REPRINTED FROM THE NEW YORK MEDICAL JOURNAL FOR NOVEMBER 9, 1889. 
NASAL INSTRUMENTS. 
j. w. gleitsmann, m. d. 
1. A Nasal Bone Forceps.—Although the writer feels some aver- 
sion to increasing the already large number of existing designs of nasal 
forceps, the instrument here described has, after repeated trials, proved 
so satisfactory that he deems it advisable to publish a description of it. 
The forceps has the usual angle of nasal instruments. The branches, 
which are slender but very strong, cross each other when the instru- 
ment is closed, thereby occupying very little space. They can be intro- 
duced through the narrowest nasal speculum to any desirable depth, 
and, on account of their smallness, do not obscure the field of vision. 
The chief point distinguishing it from other devices is the location of 
the joint near the distal end, by which arrangement great power can be 
exerted when the blades seize the part to be removed (Fig. 1). 
The design had its origin in the desire to extract pieces of septal 
cartilage, or still oftener bones which had been operated upon either 
with the nasal trephine or the saw. Especially in using the saw the 
severed bone was often found to be difficult of removal on account of 
being firmly imbedded in the stenosed canal or still adherent to the 
septum by a shred of undivided mucous membrane. The failure to 
extract the bone with a slender forceps and the difficulty of overlook- 
ficient dilatation of naturally narrow nostrils, which did not require 
active interference—viz., which did not present a turbinated hy- 
Fieri. 
F!ja. 
Fig. 3. 
pertrophy or a septal exostosis. Further, cases often presented 
themselves for treatment in which after such operations sufficient 
space could not be gained for satisfactory nasal drainage, or 
in which the danger of subsequent formation of adhesions 
was imminent. The soft rubber tubes and similar devices 
did not fulfill the requirements, and a more thorough and 
efficient method seemed highly desirable. Tupelo, to which 
the writer’s attention for this purpose was first drawn by 
Messrs. Tiemann & Co., has proved to him so eminently sat- 
isfactory that he considers it his duty to lay the results of his 
experience before the profession. He has employed it now 
in about a dozen cases, and in no instance has it failed to 
meet his expectations. A single case may serve as an illus- 
tration : A patient with naturally very narrow nostrils and bilateral ex- 
ostoses on the lower part of the septum suffered from almost com- 
plete obstruction of the nares, the lateral walls and the septum being 
in immediate contact with each other without the presence of true tur- 
binated hypertrophy. On one side the septal exostosis had been re- 
moved by a physician, but the operation had not given the desired relief. 
The introduction of the tupelo dilator four times opened the nostril 
enough for all practical purposes, and no contact of the parts took 
place afterward. The other nostril was treated in precisely the same 
manner, tupelo being introduced after the wound from the nasal tre- 
phine had healed sufficiently, and the result was equally satisfactory. 
The writer feels confident that he lias materially shortened the time of 
treatment of suitable cases since applying the tupelo dilators, and he 
would feel loath to part with them. 
The manner of application is very simple. After the nostril is 
thoroughly cleansed with a disinfectant solution and anaesthetized with 
cocaine, a piece of tupelo is cut to correspond to the required size, 
seized with an ordinary forceps, and introduced to the desired depth. 
After remaining in the nose for fifteen to twenty minutes the expansion 
is accomplished and the piece, generally swollen to quadruple its size, 
removed. After another cleansing, the patient can be sent home, or, as 
it has been my custom lately, a piece of tinfoil, which also can easily be 
shaped according to the requirements of the case, is inserted, to prevent 
contact of the parts, if there should be such an indication. The tinfoil 
may remain with impunity till the patient pays his next visit. The 
smaller piece of tupelo in the drawing represents the size generally em- 
ployed. It was put into water for ten minutes, and the second figure 
shows the appearance of the piece after that time. This is the usual 
expansion obtained in the nostril. It has been found most convenient 
to have the tupelo made up in pieces of six inches by an inch and a half 
Fig. 1. 
iug the f.eld when using a stronger straight forceps led to the construc- 
tion of the instrument. 
Although intended only for removal of bone which had been oper- 
ated upon, quite recently a foreign body, a shoe-button, which yielded 
to no other instrument, was extracted from the nostril by the aid of the 
forceps, having blades with three prongs, as shown by the second draw- 
ing (Fig. 2). 
Fig. 2. 
2. A New Nasal Dilator.—The dilator here described is made from 
the wood of the Nyssa aquatica, or tupelo-tree of the Southern States, 
which was first introduced into medical practice by Dr. G. E. Sussdorf. 
In the May number of the “Richmond and Louisville Journal,” 1879, 
he recommended its use for tents to dilate the os uteri, and subsequently 
Munde corroborated his statements. The root is subjected to heavy 
hydraulic pressure, and, when exposed to moisture, offers the following 
advantages: It expands very rapidly and equably, and is therefore pref- 
erable to laminaria, which swells irregularly, and consequently exerts un- 
equal pressure. Its surface is smooth and does not lacerate the tissue 
when introduced into a narrow opening. After removal the tissues do 
not appear dry, but even more moist and pliable than before. Tupelo 
has also to a certain degree antiseptic properties; it does not favor de- 
composition, and no smell .is perceptible after it has been extracted. 
Its chief advantage for our purpose is the softness of its texture, which 
enables us to cut it into any desirable shape with an ordinary knife 
(Fig. 3). 
The writer was for some time in search of an agent to produce suf'