ETIOLOGY OP DEVIATIONS, 
SPURS, AND RIDGES 
OP THE NASAL SEPTUM 
BY 
JOHN O. ROE, M.D., 
EX-PRESIDENT OP THE AMERICAN LARYNGOLOGICAL ASSOCIATION ; CORRESPONDING 
MEMBER OP THE SOCIETY PRANQAISE D’OTOLOGIE, DE LARYN6OLOGIE ET 
DB RHINOLOGIE ; MEMBER OP THE BRITISH MEDICAL ASSOCIATION ; OP 
THE AMERICAN CLIMATOLOGICAL ASSOCIATION I OP THE AMERICAN 
MEDICAL ASSOCIATION ; OP THE MEDICAL SOCIETY OP THE STATU 
OP NEW YORK ; OP THE NEW YORK ACADEMY OP MEDICINE ; 
OP THE CENTRAL NEW YORK MEDICAL ASSOCIATION ; OP 
THE MONROE COUNTY MEDICAL SOCIETY, ETC. 
ROCHESTER, N. Y., 
THE NEW TORE MEDICAL JOURNAL 
REPRINTED FROM 
OCTOBER 10, 1896 
NEW YORK 
D. APPLETON AND COMPANY 
1896 Reprinted from the New Yorh Medical Journal 
for October 10, 1896. 
AETIOLOGY OF DEVIATIONS, SPURS, AND RIDGES 
OF THE NASAL SJEPTUM * 
JOHN O. ROE, M. D., 
ROCHESTER, N. T. 
It is with considerable hesitation that I present for 
yonr consideration some thoughts upon the aetiology of 
deviations, spurs, and ridges of the nasal saeptum, es- 
pecially since the subject has been so ably, clearly, and 
fully discussed by different members of this associa- 
tion on several different occasions. After considerable 
study of the subject,’ however, I have concluded that 
some points have been overlooked which it is necessary 
to consider in order to explain why deviations of the 
saeptum are so frequent in their occurrence, and often 
so exceedingly peculiar as regards their form, extent, 
and location. 
Deflections of the nasal saeptum are ascribed to a 
variety of different causes. These may be divided into 
predisposing and exciting causes. 
I. Peedisposing Causes.—The two main predispos- 
ing causes are diathesis and racial characteristics. 
* Read before the American Laryngological Association at its eight- 
eenth annual congress. 
Copyright, 1896, by D. Appleton and Company. 2 
DEVIATIONS OF THE NASAL SEPTUM. 
1. Diathesis.—That diathesis is an important pre- 
disposing cause of deviations of the saeptum may almost 
be said to he self-evident, since it is a fact of clinical 
observation, verified by nearly all observers, that deflec- 
tions of the nasal saeptum are exceedingly common 
among persons suffering from the strumous, syphilitic, 
tubercular, or rhachitic diathesis. Loewy * and Loew- 
enherg f have emphasized the influence of rickets as a 
predisposing cause, perhaps laying more stress upon 
this factor than any other authors; and Harrison Allen J 
calls attention to the influence of cretinism in the pro- 
duction of deformities of the nasal chambers. 
2. Racial Characteristics.—The part that racial 
characteristics play in the production of deviated saepta 
is an exceedingly interesting topic of study. All writers 
on this subject are unanimous in showing that devia- 
tions of the saeptum are vastly more frequent among the 
civilized than among the savage races. For instance, 
among the Europeans and Americans the percentage 
varies from sixty to eighty per cent., while among the 
Mongolians, the Africans, and the Polynesians the 
deviation is found in but about twenty per cent. The 
increase in frequency of deviation of the saeptum among 
the civilized, and particularly among the Europeans and 
Americans, is ascribed to two causes: First, to the in- 
crease in the cranial development and the enlargement 
of the facial angle; and, second, to the admixture of the 
different races. 
Ecker and Lissauer # have demonstrated that under 
* Berliner klinische Wochenschrift, 1886, No. 47. 
f Zeiischrift fur Ohrenheilkunde, Wiesbaden, 1883, Bd. xiii, S. 11, 
\ New York Medical Journal, 1895, vol. Ixi, p. 139. 
# Annales des malades de Voreille et du larynx, 1892, tome xyiii, 
p. 782, DEVIATIONS OF THE NASAL SiEPTUM. 
3 
the influence of an increased development of the cranial 
mass the schematic line formed by the cranial vertebras 
has a tendency to curve in proportion as we advance in 
the evolutionary transformation. The s asp turn, accord- 
ingly, describes a movement of rotation, from above 
downward, from backward forward, around the body 
of the sphenoid taken as a centre. 
Thus it will readily he seen that as this process of 
rotation takes place, the angle formed between the fron- 
tal, the superior maxillary, and the sphenoid hones for 
the accommodation of the sseptum becomes proportion- 
ately greater, and as the posterior portion of this angle 
widens, the anterior portion becomes correspondingly 
narrowed, which gives less room for the sseptum, par- 
ticularly the anterior portion. This would account for 
the seeming redundancy of the sseptum in many cases, 
there being apparently insufficient room for its accom- 
modation, requiring it to become more or less incurvated 
or wrinkled, especially the cartilaginous portion. 
These studies have been further pursued by Poti- 
quet,* whose researches were conducted on four hun- 
dred skulls in the museum in Paris, from which he 
shows that the nasal sseptum is more prone to lateral 
curvature as the angle of the face is more inflected 
in its antero-posterior direction, and that this angle is 
more and more inflected in an ascending series as we 
rise from the anthropoid to the European male. 
The cause of the rarity of deflections of the sseptum 
among the less civilized races is believed to he due to 
the purity of these races. Among the purer races the 
features of the people are so much alike that it is with 
* Etude critique sur I’etiologie des deviations de la cloison nasale. 
Med. moderne, Paris, 1892, tome iii, p. 153. 4 
DEVIATIONS OF THE NASAL SJEPTUM. 
the utmost difficult}*' that a skilled physiognomist is 
enabled to distinguish between individuals without a 
close acquaintance with them. And thus we find that 
among the Mongolians, the Malays, the Arabs, the Afri- 
cans, the Polynesians, and the American Indians the 
shape of the sseptum and the interior of the nose vary 
as little as does the external appearance of the nose. 
Further studies in this direction show that an in- 
crease in the frequency of deviations of the sseptum 
corresponds very closely with the degree of admixture 
of the different races. This admixture in the more civil- 
ized countries, occurring largely as the result of con- 
quest and of immigration, has been taking place from 
the earliest times, until modern Europe and America 
of to-day represent this admixture of the races in the 
highest degree. 
The evolutionary changes that have taken place by 
this admixture are also readily seen in heterogeneity 
of the features of our people, as will be observed from 
the fact that no two persons will he found in whom all 
the features very closely resemble one another. There- 
fore, as Potiquet observes, “it would not he extrava- 
gant to say that a man has only exceptionally the sasp- 
tum which belongs to him.” 
Martin * observes that these anomalies all seem to 
he more clearly explained by the blending of different 
racial types than by evolutionary or devolutionary 
changes from a prognathous to an orthognathous type. 
Delavan f in his most instructive article on the iEtiol- 
* Journal of the American Medical Association, 1894, vol. xxiii, 
p. 491. 
f Transactions of the American Laryngological Association, 1888, 
vol. ix, p. 202. DEVIATIONS OF THE NASAL SJEPTUM. 
5 
ogy of Deflections of the Nasal Saeptum, also emphasizes 
the greater prevalence of deviated saepta among the 
civilized than among savage races, and also points out 
the fact that the aquiline type of nose, as illustrated in 
the Slav, the Hebrew, and the ancient Roman,* is par- 
ticularly apt to he associated with deflections. A nota- 
ble exception to this observation is the fact that the 
North American Indian, while possessing an aquiline 
nose, rarely has deflection of the saeptum. This is to 
be explained by the fact that the Indian belongs to a 
primitive and pure race, and also by their higher physi- 
cal development on account of their outdoor life, and, as 
has been pointed out by Gatlin, f by the habit among 
the Indian mothers of closing the mouths of their chil- 
dren and compelling them to breathe entirely through 
their noses from their earliest infancy, which conduces 
to a proper development of the nose. 
11. Exciting Causes.—The exciting causes of saep- 
tal deflection may he either internal or external. 
1. As internal exciting causes we have (a) defective 
development, (b) diseases of the saeptum, and (c) dis- 
eases of other portions of the nose. 
(a) Defective Development.—In studying deflections 
of the osseous and cartilaginous saeptum, it is important 
to call attention to some points in the anatomy of the 
saeptum. It will he remembered that the nasal saeptum 
is composed practically of two hones, the perpendicular 
* In jhe anthropological collection of the Peabody Museum, at Cam- 
bridge, Mass., is a cabinet containing eighteen well-preserved specimens 
of skulls taken from ancient Roman tombs. Delavan found that among 
these there was hardly a single instance in which the saeptum was straight, 
while in several of them the degree of deflection was excessive, and far 
beyond that usually seen.—Loc. cit., p. 205. 
f The Breath of Life, Reprint, New York, 1872, p. 16. 6 
DEVIATIONS OF THE NASAL SEPTUM. 
plate of the ethmoid and the vomer; and one cartilage, 
the triangular cartilage of the nose. The perpendicular 
plate of the ethmoid hone is a thin flattened lamella, 
which descends from the under surface of the cribriform 
plate, or the horizontal portion of the ethmoid bone, 
forming part of the anterior fossa of the base of 
the skull. The lower border of the posterior half 
articulates with the vomer. The vomer is a sin- 
gle hone situated vertically at the hack part of 
the nasal fossse. At an early period it consists 
of two laminae separated by a very considerable interval, 
and inclosing between them a plate of cartilage which 
is prolonged forward to form the remainder or carti- 
laginous portion of the sasptum. Ossification com- 
mences in the vomer at about the same period as in the 
vertebrae (about the sixth or eighth week of fcetal life), 
hut is not complete until after puberty; and the perpen- 
dicular plate does not begin to ossify until about the first 
year after birth. The coalescence of the laminae takes 
place from behind forward, beginning about the third 
year. The cartilage of the saeptum, extending forward 
from between the two plates of the vomer, is some- 
what triangular in form, thicker at its margins than at 
its centre, and completes the separation between the 
nasal fossae in front. Bearing in mind this fact that 
the vomer is composed of two parallel laminae which 
do not fully coalesce until after puberty—and in some 
instances do not coalesce at all *—we can most readily 
* In the Philadelphia Medical Nevis for January, 1882, Lefferts de- 
scribed a case of double septum in a man aged twenty-five. The upper 
half of the posterior edge of the partition was divided in the vertical 
direction into two distinct portions, which were separated wide enough 
to admit the end of a lead pencil between them. The space thus inclosed 
was triangular in shape, the widest part being above, and the mucous DEVIATIONS OF THE NASAL SEPTUM. 
7 
see the effect that would he occasioned hy the slightest 
imperfect development of either of these plates. Hy- 
pernutrition of one lamina would cause the other lamina 
to he pushed out of its normal line of growth; and, con- 
versely, any lack of full development of one lamina 
would occasion corresponding deviation. Any such de- 
flection in the vomer would naturally be accentuated 
in the cartilage of the saeptum. The probability of 
this view that the deflections result from defective 
development of the plates of the vomer is increased 
when we take into account the fact that scarcely if ever 
do we find two hones with precisely the same degree of 
development. 
Morell Mackenzie * evidently alludes to this fact when 
he says: “ It is not impossible that the deflection may 
result from the fact that ossification of the saeptum 
proceeds from centres situated in two different bones, 
and that these deposits of ossiflc matter do not subse- 
quently meet in the same plane.” 
The fact that ossification begins in the posterior 
end of the saeptum and that coalescence takes place from 
behind forward, explains why that end is rarely ob- 
served to he markedly deflected. It is the middle and 
anterior portions that most commonly become deviated 
as a result of the abnormal conditions that are so fre- 
quently found in children after the third or fourth 
year. The unequal development of the, plates of the 
vomer and the resulting deflection of the saeptum pro- 
duced hy these abnormal conditions become accentuated 
membrane covering it had a natural appearance. Baumgarten, of Buda- 
pest, describes a case of a double nose with two cartilaginous saepta and 
three nares.—Rev. de lar., d'otol., etc., 1894, tome xiv, p. 10. 
* Diseases of the Throat and Nose, 1884, vol. ii, p. 484. 8 
DEVIATIONS OF THE NASAL SEPTUM. 
as the development of the child takes place. Welcker * 
has not observed deflections of the sajptnm before the 
fourth year, while Zuckerkandl f states that he has 
not observed them in children under seven years of 
age. Anton, however, has shown that these deviations 
may he congenital by the examination of fifty-six ca- 
davers of newborn infants, in which he found deviations 
in nine cases (equal to sixteen per cent.). 
The peculiar forms which deflections of the step- 
turn may assume can readily he explained in the light 
of the fact that the different plates develop unequally. 
Unequal development of the separate plates may take 
place in a vertical direction or in a horizontal direction. 
Thus, if we have a vertical overgrowth of the lamina 
on one side or a defective growth on the other, we may 
have simple deflection of the sseptum toward the side 
of greater development. Again, if we have an over- 
growth in one plate in an anterior posterior direction, 
and of the other plate in a vertical direction, we may 
have the peculiar conformation of the sseptum called 
the sigmoid deflection, which naturally suggests the 
idea of redundancy of sasptal growth, as was first ob- 
served by Morgagni, \ Chassaignac # has also advocated 
this view. 
Ingals | has emphasized the importance of local mal- 
nutrition as an setiological factor in seeptal deflection, 
but, reversing the sequence of cause and effect, main- 
* Die Asymmetric der Nase und des Nasen-Skelets, Stuttgart, 1882. 
f Anatomic der Nasenhohle, Bd. i, S. 102, zweite Auflage, 1898. 
\ De sed. et cans, morb., Lugd. Batav., 1767, epist. xiv, art. 16, vol. 
i, p. 207. 
* Bulletin de la Societe de chirurgie, 1851- 52, tome ii, p. 253. 
| Transactions of the American Laryngological Association, 1882, 
vol. iv, p. 61. DEVIATIONS OF THE NASAL SEPTUM. 
9 
tains that the “ deflection of the saeptum usually com- 
mences in the cartilaginous portion, and that the flex- 
ion of the vomer, which often exists, is of me- 
chanical origin, due to firm articulation of this bone 
with the cartilage.” Others, among whom we may 
mention Delavan, * J. H. Mackenzie,! Sedziak, J and 
Rosenthal,# have, in a general way, considered defective 
development as an important factor in the production 
of sseptal deflection. 
(h) Diseases of the Sceptum.—Hypernutrition of 
either side in excess of the other my readily he pro- 
duced by diseases of the sasptum itself. An abnormal 
condition of the nasal saeptum, which may act as the 
exciting cause of deviation, is chronic disease of the 
tissues covering the sseptum, usually associated with 
more or less disease of other parts of the nasal passages. 
A condition of hypernutrition of the sasptum may he 
caused by the engorgement of the cavernous tissues 
which cover the lower posterior portion of the saeptum 
as well as the turbinated bodies. This cavernous tissue, 
as is well known, is so sensitive to irritation as to become 
readily engorged by any external or internal irritant. 
Therefore, when this tissue is subjected to frequent 
irritation, diseased action sooner or later takes place, 
resulting in chronic distention of the vessels. This 
hypernutrition tends to an increased growth of the 
structures, and, as Greville Macdonald || observes, re- 
sults in a tendency to a vertical as well as a horizontal 
overgrowth. As, vertically, the sseptum lies between 
* Op. cif., p. 207. 
f Transactions of the American Laryngological Association, 1887, 
vol. ix, p. 211. 
t Journal of Laryngology and Rhinology, 1891, vol. v, p. 94. 
# These de Paris, 1888. 
Diseases of the Nose, London, 1892, p. 195. 10 
DEVIATIONS OF THE NASAL SiEPTUM. 
fixed limits, any increase in that direction must re- 
sult in its being bent to one side or the other. 
Supernutrition and a diseased condition of the ssep- 
tum may also result in spurs and ridges along the sseptum. 
These spurs and ridges are usually found located along 
the articular surfaces of the sseptum; that is, (1) along 
the line of junction of the vomer with the superior 
maxilla, and (2) along the line of junction of the 
anterior border of the vomer with the triangular car- 
tilage of the sseptum and the lower posterior part of 
the perpendicular plate of the ethmoid, and (3) along 
the line of junction of the anterior border of the eth- 
moid with the triangular cartilage. The exostoses may 
be unilateral or bilateral. The ridges along the junc- 
tions of the vomer with the triangular cartilage and 
with the superior maxilla are more often bilateral than 
the ridges elsewhere. When occurring upon one side 
of the sseptum alone, they are frequently looked upon 
as constituting a deviation of the sseptum, but they are 
by no means a condition of deflection. Inflammatory 
states may not only be excited by a hypernutrition of 
the part, but may also result from inflammation set up 
by reason of external influences producing a condition 
which may be looked upon as an arthritis. These ex- 
crescences may indeed be the direct cause of the de- 
flection of the sseptum, by reason of the pressure which 
the turbinated bodies may exert upon them, forcing 
them and the sseptum over to the opposite side. This 
condition, however, is not common; for these out- 
growths and ridges are usually found upon the project- 
ing or prominent portion of the angle of deflection, and 
may therefore be looked upon as the result of the con- 
dition that has been the primary cause of the de- 
viation. DEVIATIONS OF THE NASAL SJ3PTUM. 
11 
(c) Diseases of Other Portions of the Nose.—Mal- 
formation of the superior maxilla and a very small and 
highly arched hard palate have so frequently been ob- 
served to he associated with deflection of the sasptum as 
to make it necessary to regard them as an exciting 
cause. This view was first suggested by Trendelen- 
burg,* hut especial attention was directed to it by Jar- 
vis, f who says that of a number of instances of highly 
arched palate, in every ease deflection of the sseptum 
was found. He also states that this condition was he- 
reditary in a number of cases in which he had traced 
it through several generations. 
Welcker J has pointed out that a deflected sseptum 
is frequently associated with more or less dispropor- 
tionate development of the whole face. The orbits may 
lie on different planes, resulting, as a matter of course, 
in various ocular troubles, and the superior maxilla and 
alveolar processes may be developed unequally, which 
may possibly have resulted, as Bosworth* suggests, 
from scoliosis of the whole face. 
In nearly all cases of deviation of the sseptum we find 
the turbinated body on the concave side of the sseptum 
very greatly hypertrophied, whereas the turbinated body 
on the convex side of the sasptum may be comparatively 
small, or at least not in a condition of hypertrophy. 
An interesting question has arisen in connection with 
this fact as to which is the cause and which is the effect. 
Baumgarten || and some others maintain that the hyper- 
* Cited by Schaus, Archiv fur Min. Chirurgie, Bd. xxxv, Heft 1, 
1887. 
f Medical Record, vol. xxvii, p. 284. 
\ Loc. cit. 
* Diseases of the Nose and Throat, 1889, vol. i, p. 288. 
| Ueber die Ursachen der Verbiegungen der Nasenscheidewand. 
Deutsche med. Woch., 1886, Bd. xiii, S. 373. 12 
DEVIATIONS OF THE NASAL SEPTUM. 
trophy of the turbinated body has been the exciting 
cause of the deviation, forcing the saeptum over to the 
opposite side, whereas others believe that the hyper- 
trophied turbinated body is the result of the saeptum 
being deflected from the median line. This latter view 
is, to my mind, the correct one, for the reason that we 
usually find the turbinated body on the concave side of 
the saeptum sufficiently hypertrophied to fill the space, 
while not hypertrophied enough to press against the 
saeptum. On the convex side, however, we find the 
saeptum pressing closely upon the turbinated hod}". If 
the deflection of the saeptum had been the result of the 
pressure, the pressure found upon the convex side would 
have been sufficient to force the saeptum into the median 
line, or to the opposite side. I believe it is false, how- 
ever, to hold that the deflection has had nothing to do 
with the hypertrophy of the turbinated body. The 
hypernutrition has been caused by the irritation con- 
sequent upon the excessive amount of air passing 
through the unobstructed passage, producing vascular- 
ity and hypernutrition of the part. Hypertrophy may 
he a compensation of Nature for this extra work. It 
is a well-known fact of observation that when the re- 
spired air passes through one nostril only, sooner or 
later irritation of this nostril is set up. In normal respi- 
ration the current of air that passes through the nos- 
trils is equally divided, hut wdien the respiratory cur- 
rent passes through one side only it causes dryness of 
the passage, irritates the nostril, and there is ultimately 
more or less diseased action. It is a rule that should he 
invariably observed that no matter how easily respira- 
tion may he carried on through one nostril, the other 
nostril should he opened so that an equal amount of DEVIATIONS OF THE NASAL SEPTUM. 
13 
air may pass through it, although it may not he neces- 
sary to make the passage as wide or free as the other 
nostril, which may he abnormally large. It is almost 
invariably the case that we find the most disease in the 
nostril through which the greater current of air passes, 
and very frequently we see an aggravated form of so- 
called nasal catarrh in the free nostril very rapidly 
become ameliorated by establishing free respiration 
through the other side. 
The obstruction of the anterior portion of the nasal 
passage when the other portion of the passage remains 
free is undoubtedly sometimes the cause of deviations 
of the sseptum, although not the main cause, as it is 
believed to he by Collier.* The direct effect of obstruc- 
tion of the anterior portion of the nasal passage during 
respiration is to cause more or less rarefaction of the 
air in that nasal chamber, which, acting upon the nor- 
mally thin and easily yielding sseptum, particularly in 
children, will cause a bending of the sseptum toward 
the nasal chamber in which the air becomes rarefied, or, 
in other words, in which the normal atmospheric pres- 
sure is reduced by the inspiratory current. The effect 
of obstruction of the nostrils in the production of de- 
formities of the face is very clearly shown by Ziem f 
in his experiments of artificially blocking one nostril 
in young animals. In every case there was defective 
development of the side of the face and skull on the 
side of the obstructed nostril. 
Obstruction of the anterior portion of the nasal 
chamber may be caused by temporary excessive vascu- 
larity and turgescence of the turbinated tissue of the 
* Journal of Laryngology and Rhinology, vol. v, 1891, p. 501. 
f Monatsschriftfur Ohrenheilkunde, 1883, Nos. 2, 3, 4, and 6. j 14 
DEVIATIONS OF THE NASAI/rS^PTUM. 
anterior portion of the turbinated body, or by a chronic 
condition of turgescence and hypertrophy of this tissue. 
Or the obstruction may be the result of foreign growths, 
or from synechia, the result of previous ulceration. 
It may also be due to dislocation of the triangular car- 
tilage, occluding the nostril. A flattened condition of 
the ala of the nose may also occlude the nostril. Such 
flattened condition may he due either to the destruction 
of the shield cartilage of the ala, or to a condition of 
paralysis of the dilator muscles of the nostril. This lat- 
ter point has been emphasized by Collier.* 
2. External Exciting Causes.—The main external 
exciting cause of deviation of the seep turn, particu- 
larly of the anterior portion, is traumatism. The vast 
number of cases of deflection in which a distinct history 
of trauma can be obtained leaves but little to be desired 
in the way of proof on this point. Traumatism is con- 
sidered the main cause of deviation of the nasal sseptum 
by Bosworth, f Genzraer, J Ziem,# Bresgen, || Schaeffer,A 
Woakes, t) Walsham,| Yoltolini, $ Moure,** 
Rosenthal, ff and Lennox Browne. JJ 
* Op. cit., p. 506. 
f New York Medical Record, IBS'?, vol. xxxi, p. 115. 
X Revue de chirurgie, 1887, No. 12. 
* Allgemeine med. Centralzeitung, Nos. 20, 23, 1886. 
|| Wiener medicinische Presse, 1887, Bd. xxviii, S. 237. 
A Chir. Erfahrungen in der Rhin. und Lar., 1885, Wiesbaden. 
t) Journal of Laryngology and Rhinology, 1890, vol. iv, p. 437. 
X Ibid., p. 439. 
X Die Erankheiten der Ease, 1888, S. 108. 
J Deviations of the Nasal Sceptum, 1888, London. 
** Journal of Laryngology and Rhinology, 1890, vol. iv, p. 495. 
f f Sur les deformations de la cloison du nez et lews traitements chi- 
rurgicaux, 1888, Paris. 
\X The Throat and Nose and their Diseases, p. 587, 1890, London. DEVIATIONS OF THE NASAL SJ3PTUM. 
15 
Traumatism may produce deviation of the saaptum 
in a variety of ways. It may result either in direct dis- 
location of the triangular cartilage at its point of attach- 
ment with the perpendicular plate of the ethmoid and 
the vomer, and at the attachment of the perpendicular 
plate of the ethmoid with the vomer, or the attachment 
of the triangular cartilage and the vomer with the su- 
perior maxilla. The dislocation may take place singly, 
or there may he more or less disturbance or dislocation 
of all these attachments at the same time, should the 
external forces he sufficient. These dislocations are more 
apt to take place in children than in adults, owing to the 
incompleteness of the attachments during childhood. 
The dislocation, however, may he slight in the child at 
first, but as the growth of the sseptum proceeds, the 
deflection becomes correspondingly accentuated. 
Dislocation of the triangular cartilage is, however, 
one of the most frequent deformities of the sasptum as 
a result of traumatism, owing to the frequency of slight 
blows upon the nose that are not of sufficient force to 
cause disturbance of the attachment of the perpendicu- 
lar plate of the ethmoid with the vomer, and also owing 
to the fact that the triangular cartilage is much the 
thinnest portion of the sseptum, and is most easily dis- 
turbed by external causes. In many cases there may 
be no history of traumatism, since the deflection may 
have resulted from an accident that has long since been 
entirely forgotten, but which was, nevertheless, the pri- 
mary cause, as can be readily seen from the overlap- 
ping of the parts, which could not easily have resulted 
from any other cause. The probability that these devia- 
tions result from traumatism, though there may be no 
history of such accident, is heightened by the fact that 16 
DEVIATIONS OF THE NASAL SJSPTUM. 
these cases are found three or four times more frequent- 
ly in boys than in girls, and in men than in women, the 
masculine sex being more exposed to injuries of the 
nose than the feminine. In such cases of deviation, 
one of the best proofs that the deflection is the result of 
traumatism is the fact that we almost invariably find a 
great amount of callus thrown out on the convex side 
of the angle of the two articulated surfaces, whereas if 
the ridge had been thrown out as the result of disease of 
the articulated surfaces, it would he unilateral. 
Among other external influences which are believed 
to he the cause of deviation, habitually blowing the 
nose with the same hand has been mentioned by Morel 1 
Mackenzie.* A diseased condition of the interior of 
one nostril, producing a hypersecretion from that nos- 
tril, and a person habitually closing the opposite nostril 
by pressure with the thumb or finger in order to clear 
the passage of the discharge, and the habit of insert- 
ing the finger into one nostril to remove scabs, crusts, 
etc., would also have a like effect. This does not of 
itself seem a sufficient cause for the production of a 
deformity, although it is quite probable that deflection 
of the end of the nose quite frequently results from 
this cause, since misshaped noses in the young may be 
molded into symmetrical form, as was the custom of 
the ancient Persians with babes of the royal blood, for 
no man was allowed to sit upon the throne who had 
a crooked or deformed nose.f 
On considering the constant and extreme variations 
which take place in the composite races in the develop- 
* Diseases of the Throat and Nose, vol. ii, p. 434. 
f Mackenzie, Transactions af the American Laryngological Associa 
tion, 1885, vol. vi, p. IOY. DEVIATIONS OF THE NASAL SEPTUM. 
17 
ment of the osseous structures, and particularly those 
of the face and skull, it is not surprising that these 
variations should occur quite as frequently in the nasal 
sasptum as in other parts. One can not be more forcibly 
impressed by the frequency of these variations than by 
examining the various cavities contained within the 
skull, and particularly the accessory sinuses of the nose. 
In the examination of any number of skulls no two cavi- 
ties in the same or in different skulls will he found to be 
of exactly the same shape, size, and dimensions. There- 
fore, the great variations that take place in the size and 
shape of the nasal cavities and the sgeptum can not be 
wondered at. 
From the present status of our knowledge regard- 
ing the aetiology of deflections of the nasal sseptum we 
may draw the following conclusions: 
1. That deviations of the saeptum are produced by 
a variety of causes operating upon different persons; 
and that upon the same person several different influ- 
ences may be operating at the same time. 
2. That heredity plays a very important part as a 
predisposing cause, not only by the dyscrasias which may 
be transmitted, hut by the blending of different races 
in the composite type, which brings about an infinite 
variation in the conformation of the osseous and car- 
tilaginous structures. 
3. That the three local causes most frequently pro- 
ducing deviation, spurs, and ridges of the sa3ptum are 
trauma, nasal obstruction, and unequal growth of the 
different component parts of the vomer. The last-men- 
tioned cause is itself produced mainly by local malnu- 
trition or diseased conditions of the structures of the 
nasal passages, inducing an unequal development of the 18 
DEVIATIONS OF THE NASAL SEPTUM. 
two sides of the saeptum, which causes a bulging or 
bending to the side of greatest development. The fact 
that the vomer is composed of two laminae, separated 
by a plate of fibro-cartilage which is continued forward 
to form the triangular cartilage of the nose, readily ex- 
plains how this unequal development takes place. The New York Medical Journal. 
A WEEKLY REVIEW OF MEDICINE. 
FRANK R. FOSTER, M.D. 
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