THE 
GALVANO-CAUTERY 
AS A 
THERAPEUTICAL MEASURE IN CHRONIC NASAL 
AND NASO-PHARYNGEAL CATARRH. 
BY 
E. L. SHURLY, M. D., 
F KLLOW OK THE AMERICAN LaRYNGOLOGICAL ASSOCIATION, LECTURER ON 
Therapeutics and < linical Laryngology, in the 
Detroit Medical, College, etc. 
Read before the American Laryngological Association, New York. 
[Ueprinted from the St. Louis .Medical and Surgical Journal, Jan 5,1880.] 
ST. LOUIS: 
GEO. O. HUM BOLD & CO. 
1880. THE 
GALVANO-CAUTERY 
AS A 
THERAPEUTICAL MEASURE IN CHRONIC NASAL 
AND NASO PHARYNGEAL CATARRH. 
BY 
I 
E. L. SHURLY, M. D., 
Fellow of the AmericatHLabxngological Association, Lectures on 
Therapeutics aNTf^mnical Laryngology, in the 
Detroit Medical College, etc. 
Read before the American Laryngological Association, New York.. 
[Reprinted from the St. Louis Medical and Surgical Journal, Jan. 5,1880.1 
ST. LOUIS: 
GEO. O. RUMBOLD & CO. 
1880. THE GALVANO-CAUTERY AS A THERAPEUTICAL MEASURE 
IN CHRONIC NASAL AND NASO-PHARYNGEAL CATARRH. 
It is not my intention to present a long compilation of the 
literature of chronic nasal and naso-pharyngeal catarrh, with 
annotations; but to invite your attention at once to the points 
connected with the use of galvano-cautery as a therapeutic meas- 
ure in these conditions. The pathological state of the nasal or 
naso-pharyngeal lining, to which this agent seems applicable, 
may be briefly summed up and expressed as either hyperplasia, 
glandular hypertrophy or atrophy, ulceration or neoplasm, at- 
tended by excessive, deficient or altered secretion and innerva- 
tion. 
These structural changes, affecting narrow and delicate pass- 
ages, which are so intimately connected with the important func- 
tions of respiration, vocalization, articulation and the senses of 
hearing, taste and smell, beget, in many individuals, as we are all 
aware, a train of functional derangements which demand strenu- 
ous effort at cure-not alone amelioration-while in a few a con- 
siderable amount of such structural change is borne with but little 
or no local or general disturbance. Now, passing in review the 
local medicaments hitherto in use for the relief and cure of these 
morbid conditions, we find that the various astringent, deter- 
gent, emollient and so-called alterative snuffs, douches, pigments, 
sprays and vapor inhalations have been attended with but a 
small degree of permanent relief as compared with the result of 
similai' treatment applied to other overt mucos surfaces. 
This apparent failure perhaps is due to the incompetence of 
such measures to produce radical vital change. Therefore I 
have been led to believe, with others, that more or less destruc- 
tion of a portion of the altered mucous membrane must be ac- 
complished in order to effect a cure. This becomes necessary, 4 
not only for the important object of relieving mechanical ob- 
struction of the nasal passages; but also-through destruction of 
glandules, varicose blood vessels, etc.-for the purpose of ex- 
citing physiological cell growth in the surrounding tissues. 
This proposition being granted, the question arises, with what 
agent or agents can we best accomplish our purpose ? The min- 
eral caustics, such as nitrate of silver, etc., have been adopted 
with considerable success; also the practice of evulsion or cutting 
off exuberent portions of nasal mucous membrane by means of 
forceps and scissors. But each of these methods being not only 
very painful, but only applicable to the more accessible portions 
near the anterior nares, are consequently open to objection. We 
have, however, in the galvano-cautery (first applied, I think in 
this practice by Voltolini), an agent which, to my mind, answers 
every requirement. 
The great danger of using so potent a destructive agent in 
such regions as the nose, naso pharynx and pharynx has been 
urged (very properly perhaps) as an objection to its adoption, and 
ought to be appreciated by every operator. But if the proper 
instruments are at hand, the hand steady and the battery un- 
der control, it is as devoid of danger and as easy of application 
as any other agent which might be selected for cautery purposes. 
I once had the misfortune to burn not only the exuberant por- 
tion of mucous membrane covering the turbinated bone, which I 
was after, but the opposite part of the septum, which nearly re- 
sulted in permanent agglutination and consequent obstruction of 
the nasal passage. But such an accident need never happen if 
the parts are properly protected. 
For applications to the anterior and middle portions of the in- 
ferior and middle turbinated bones, a nasal speculum, affording 
proper protection to the meatus, is indispensible; those preferred, 
so far as I know, are the ivory cylinder devised by Dr. Lennox 
Browne and constructed with a longitudinal slit or fenestra through 
which the diseased membrane is touched; or, what is still better, 
the speculum devised by our distinguished President, and bearing 5 
his name (the Elsberg speculum) the blades of which, as suggested 
by Dr. Browne, are made of ivory. Both of these instruments, 
although very excellent, are open to some objection, according to 
my experience. The former (Browne's), although giving most 
perfect protection, is too large for introduction and maintenance 
in many nostrils, while it allows of only a limited exposure of 
surface, and that for only a short distance in. And the latter 
Fig. 1. 
Self-retaining nasal speculum, with sliding ivory blade, which serves 
to protect opposite side of nasal passage from the glowing electrode. 
(Elsberg's) is too heavy to be self-holding, with blades too nar- 
row to afford good protection, and too long to be introduced and 
opened far in the meatus without producing considerable pain. 
For these reasons I have devised a speculum (Fig. 1) for this 
purpose which should be in a measure free from these objections, 
and still be easy of introduction for applications well into the 
nares. It is composed of two parallel limbs, connected by a joint 
near their center, similar to the Elsberg speculum. At the nasal 
extremity one limb is finished into a fenestrated blade for hold- 
ing out the ala, and the other into a slot-like blade, into which 
slides a thin concavo-convex plate of ivory, about two inches 
long by about one-half inch wide. The handles (which are short) 
are held separated and the blades in apposition by a small inter- 
vening spring, while the blades are separated by means of a small 
thumb screw. I generally use a pair, one for each nostril; but 
this is not absolutely necessary, as the instrument may be inverted 
for introduction to the opposite side of the nose. 
It should be introduced with the blades in apposition and the 6 
ivory shield pulled out. Then, after pushing the shield gently 
in along the septum to the required depth, the blades may be 
separated and the cartilaginous nose dilated to the required width 
by means of the small thumb screw. Now the cautery electrode 
may be introduced along the ivory plate as a guide, the current 
turned on, and the diseased membrane destroyed to the required 
depth and extent; or, after the plan of Michel, several fine lines 
may be drawn across a selected spot at one introduction. In 
burning polypi or other large excresences, the ivory plate will 
be found highly useful, as the electrode may be introduced with 
great freedom between it and the growth. It will also be found 
very effective in this method of treating ulcerations and papular 
protuberances of the membrane covering either the middle or 
inferior turbinated bones. This agent, the cautery, will be found 
none the less useful in the treatment of structural change, neo- 
plasms and ulceration at the posterior nares and vault of the 
pharynx. 
Fig. 2. 
Fig. 2 illustrates the handle with the pharyngeal electrode attached; 
on the upper surface are the two posts for the adjustment of wire reel rep- 
resented at the right hand of Fig. 3. 
For applications to these regions I use either a long electrode 
or knife insulated except at the extremity, which is passed 
through from the anterior nares and applied to the part, under 
the guidance of the rhinoscopic mirror, or curved electrodes with 
platinum points, constructed so as to pass through the mouth and 
up behind the soft palate to the place to be touched. I am in 
the habit of securing the soft palate for these operations accord- 
ing to the method of Surgeon Wales, U. S. N., by passing a rub- 
ber cord through the floor of the nose and out through the mouth. 
This can be readily done without the aid of a Belloque's sound,, 
and is much more agreeable to the patient than the palate hook. 7 
It is obvious, of course, that these manipulations are bereft of 
much danger by possessing perfect control of the electric stream, 
which may be obtained most perfectly, I think, by using a han- 
dle with a current breaker, easily managed by the operating hand, 
such as has been made for me by the Detroit Electrical Works. 
Regarding the galvano-cautery snare or wire for the removal 
of polypi, I have had but little experience except to learn how 
difficult it is to apply it. In " chronic follicular pharyngitis " the 
most rapid success has followed, in my hands, the touching of ex- 
uberant patches and varicose with the glowing electrode. 
Fig. 3. 
Fig. 3. A represents the two parallel tubes through which the wire for 
a snare runs; J?, the short straight electrode or knife for use in the ante- 
rior part of the nares; C, the post nasal electrode to be introduced be- 
hind the soft palate, and D the long electrode or knife for introduction 
through the nares to posterior ends of turbinated bones and pharynx. 
In closing, allow me to express the hope that the galvano- 
cautery may be more extensively employed for the relief of these 
common and troublesome morbid conditions of the nose and 
pharynx.