Having operated with unvarying success upon a very large number and variety of nasal tumors at the Invalids' Hotel and Surgical Institute we are positively assured that the means and methods which we employ are neither severe or dangerous; _no pain_, consequently _no shock_; recovery rapid and permanent. Many forms of injection and local treatment are in use for the removal of nasal polypi, none of which have proven to be curative; recurrence of the tumor many times following such treatment. Many cases have presented themselves after having been treated by the heroic method of seizing the polypus with a pair of forceps and forcibly tearing it loose, bringing with it segments of healthy tissue, leaving bone exposed, and a ragged, uneven surface of diseased membrane. It is much easier to properly treat a case from the beginning than to undertake it in such a rendition.
Owing to the fact that these nasal tumors grow directly from the lining membranes it is necessary not only to thoroughly remove the tumor but to treat the diseased membrane at the point from which the polypus springs; otherwise another tumor may develop at the same point. The nasal passage having been thoroughly anaesthetized, or benumbed, by the use of cocaine, the nasal speculum is introduced, and by means of reflected light from the head mirror worn by the operator, the interior of the nostril is brought into view. (See Fig. 9, p. 479.)
Often the attachment of the growth is entirely hidden behind the irregular bony structures of the nostril so that it requires the skill of an expert specialist, deft in the manipulation of these parts, to operate properly.
Many styles and shapes of delicately devised instruments are necessary to completely remove the growth without doing injury to the adjacent structures. By our newly devised operation the tumor is at once removed, without pain, and with the loss of only a few drops of blood. Further, because the tumor is entirely removed and the base properly treated there is not the offensive discharge for a long time afterward and the danger from infection and blood-poison to which the patient is subjected in other forms of treatment.
In conclusion we would say that we claim for our operation the following points that are worthy of the careful consideration of every one who may be so unfortunate as to require the services of a specialist for the removal of growths in the nasal or upper air passages.
1st. Our operation is absolutely painless.
2d. No chloroform or ether is required.
3d. We insure perfect removal of growth.
4th. There is no injury to other adjacent structures.
5th. The operation is bloodless.
6th. The recovery is rapid.
7th. There is no slough to produce pus that may be absorbed and cause blood-poisoning.
DEFORMITY OF THE NASAL SEPTUM.
In health the nasal septum is a bony or cartilaginous plate, as shown in _A_, Fig. 14, dividing the nasal passages into two cavities of the same size and shape. This plate or partition is also a support to which the flexible structures which form the tip of the nose are attached. In early life the septum is flexible and may be bent or doubled by injury to the nose; but owing to its elasticity usually resumes its natural position and shape. After maturity any dislocation or change in this bony plate usually remains permanent unless some means are employed for its correction. In a limited number of cases supposed to be chronic nasal catarrh, we have found upon examination that one or both nasal cavities were more or less obliterated and obstructed by the deformed and thickened septum. (See _A_, Fig. 15.) Many of these cases date from an injury to the external parts, causing only bleeding from the nose and a slight pain for a short time. Chronic inflammation develops at the point where the bone is bent or cracked, resulting in thickening, often producing nodules or spur-like projections which not only interfere with nasal breathing, but also act as irritants to the adjacent delicate membranes and produce many of the symptoms common to nasal catarrh.
[Illustration: Fig. 14.
Anterior view of the healthy nasal passages as seen with the projecting portion of the nose removed.
_A._ Vertical septum or bony plate separating nostrils. _B, B._ Turbinated bodies. _C, C._ Nasal passages.]
Among other common causes are unequal or imperfect development of the nasal bones, due to an inherited strumous tendency and local ulcerative disease, weakening or destroying the bone.
SYMPTOMS. The location and extent of the deformity of the nasal septum necessarily gives opportunity for a variety of symptoms. In aggravated cases the nose appears to be bent toward one side. In the earlier stages there is an excess of mucous secretion, often dropping into the throat from behind the palate. The discharge is variable as in nasal catarrh with more or less difficult nasal breathing, the stoppage changing from one nostril to the other. Sneezing and frequent attacks of nose bleed are often common symptoms. The tendency of the disease is to extend backward often causing headache, deafness, roaring in the ears and post-nasal disease which results in a chronic sore throat, the latter disease often being the one for which the patient seeks advice. If allowed to progress uninterruptedly the throat gradually becomes more irritable, associated with an annoying cough, and the voice becomes harsh and has a nasal tone. The general health is impaired, the nervous system excitable; laryngitis, asthma, and lung disease become complications, which render the existence of the individual miserable.
TREATMENT. In mild cases where the deformity is slight, and the obstruction is not a constant symptom, the nasal cavities should be cleansed (See treatment of nasal catarrh) after inhaling dust, and special attention given to the prompt treatment of cold in the head.
Should there be irritability, sneezing, or a constant discharge, it is advisable to use Dr. Sage's Catarrh Remedy as directed on p. 483 to soothe the excitability and lessen the inflammatory action in and about the thickened and deformed septum. As an auxiliary to promote the absorption of the thickened tissues and restore them to a healthy activity, a number of bottles of the "Golden Medical Discovery" should be taken while using the local treatment. Any dormant condition of the liver or digestive tract may be corrected by taking Dr. Pierce's Pleasant Purgative Pellets. In advanced cases after the structures are so diseased and thickened that it renders local treatment hopeless, only surgical interference can prove curative.
OUR PAINLESS OPERATION.
By the application of a few drops of a solution of cocaine in the nostril, at the point to be treated, we are now able to produce such local anaesthesia as to render the operation entirely painless without the administration of either chloroform or ether. This is an important consideration as many are adverse to taking chloroform or ether, and now that we possess an agent that produces, locally, complete insensibility to pain, we are very glad to dispense with their use in all such minor operations. There is no pain caused even by the application of the cocaine to deaden the sensibility of the part. Many examinations of the upper air-passages heretofore very annoying and even painful to the patient and sometimes unsatisfactory, are rendered entirely painless, and carried out with a thoroughness that would be impossible without the use of this wonderful agent. Not only in surgery of the nose and throat, but alike in other departments, our surgeon-specialists employ the same local anaesthetic in all minor operations, none of which are attended with the least pain.
Our specialists were among the first surgeons in this country to employ this newly-discovered anaesthetic. We regard it as a great boon to our patients, and never withhold it in any case where it can be employed to prevent suffering. Its use is attended with no danger, nor is it followed by bad or disagreeable results.
OUR OPERATION.
[Illustration: Fig. 15.
Anterior view of deformed nasal passages as seem with the projecting portion of the nose removed.
_A._ Deformed and thickened septum or bony plate separating nostrils. _B,B._ Irregular and obstructed nasal passages. _C._ Diseased and swollen turbinated body. _D,D._ Turbinated bodies crowded back by septum.]
The nostrils being the entrance to and the beginning of the air passages no dexterity and skill can be spared in treating and properly correcting any deformity that may exist. Mutilation of these sensitive structures is sure to be followed by serious reflex symptoms in adjacent parts.
Consequently cases of this nature should only be entrusted to the care of a competent and experienced specialist. Our resources and appliances are unlimited and seldom do we use the surgeon's knife in a case of this nature.
As in the treatment of other pathological growths in the upper air passages the rhinoscope is indispensable. The parts can only be brought into the view of the operator by means of this instrument and sets of mirrors to reflect light on all sides of the deformed and hidden parts.
By our operation both nasal cavities are restored to their normal size and contour (compare Figs. 14, 15), unhealthy and diseased tissues are removed, and free nasal respiration established.
All treatments are carried out under strict aseptic precautions, thus reducing the danger from absorption of poisonous secretions to the minimum. By our skillful and ingenious management of these cases we never have had a single patient manifest any serious symptoms after operation. In such cases we consider this the only safe, practical, and permanent cure. Every year hundreds pass out of existence the victims of incurable disease of the air-passages resulting from morbid nasal conditions, who might be saved by proper and timely treatment.
PHARYNGITIS AND POST-NASAL CATARRH.
[Illustration: Fig. 16.
Use of the Post-nasal Syringe in the treatment of Post-nasal Catarrh.
_A_. Tongue. _B_. Epiglottis. _C_. Soft palate. _D_. Anterior opening of the nostril.
_E,E,E._ Turbinated bodies. _F_. Junction of the nasal passage and throat. _G_. Diseased and roughened mucous membrane. _H_. Throat or Pharynx. _I, I_. Interior of nasal passage.]
Simple chronic pharyngitis seldom exists alone and uncomplicated; most cases being the result of previous existing disease of the nasal or post-nasal passages. Many cases are associated with hypertrophy, or enlargement, of the tonsils. Usually the disease is located in the upper part of the pharynx, or throat, behind and above the uvula and soft palate, and is thus hidden from view when looking into the throat through the mouth. When not associated with nasal catarrh the common symptoms are dropping of tenacious mucous in the throat, causing a constant desire to hawk and spit; sense of dryness in this region; cough and expectoration on rising in the morning, which is due to the irritability of the throat, and may invade the lower air-passages. The throat may be studded with red and thickened patches of its mucous membrane. Respiration may be embarrassed, the voice affected and the general health gradually decline. The membrane above and behind the palate is angry, reddened, thickened and roughened, as represented in _G_, Fig. 16.
TREATMENT To rationally treat a disease, attack the cause. Therefore, in an uncomplicated case of post-nasal disease of the pharynx the medicine should be applied at this point. For this purpose we recommend the regular and continuous use of Dr. Sage's Catarrh Remedy administered preferably by means of the post-nasal syringe as illustrated in Fig. 16.
The efficacy of Dr. Sage's Catarrh Remedy as a curative agent in catarrh of mucous membranes is unequaled if the medicine be properly and thoroughly applied. The Catarrh Remedy fluid should be prepared as directed in the pamphlet which accompanies the medicine. Warm enough of the medicine to fill the syringe twice. After the syringe is filled with the warm medicine, introduce the curved tip behind the soft palate, holding the syringe as seen in Fig. 16, then incline the head forward over a wash bowl and empty the syringe by pressing the plunger quickly.
The medicine will immediately come in contact with the diseased surfaces and pass out through the nostrils, thoroughly medicating, disinfecting and cleansing the upper part of the throat and the posterior region of the nostrils. Two syringes of the medicine should be used for each treatment, and two or more applications made every day until a cure is effected.
At the same time the local treatment is being used, Dr. Pierce's Golden Medical Discovery should be taken to act through the blood upon the diseased tissues.
The Catarrh Remedy may be administered by means of the Nasal Douche, if the case is complicated by nasal catarrh. Should tumors or deformities exist, it is advisable to consult a specialist.