nose and naso-pharynx with pathological conditions of 
the eye. 
2. The proximity of the eye to the nasal cavities and their 3 
connection by means of the lachrymal duct, as well as by vas- 
cular and lymphatic circulation, would naturally suggest that 
the eye might be a frequent sufferer as a result of diseases of 
the upper respiratory tract, and that such is the case is a mat- 
ter of common experience. 
The manner in which the eye is affected may be by way 
of the lachrymal duct. This may either be through direct ex- 
tension of the pathogenic process, or through interference 
with the free drainage of the duct from atresia at the nasal 
opening, compression from hypertrophies, polypi, foreign 
bodies or crusts. 
The following case will exemplify the influence on the eye 
of a purulent process in the nose: 
Case i.—Emily M., aet. 5, was kindly referred to me by 
Dr. C. A. Gaudet. The child had been suffering for some 
days with a purulent discharge from the nose, when suddenly 
a severe conjunctivitis of the left eye took place. Dr. Gaudet, 
correctly supposing that the disease of the eye was due to ex- 
tension from the nose by way of the lachrymal duct, referred 
the child to me. 
In a few days the purulent rhinitis was under control, and 
the conjunctivitis at once subsided. For some weeks after- 
ward there was lachrymation due to congestion of the 
mucous membrane of the lachrymal duct, which, however, 
soon subsided. 
De Schweinitz,6 after reporting a number of cases of eye 
diseases, points out the importance of treating not only the 
lachrymal duct, but also radically treating the nasal chambers, 
which are frequently the cause of the trouble. 
A not uncommon cause of eye symptoms is due to empy- 
ema of the accessory sinuses of the nose. Asthenopia is a 
common symptom of pus in the Antrum of Highmore and 
frontal or ethmoidal sinus, and I have observed this symptom 
even in empyema of the sphenoidal sinus. Pressure and pain 
about the eye are occasionally the only symptoms complained 
of in these affections. 
Ziem7 states that there may be an actual conveyance 
(Verschleppung) of the pus to the eye by means of the lym- 
phatic or venous circulation, and reports three cases of iritis 4 
which were treated with marked success by treatment of the 
nose and the maxillary sinus. 
When we remember the anatomical situation of the eye, 
located as it is between the accessory sinuses of the nose, we 
can not be surprised that pain or pressure on the eye is one of 
the first symptoms complained of in disease of these cavities. 
The following case will illustrate the importance of re- 
cognizing the influence on the eye of diseases of the accessory 
cavities of the nose. 
Case 2.—Miss Ella P., aet. 33, consulted me in the hope 
that the violent pain which she had in and over the right eye 
might be due to ‘‘catarrh” from which she thought she suf- 
fered. The following history was given me by the patient: 
“About eleven years ago I had an occasional bleeding of 
the nose for several days, followed by a severe haemorrhage 
from the right nostril. I called in a physician, who immediately 
sent for another for.consultation. They placed an instrument 
through the nostril backward from the mouth, and after at- 
taching a piece of sponge with a solution of iron, they plugged 
the right side, when immediately the blood flowed through the 
left nostril. Upon plugging this side, the blood flowed through 
the mouth. Ice and other remedies were applied, and the 
haemorrhage was stopped after three hours. The physician re- 
moved the sponge on the second day, and replaced it after 
washing the nose with carbolic acid and water. After a week 
he removed the plugging and the bleeding stopped. Shortly 
after the haemorrhage I suffered with occasional attacks of neu- 
ralgia on the right side, back of the right eye, leading to the 
temple. 
“About eight years ago I suffered for about four months 
with acute neuralgia back of the right eye. The attending 
physician treated the entire system and nerves without any re- 
lief. Tried electric battery and blistering around the eye, and 
fly blister back of right ear, but I received no relief except 
from opiates. The doctor diagnosed the case as ‘obstinate 
neuralgia.’ 
Until three years ago I was treated by the same physician. 
At that time I had such a severe attack of neuralgia back of 
the right eye that I called in another physician, but was con- 5 
fined to bed for three weeks. During that time I could not 
stand the light and suffered intensely. The only relief I ob- 
tained was from hypodermic injections of morphine. This 
physician diagnosed the case as ‘ neuraigia of the optic nerve.’ 
After this attack I was left in a very nervous state. 1 was 
under the treatment of this physician until last summer. 
“While in Louisville last summer I had another severe 
attack of neuralgia. The physician attending me there treated 
me locally, putting belladonna in the eyes, and four fly blisters 
(each following the other before the blister was healed) be- 
hind the right ear. After this I suffered with a severe pain 
between the brows. When bending my head forward I felt 
as though something moved, causing severe pain. The physi- 
cian in Louisville advised me to consult a specialist, as, in his 
opinion, there was some cause for the neuralgia which his 
treatment did not relieve. 
. “ During the past eleven years I have scarcely been a day 
without neuralgia, suffering more or less severely. Ever since 
the haemorrhage I have had considerable discharge of pus and 
streaks of blood daily from the right nostril. Almost every 
morning there was a scaly discharge from this nostril. I had 
also an occasional nose-bleeding from the right side. I used 
daily a solution of salt and warm water as a nose wash. My 
eyes were very much swollen after lying down, but the swell- 
ing would pass off after being up awhile. The right eye 
always felt strained, especially after looking up or outward, 
and looking down to read or sew caused extreme nervous- 
ness.” 
A rhinoscopic examination showed the anterior part of 
the right middle turbinal covered with pus, and the opening of 
the frontal sinus (ductus naso-frontalis) blocked with polypi. 
The removal of these by means of the snare, followed by 
catherization and washing out of the frontal sinus at once 
gave marked relief. 
The case proved to be one of empyema of the frontal and 
anterior ethmoidal cells, probably resulting from the plugging 
of the nostrils and the irritating solutions or decomposing 
blood setting up a pyogenic process in these cavities. 
Attention has also been called to the etiological influence 6 
of adenoid growths of the naso-pharynx on the eye. This 
influence is well shown in the following case: 
Case 3.—Mary R., rnt. 7, was referred to me by Dr. B. A. 
Pope, with the request that I make a rhinoscopic examination 
in order to learn if there were present any nasal trouble which 
could explain why the phlyctenular ulcer, which the child 
had on the right cornea, would not react to the usual treat- 
ment. 
An examination showed post-nasal adenoids and conges- 
tion of the mucous membrane of the nose, the latter probably 
depending upon the former condition. 
Dr. Pope has, at my request, kindly given me the follow- 
ing history of the case: 
Mary R., 7 years. March 10th, 1894. 
Central phlyctenular ulcers of right cornea. The largest 
of these is infected, the infiltrated area extending over nearly 
one-third of the cornea. Intense ciliary congestion, and the 
palpebral conjunctiva is both strongly congested and swollen. 
Touched the infected ulcer with pure carbolic acid. 
Gave a solution of cocaine, pilocarpine and boric acid 
to use locally, hot water applications, and dark glasses. 
The carbolic acid was applied on three successive days 
and then discontinued, as the ulcer was no longer progressive. 
13th—Ulcers improved, but more redness of conjunctiva* 
and more secretion. 
Ordered a bandage to be worn constantly on the eye. 
Touched lids with i per cent, nitrate of silver solution. 
17th—Above treatment has been continued. 
Touched ulcers with 1 to 500 methyl-violet solution. 
19th—Silver solution discontinued, and dusting in of En- 
glish calomel tried. Eye about the same. 
21st—Has been treated every day. Began using hypo- 
dermic injections of strychnine daily. 
29th—Ulcer again slightly infected. Scraped it clean. 
Discontinued bandage. 
April 3d—Requested Dr. Scheppegrell to remove ad- 
enoid growths of naso-pharynx. Stopped methyl-violet. 
5th—Growth removed two days, and already much better. 
6th—Very much better. Almost no ciliary or palpebral 
congestion. Blood vessels gone from cornea. Fig. i—Defective development of Superior Maxilla 
from Post-Nasal Adenoids. 
Fig. 2—Defective development of Superior Maxilla 
from large Pos-tNasal Adenoids. 
Fig. 3—Patient who has suffered since infancy 
from obstructed Nasal breathing, due to marked 
Hypertrophy of the Pharyngeal Tonsil. 
Fig 4—Patient with large Fibroid Tumor of the 
Naso-Pharynx, causing mouth breathing. 7 
9th—Much better. To leave off dark glasses except in 
sunlight. Have been using hypodermics of strychnine and the 
local treatment. 
ioth—Discontinued use of hot water. 
I2tli.—Practically well. 
14th—Discharged well. 
It will be noted that the improvement after removing the 
adenoids was sudden and very marked. 
B. A. Pope, M. D. 
3. Nasal and post-nasal disease frequently has a marked 
influence on the development of the individual. In children 
whose nasal breathing is obstructed we have frequently a narrow 
chest, the so-called “ adenoidean face,” and the high-arched 
palate in which the alveolar process is without sufficient space 
for the proper development of the teeth. 
Korner8 has published an interesting monogram on the de- 
fective development and deformities of the upper maxilla as a 
result of obstructed nasal breathing. The obstructed breathing 
may be due to atresia of the nostrils or choanas, post-nasal 
adenoids, tumors, etc. In figures 1 and 2 are shown the max- 
illae of cases in which the normal development is retarded by 
large adenoid growths of the naso-phary-nx. The influence of 
obstructed nasal breathing is well recognized by the leading 
dentists, and the subject was thoroughly discussed at an assem- 
bly of the First District Dental Society, State of New York 
(January 14-16, 1890), not less than ten speakers taking part 
in the discussion. Delavan,9 in the Dental Cosmos, states that 
a diagnostic sign of an habitual mouth-breather is a high arched 
and narrow hard-palate, associated with deflection of the nasal 
septum. 
Figure 3 represents a patient who has suffered since 
earliest infancy from obstructed nasal breathing due to immense 
adenoid growths. The expression of her face is characteristic 
of this form of obstruction. 
Figure 4 illustrates the facial expression of a patient who 
is an habitual mouth-breather. In this case the obstruction is 
a fibroid tumor of the naso-pharynx. 
There are other conditions of the nose besides obstruc- 
tion, which may cause deformity of the face. Ozoena, in 8 
advanced cases, has not only a characteristic odor, but also a 
well defined facies. Abscess of the nasal septum, as shown 
by Gougenheim,10 is frequently responsible for the facial de- 
formity due to the “saddle-back nose.” The nose is such a 
prominent feature that any disease which materially changes 
its natural contour at once mars the appearance of the face. 
Fig. 5 represents the case which I recently reported before the 
Orleans Parish Medical Society,14 in which I removed 
seventy-six polypi from the nostrils of the patient. The im- 
mensely distended alas of the nose, resulting from the pressure 
of the myxomatous growths, are well shown. 
6, the deformity is due to a sarcoma involving both 
nostrils and encroaching upon the orbits. In Fig. 7, the luetic 
processjhas destroyed the nasal septum, and the nose has sunk 
backward through loss of its natural support. In Fig. 8, the 
deformity is due to the loss of tissue resulting from a rodent 
ulcer. 
The cases here shown are from the clinic of the Eye, Ear, 
Nose and Throat Hospital, the photographs having been taken 
for me by my esteemed colleague, Dr. Augustus McShane. 
4. Disturbances of speech are a common result of nasal 
and naso-pharyngeal disease. We are all familiar with the 
nasal intonation due to an obstructed nose, and the difficulty of 
articulating certain sounds when suffering even from a severe 
coryza. Children with large adenoids have a muffled voice, 
and they will say bay for may and day for nay, from inability 
to articulate sounds which depend upon nasal expiration. 
Besides these effects, we have certain cases of stuttering 
and stammering, which owe their origin to nasal affections. 
Winkler,11 at the congress of the Deutscher Naturforscher und 
Aerzte in Bremen (1890), laid down the following proposi- 
tions: 
(1) Nasal disease may be the sole cause of stammering. 
(2) By means of the treatment of the nasal conditions 
alone, the stammering may sometimes be cured. 
(3) No treatment of the stammering can be permanently 
successful should existing pathological conditions in the nose 
not be radically removed. 
Kafeman,12 after giving some important statistics which 9 
show the frequency of nasal and naso-pharyngeal disease in 
children who stammer, points out the importance of operating 
before the hesitancy of speech becomes inveterate and difficult 
to remedy. 
5. When we consider the important function of the nose 
of warming, moistening and cleansing the air which passes into 
the lungs, we can easily understand how the impairment or 
loss of this function would develop irritation and inflammation 
of the mucous membrane of the pharynx, larynx and bronchial 
tubes. This function may be disturbed not only by hyper- 
trophies, large septal ridges, tumors or enlarged tonsils, which 
necessitate mouth breathing, but also by atrophic conditions in 
which the nasal chambers are widely distended, and in which 
the destruction of the glandular elements and the crusts form- 
ing over the mucous membrane impair the respiratory function 
of the nose. It is in these atrophic cases that we frequently 
have the most chronic forms of pharyngeal, laryngeal, and 
bronchial inflammations. The following case will illustrate 
this : 
Case 4.—Rev. Mr. E., a sufferer from chronic bronchitis 
for 15 years, was sent to me by my friend, Dr. Wm. E 
Brickell, who concluded that the condition which resisted aL 
the usual remedies might be due to nasal disease. 
A rhinoscopic examination at once revealed the cause of 
the bronchial irritation. Both nostrils were so atrophied and 
patulous that the pharynx, which was dry and glazed, could 
be plainly seen through them. The upper parts of the nostrils 
were covered with scabs, which still further handicapped the 
little capacity that was left in the mucous membrane to prepare 
the inspired air for the lungs. The nasal condition clearly 
explained the unsuccessful result of the therapeutic measures. 
6. Affections of the nose may not only have their influence 
on the respiratory passages as shown above, but also in another 
manner—by their reflex disturbance of respiration. These 
reflexes consist of sneezing, coughing, snorting, asthmatic at- 
tacks, hay fever, and stridulismus. 
The influence of certain conditions of the nose on sneez- 
ing, as irritation from a foreign body, or a coryza, is an every 
day experience, but cough, as a pure-nasal reflex, is also not 10 
uncommon. In many persons, if the mucous membrane of 
the nose be irritated, there will follow a paroxysm of coughing 
instead of sneezing, as in the following case: 
Case 5.—Daniel R., ast. 11, suffered from repeated at- 
tacks of coughing, which would immediately follow exposure 
to a slight draught. The parents, fearing tuberculosis, re- 
quested me to examine the case. 
A physical examination of the chest revealed nothing 
abnormal, but as soon as the speculum was placed in the 
nostril the patient had a violent fit of coughing. The cough 
was repeated each time that the mucous membrane of the nose 
was touched, but ceased entirely as soon as the sensibility of 
the parts was destroyed by cocaine. Concluding that the 
cough was due to a special reflex together with congestion of 
the mucous membrane of the nose, I made an application of 
chromic acid to both nostrils, resulting in a cure of the 
cough. 
In 1872, Voltolini13 published a case of asthma in which 
the attacks at once disappeared on removal of nasal polypi, 
and called the attention of rhinologists to the possibility of 
asthma being due to a nasal reflex. Since then a large num- 
ber of cases have been published showing the etiological in- 
fluence of nasal irritation in many of these cases. 
Recently I reported, before the Orleans Parish Medical 
Society, a case of asthma in a patient whose nostrils were oc- 
cluded with polypi. The removal of these growths resulted in 
the disappearance of the asthmatic attacks for four months, but 
after this period of time the attacks reappeared. A rhino- 
scopic examination showed that a number of polypi had de- 
veloped again, and the removal of these again resulted in a 
cessation of the asthmatic attacks. Since I reported this case, 
I have successfully treated another case of asthma by the re- 
moval of a sharp nasal spur, which, while not sufficiently large 
to materially obstruct nasal breathing, probably set up the re- 
flex by irritation of the opposed mucous membrane. 
Bosworth,15 at the meeting of the American Laryngologi- 
cal Society, stated that there were three factors which were 
necessary to precipitate an asthmatic attack: 1. A special neu- 
rosis; 2. Certain external, probably atmospheric, irritations; Fig. 5—Patient whose Nostrils are occluded and 
ala; distended with excessive development of Nasal 
Polypi. 
Fig. 6—Sarcoma of both Nostrils, originating 
from the Septum of the Nose. 
Fig. 7—Collapse of Nose from Leutic Necrosis of 
the Septum Nasi. 
Fig. 8—Destruction of Nose from Rodent Ulcer. 11 
3. Frequently a local process in the nose to which the unusual 
susceptibility to certain irritations is due. Blair,16 Tissier,17 Bol- 
linger,18 (asthma due to rhinolith), Tortensson,19 Schech,20 and 
Bosworth,21 have each published a number of cases in which 
the asthma was due to pathological conditions in the nose, and 
successfully treated by their removal. 
Hay fever resembles asthma in requiring, as in asthma, 
three factors for its production, the external irritation, how- 
ever, being probably the pollen of certain flowers. By send- 
ing such patients to certain localities we prevent the attacks by 
removal of one of the factors which is necessary for the devel- 
opment of the paroxysm—that is, the irritating pollen. By 
remedying, however, the pathological process which is usually 
formed in the nose in such cases, we frequently cure the dis- 
ease by the removal of another essential factor in these attacks. 
The following case will illustrate this: 
Case 6.—Miss Hilda T., ast. 17, referred to me by Dr. 
Wm. E. Brickell, was a chronic sufferer from hay fever. She 
had been advised by a former physician to use cocaine, in the 
form of a spray, to relieve the unpleasantness of the attacks. 
The patient used the cocaine many times during the day, as its 
influence would last only a short time. Dr. Bricked, fearing 
that the patient was acquiring the cocaine habit, referred the 
case to me. The removal of a septal ridge, and the cauteriz- 
ation of the opposed irritable mucous membrane, controlled 
these attacks in a short time. 
Laryngismus stridulus ma}' also be due to nasal or naso- 
pharyngeal disease. Botey,22 Duplay,23 and others report cases 
resulting from enlargement of the pharyngeal tonsil, and Len- 
nox Browne24 claims that the majority of cases of laryngismus 
is found in children who are mouth-breathers. 
7. Dyspepsia is sometimes due to nasal disease, especially 
in those cases in which there is a purulent process and the pus, 
which accumulates in the naso-pharynx, is swallowed, as often 
occurs. In many of these cases, as where the pus is dis- 
charged from one of the accessory sinuses of the nose, there 
is likewise an elevation of temperature, which also affects the 
appetite and the digestion of the patient. 
Case 7.—Mr. T. L. F. consulted me for a catarrhal dis- 12 
charge from his throat, which he thought affected his stomach 
and system generally. He complained of dyspeptic troubles, 
and had a temperature of 99 6 Fahr. The laity recognize all 
pathological conditions of the nose as “ catarrh,” and Mr. F. 
placed the responsibility of all his complaints on the ‘'catarrh.” 
His conclusions were correct, but his “ catarrh” proved to be 
an empyema of the antrum of Highmore on both sides. The 
drilling and disinfection of these cavities prevented the accu- 
mulation of pus in his naso-pharynx and brought the temper- 
alure to the normal. This treatment removed the dyspepsia 
which all the powders and waters had naturally failed to 
benefit. 
8. S. Weir Mitchell25 in his admirable paper before the 
Ophthalmologic Section of the College of Physicians of Phila- 
delphia, March 26, 1894, states that “ the general practitioner, 
when called to treat a neurosis, especially a headache, habit- 
ually refers the patient to an ophthalmologist.” Now, while I 
do not question the wisdom of this procedure, I wish to call 
attention to the fact that many neuroses, and especially head- 
ache, form a common symptom of many diseases of the nose. 
In empyema of the accessory sinuses, in atrophic rhinitis, and 
in necrotic processes, it is rarely absent, while it is frequently 
present in nasal stenoses. I call to mind the following case : 
Case 8. Capt. W. consulted me for ear trouble. A 
rhinoscopic examination showed marked hypertrophy of the 
turbinals on both sides, almost completely obstructing the 
nostrils. 
Believing that the nasal obstruction was responsible for 
the ear disease (otitis media non supp.), I removed the nasal 
stenosis by means of the electro-cautery. Some months after- 
ward, the patient informed me that he had been a sufferer 
from severe headaches for many years, a circumstance to 
which he had not previously called my attention; but since he 
had been able to breathe freely through his nostrils, he had had 
but one headache in three months, and this a very light attack. 
9. There are a number of nasal reflexes which are not yet 
quite understood, and of which a wider experience is needed 
to give them their proper clinical value. Thus Dobberke26 
records a case of epilepsy in which the attacks did not return 13 
after an operation for the removal of adenoids. An inability 
to fix the attention on a subject, and headache after mental 
exertion (aprosexia), are occasional but well recognized 
symptoms of an enlarged pharyngeal tonsil. 
Enuresis nocturna is also occasionally due to adenoid 
growths of the naso-pharynx—a circumstance which is not 
surprising when one watches the restless tossing and efforts at 
respiration of a mouth-breathing child. Cases in which this 
affection has been cured by removal of adenoid growths are 
reported by Sokolowski,27 Korner28 and others. 
The advisability of inspecting the nostrils in tic doulour- 
eux is exemplified by reports of cases made by B. Fraenkel,29 
Peltesohn30 and Dunn,sl in which this was cured by intra-nasal 
operations. 
Jacobi,32 of New York, claims ten cases of chorea due to 
nasal and naso-pharyngeal disease. 
In conclusion, I would again call your attention to the im- 
portance of the nose and naso-pharynx in many pathological 
conditions, which, at first, may appear to have no connection 
with these parts. The human body is, however, made up of 
various distinct, and yet inter-dependent, organs, the derange- 
ment of any of which or of its function, can not but have an 
adverse influence on the corporate body. 
If then I have impressed you sufficiently, so that, in ex- 
amining a patient, after having auscultated the heart and lungs, 
and percussed the liver; after examining into the condition of 
the kidney, spleen and intestinal canal, you make some inves- 
tigation as to the condition of the nose and naso-pharynx, my 
object in reading this paper will have been accomplished. 
BIBLIOGRAPHICAL REFERENCES. 
1. Swinburn: Medical Record, August, 1892. 
2. Turnbull; Diseases of the Ear, Philadelphia, 1887. 
3. Goodwillie: New York Medical Journal, August, 1889. 
4. Sexton; The Ear and Its Diseases, New York, 1888. 
5. Massei: Revue Internat. de Rhinologie, etc., February, 1894. 
6. De Schweinitz: University Medical Magazine, May, 1892. 
7. Ziem: Wiener. Klin. Wochenscrift, November 29, 1892. 
8. Korner: Untersuch. iiber Wachsthumsstoerung, etc., Leipzig, 1891. 
9. Delavan: The Dental Cosmos, March and April, 1890. 
10. Gougenheim: Annales des Malad. de l’oreille, November 9, 1890. 14 
11. Winkler: Internat. Centralblatt fur Laryngologie, Berlin, February, 
1891. 
12. Kafeman: Ueber die Beziehungen Gewisser Nasen-und Rachenleiden 
zum Stottern, Danzig, 1891. • 
13. Voltolini: Die Anwendung der Galvano-Caustik, Vienna, 1872. 
14. Scheppegrell: Proceedings of the Orleans Parish Medical Society, 1893. 
15. Bosworth: Proceedings of the American Laryngological Society, 1891. 
16. Blair: Medical and Surgical Reporter, January, 1892. 
17. Tissier: Annales de Med., 1892. 
18. Bollinger: Miinchn. Med. Wochenschrift, No. 45, 1892. 
19. Tortenssen: Vortrag. bei der fiinften allgetn. Versamml. schwedischer 
Aerzte, 1891. 
20. Schech: Die Krankh. der Mundhohle, des Rachens und der Nase 
Leipzig, 1892. 
21. Bosworth: Diseases of the Nose and Throat, New York, 1889. 
22. Botey: Revista de ciencias medicas de Barcelona, November 12, 1891. 
23. Duplay: Gazette des Hopitaux, 1892. 
24. Lennox Brown: Diseases of the Nose and Throat, New York, 1892. 
25. Weir Mitchell: Philadelphia Medical News, April, 1894. 
26. Dobberke; Weekbl. voor Geneesk., November 2, 1894. 
27. Sokolowski: Gazeta Lekarska, No. 4, 1892. 
28. Korner: Centralblatt fiir Klin. Med., No. 23, 1891. 
29. B. Fraenkel: Centralblatt fiir Laryngologie, 1893. 
30. Peltesohn: Proceedings of the Berliner Laryngol. Gesellschaft, De- 
cember, 1890. 
31. Dunn: Virginia Medical Monthly, February, 1892. 
32. Jacobi: New York Medical Record, May, 1890.