Hemicrania and Other Neural- 
gic Affections of the Head 
relieved by Intranasal 
Surgery. 
BY 
SARGENT F. SNOW, M. D., 
SYRACUSE, N. Y., 
Aurist and Laryngologist to the House of the Good Shep- 
herd and the Syracuse Free Dispensary; Member of 
the Central New York Medical Association, 
The Syracuse Academy of Medicine, etc. 
REPRINTED FROM THE 
Neb) ¥orft JUebfcal 
for March 57, Reprinted from the New York Medical Journal 
for March 31, 1894. 
HEMICRANIA 
AND OTHER NEURALGIC AFFECTIONS OF THE HEAD 
RELIEVED BY INTRANASAL SURGERY.* 
By SARGENT F. SNOW, M. D., 
SYRACUSE, N. Y., 
AURIST AND LARYNGOLOGIST TO THE HOUSE OF THE GOOD SHEPHERD 
AND THE SYRACUSE FREE DISPENSARY ; 
MEMBER OF THE CENTRAL NEW YORK MEDICAL ASSOCIATION, 
THE SYRACUSE ACADEMY OF MEDICINE, ETC. 
The object of this paper is not to set forth a dogmatic 
claim of priority in presenting the subject, or that all cases 
coming under the above title can be cured by intranasal 
surgery. I well remember patients that were under my 
care while in general practice where gynaecological treat- 
ment in some, and correction of digestive disorders in oth- 
ers, brought the desired result. 
My proposition is this : that there are a certain number 
of cases that can be cured, or at least relieved, by the proper 
treatment of pressures and contacts within the nose. In 
* Read before the Onondaga County Medical Society, at Syracuse, 
June 13, and before the Cayuga County Medical Society, at Auburn, 
N. Y., July 13, 1893. 
Copyright, 1894 by D. Appleton and Company. 2 
HEMICRANIA. 
support of this I will read you notes of a few of the cases 
that have come to my notice during the past three years: 
Case I.-Mrs. K., aged thirty-two years, referred to me by 
Dr. M. on April 16, 1892. Good family history and in com- 
fortable circumstances. General health rather poor, unable to 
do her own housework, but better than she was a year ago, the 
improvement being due, she thought, to treatment given her for 
uterine trouble. 
She complained of severe paroxysms of sick headache two 
or three times a week, most of the pain being over the right eye 
and in the temple. During these attacks, pains streaked up 
from the bridge of the nose; the eye was swollen and the sur- 
rounding areas were tender. She also had rushes of blood to 
the head. The nostrils were not stuffed, but she had frequent 
droppings of mucus into her throat. This train of symptoms 
had continued, with varying degrees of severity, for four years. 
I examined her nose, and found that she had good breath 
space; sseptum straight, but both middle turbinates were en- 
larged, pressing against the sseptum and outer walls. The one 
on the right side had also become overgrown downward, and 
pressed into the inferior turbinated. 
Treatment was at once begun and continued until Septem- 
ber 1st, during which time I bad operated upon each middle 
turbinated by the snare, removing the enlarged anterior por- 
tion and clipping off the lower border that was pressing into 
the inferior turbinated on the right side. At that date she had 
been free from the headache and neuralgia for three months 
and a half. She then went out of town for a short visit, and 
while there had one of her old-time attacks. Upon her return 
she came to me, and I found, by deep exploration with the. 
probe, a large pyramidal-shaped osseous growth at the junc- 
tion of the middle with the posterior third of the sseptum, high 
up, pressing against the inner surface of the right middle tur- 
binated. 
This growth had been entirely unsuspected, and even then 
was hidden from view by that portion of the turbinated body 
in front of it, though, as you will remember, I had already HEMICRANIA. 
3 
removed the enlarged anterior tip. I operated on this deep- 
seated growth with the electro trephine, December 20, 1892, 
since which time she has had no return of the headache or 
neuralgia until April 15, 1893. A short time before this I dis- 
covered that a small fibrous bridge was being formed between 
the inner surface of the middle turbinated and the area upon 
which the growth had been located ; this I removed, and ap- 
plied a dressing of borated gauze between the opposing sur- 
faces. 
I did this on Saturday, and upon her next visit, two days 
later, she informed me that she had been suffering with a ter- 
rific attack of her old trouble. The pain began soon after she 
left my office, but was fully relieved upon removal of the 
offending pressure. Since that time she has had no return of 
the symptom, has improved in general health, and is now able 
to do her own work. No other treatment having been taken, 
it is with confidence we attribute her improvement to the in- 
tranasal work. Allow me to add that the bony growth men- 
tioned, springing from the saeptum and impinging against the 
inner surface of the middle turbinated high up, usually hidden 
from view by a hypertrophied anterior tip, is not so rare as I 
at first supposed. 
Within the past five months I have removed no less than 
six besides the one described. In nearly every instance I have 
found them only by deep, careful probing, and that done a few 
weeks after I had removed an overgrown anterior portion of a 
middle turbinated. 
Case II.-Mrs. C., aged thirty years, a lady of rather slen- 
der figure, but able to do a part of her housework ; mother of 
two children, one living. General health fairly good. Com- 
plained of a severe, steady pressure on the top of the head, of 
the size of a half dollar, sore to touch, but no swelling. This 
was usually accompanied by pains streaking in an irregular 
course from the bridge of the nose and from the back of the 
head up to the vertex. The paroxysms came on from one to 
three times each week, many times making her unfit for work 
for several days. She thinks she was never entirely free from 
the pressure on the top of the head since it began. 4 
HEMICRANIA. 
Incidentally I would remark that I have always looked upon 
this particular symptom as indicating some trouble with the 
uterus or its appendages, consequently I gave it only a passing 
notice when taking her history. Whenever she took cold neu- 
ralgic attacks would set in, often prostrating her for a whole 
day. Besides the above-mentioned symptoms, there were fre- 
quent attacks of dyspnoea, forcing her often to leave church, 
waking her from a sound sleep at night, and sometimes causing 
her to stop in the street and catch something for support until 
the seizure passed away. 
She had some dropping into her throat, but did not soil 
many handkerchiefs. Occasionally she had tinnitus, walked 
with her mouth open, but could breathe through her nose when 
quiet. These symptoms continued for the past five years, dur- 
ing which time she had been operated upon by Dr. V. for 
laceration of the cervix. This was followed by an improve- 
ment in her general condition, but her neuralgic troubles were 
not materially relieved. When she came under my care, Janu- 
ary 17, 1893, I found comparatively free breath passages and 
regular nostrils, but each middle turbinated body had under- 
gone a cystic enlargement of the bone in its anterior portion, 
until they were about the size of a marrowfat bean, crowding 
the outer walls and sseptum so closely in some places that I 
could not pass a No. 5 piano-wire loop around the one on the 
right side. 
I finally succeeded in snaring the one on the left side, Feb- 
ruary 2d, and removing the other, piece by piece, with for- 
ceps, three weeks later. The last operation was followed by a 
complete cessation of the pressure on the top of the head, ten- 
derness over the bridge of the nose, streaking pains to vertex, 
and the dyspnoea, though a deep-seated pain in the right eye 
would come on if she read or sewed even for a few minutes. A 
short rest would bring relief. At my suggestion, she consulted 
Dr. Marlow, who fitted her with glasses, so that now she tells 
me, June 12, 1893, that even that trouble is removed. Her 
general health is first class; all catarrhal symptoms are bet- 
ter, and she is able to breathe through the nostrils while 
walking. HEMICRANIA. 
5 
Case III.-Mr. K., aged fifty-six years, timekeeper in one 
of the large industries of our town ; referred to me by Dr. M. 
General health fairly good, though not robust. Had been both- 
ered for several years with a stuffed-up nose; severe pain over 
right eye and temple, especially after a day of severe mental 
labor. Examining nose, I found nostrils pretty well filled 
with a yellowish boggy membrane, the upper third being one 
mass of thickened tissue; both middle turbinates enlarged in 
their bony and membranous structures. I began operations on 
him April 20, 1893, and finished October 1st, removing, during 
this period, the hypertrophied anterior tips of the middle turbi- 
nates, cauterizing the thickened tissues, where necessary, 
stimulating degenerated membranes, and in other ways restor- 
ing the nasal functions. The result is that he informed me by 
telephone this day, June 12th, that be had suffered no return 
of his hemicrania, though he is still engaged in the same kind 
of work, only more of it. He breathes freely through his nose, 
and the catarrhal manifestations are much improved. 
Case IV differs from the preceding in that it was not re- 
ferred to me especially for the cranial neuralgia, but came for 
ear treatment. Mrs. Y., aged forty-eight years, a lady from 
Johnstown, N. Y., who consulted me about a year ago for ca- 
tarrh of the middle ear. Incidentally she remarked that there 
was a constant dull, heavy pain at the back of the head, just 
above her neck, which had bothered her for five years. Exami- 
nation disclosed a long bony shelf extending across the left nos- 
tril. This I removed by the saw, as a necessary part of the 
treatment I was giving her for the ear affection, with the result 
that the peculiar pain was at once relieved, and she now writes 
me that it has never returned. 
In looking over my records, I find notes of many other 
cases in which intranasal surgery has brought just such un- 
expected and satisfactory results, until now it has become 
my rule to advise all patients with cranial neuralgia, chronic 
ear, nose, or throat trouble, to have each contact and pres- 
sure within the nose removed. It may not cure every one, 6 
HEMICRANIA. 
but that it does materially relieve a large proportion of 
cases goes without saying. 
Note.-Since writing this I have collected five additional cases in 
which pressure on top of the head accompanied hemicrania, or was 
coincident with the neuralgic affections. Three of them have been 
relieved by intranasal work; two of them are now under treatment. I 
have also collected four more cases of well-marked hemicrania in 
which the correction of nasal disorders has brought happy results. 
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