Influence of Naso-Pharyngeal Growths, 
Obstructions and Hypertrophies 
upon the Hearing, 
With a Few Gases in Point. 
BY 
JOSEPH A. WHITE, M. 0, 
Senior Surgeon of the Richmond Eye, Ear and Throat 
Infirmary. 
Read before Virginia State Medical Society, and Reprinted 
from Virginia Medical Montnly, February, 1885. PURCELL, I,A DI) & CO'S 
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RICHMOND, -V Ak. Influence of Naso-Pharyngeal Growths, 
Obstructions and Hypertrophies upon 
the Hearing, with a Few Cases 
in Point.* 
By Joseph A. White, M. D., 
Senior Surgeon of the Richmond Eye, Ear and Throat Infirmary, Richmond,Va. 
Read before the Virginia State Medical Society, September 9, 1884. 
About eighteen months ago I wrote a short paper (by re- 
quest) for the Richmond (Va.) Academy of Medicine, em- 
bodying known facts about "Naso-Pharyngeal Catarrh and 
its Treatment," viewed from the standpoint of my own ex- 
perience, in order to call the attention of the local medical 
profession to the great prevalence of this trouble. Rich- 
mond, particularly, has fully its share, because of the quan- 
tity of irritating dust constantly floating in its atmosphere, 
and this dust I claimed to be one of the most active and pro- 
lific causes of naso-pharyngeal irritation. This, added to the 
fact that our climate is subject to very sudden and startling 
changes of temperature, with great dampness and moisture 
in winter, made a very good nursery for naso-pharyngeal 
catarrh. 
But in that paper-a very imperfect one from want of time 
and space-I merely referred to the influence of catarrh and 
♦Reprint from the Virginia Medical Monthly, February, 1885. 2 
its accompanying hypertrophies on the sense of hearing. I 
wish now, however, to bring to your notice, more particu- 
larly, this influence and the importance of attention to the 
nose and naso-pharynx in cases of defective hearing. Four 
or five years ago I read before this Society a short paper on 
" Catarrhal Deafness," with the same object, but it differed 
'considerably from the present pages. 
In naso-pharyngeal catarrh the deafness which so fre- 
quently accompanies it may be due to any one of four causes: 
First. To extension of the inflammatory process along the 
mucous lining of the Eustachian tube, or catarrh of the tube 
and tympanum. 
Second. To direct obstruction of the mouth of the tube by 
hypertrophic mucous tissue. 
Third. To interference with the normal ventilation of the 
tube by nasal stenosis. 
Fourth. To loss of normal action of the palato-tubal mus- 
cles-the so-called " paretic deafness." 
(1st.) In "catarrh of the tube and tympanum" the mucous 
lining of the tube and drum participates in the chronic in- 
flammation, becomes thickened, the calibre of the tube is 
narrowed, and hearing is impaired by loss of motion in the 
drumhead and ossicles, resulting both from rarefication of 
the air in the tympanum and the inflammatory changes. 
Such cases, if seen before radical changes (as, e. g., stiffening 
of the articulations of the ossicles, bands of adhesion in the 
tympanum, etc.,) have taken place, can have the hearing re- 
stored by treatment of the naso-pharyngeal disease and sys- 
tematic inflation of the drum. 
(2d) Where we have direct obstruction of the mouth of 
the tube, it may be due to hypertrophy of the pharyngeal 
tonsil, or to posterior hypertrophy of the erectile tissues over 
the lower turbinated bones, o± to post-nasal vegetations (so- 
called adenomatous growths), particularly those on the pos- 
terior wall of the pharynx, with hyperplasia of the mucous 
folds. I have seen these latter cases in children, where the 
deafness had persisted for years, with occasional improve- 
ment in warm weather, have the hearing almost perfectly 
restored by a removal of the obstructions, and a short course 3 
of treatment of the tubal and tympanal complication. Now, 
although my experience with a large number of cases, since 
my attention was first called to the existence of these growths, 
bears out my assertion of deafness being a frequent result of 
vegetations in the upper pharynx, with the authority of 
Mackenzie, Woakes, Meyer, Voss, and others to support it, 
there are some who hold a different opinion. Dr. Beverley 
Robinson, of New York, read a paper on this subject at the 
recent meeting of the American Laryngolocical Association; 
and, although I have not seen his paper, the journal reports 
of its discussion show that his experience does not agree 
with mine in the frequent production of deafness from this 
cause. It may be that he does not make a routine practice 
of testing the hearing of all his cases that have adenoid 
growths, or hypertrophy of the pharyngeal tonsil, and he 
may therefore frequently overlook defective hearing when it 
exists. I have often found this effect by tests when the pa- 
tients made no complaint of it, and did not seem aware of 
any defect in their hearing. 
(3d.) Interference with tube ventilation by nasal stenosis 
causes deafness by obstructing nasal respiration, cutting off' 
the normal current of air along the inferior nasal meatus, and 
thus preventing the automatic capillary attraction of the Eus- 
tachian tubes upon the air current. Nasal stenosis, partial 
or complete, may be due to hypertrophy of the erectile tis- 
sues over the turbinated bones, either anteriorly or poste- 
riorly; to polypi; to post nasal vegetations; to hypertrophy 
of the pharyngeal tonsil; to growths and deviations of the 
septum; to posterior thickening of the septum; to naso-pha- 
ryngeal tumors; to general hypertrophy of the nasal mucous 
membrane; and to rhinoliths. 
(4th.) The last form of deafness from "paresis of the pa- 
lato-tubal muscles" was first described by Weber-Liel, my 
former preceptor in Berlin, under the name of "progressive 
deafness," and he claimed it to be of central, reflex, or vaso- 
motor origin. This valuable publication did not meet with 
the reception it deserved. Subsequently we are indebted to 
Woakes for considerable labor in this same direction. In 
1872, I wrote an article, under the heading of "Tenotomy of 4 
the Tensor Tympani Muscle," for the Baltimore Medical Jour- 
nal, which was, as far as I can learn, the first publication in 
this country on the subject-Weber-Liel claiming that, on 
account of the deficient power of the tubal muscles the un- 
opposed action of the tensor tympani acted deleteriously by 
drawing in the drumhead and impacting the stapes in the 
oval window, thus producing greater deafness, tinnitus and 
giddiness. Ultimately this resulted in its permanent con- 
traction, with anchylosis of the chain of ossicles, and absolute 
deafness. Hence its tenotomy before such permanent con- 
traction took place was of great importance. The congestion 
and dilatation of the blood-vessels of the naso-pharynx, which 
often precede and always accompany catarrh, if it extends 
to the nutrient vessels in the sheaths of the motor nerves of 
the palato-tubal muscles, will necessarily, by the pressure of 
these vessels on the nerves, enfeeble their motor-power and 
cause deficient action of these muscles. This vaso-motor in- 
fluence is probably the explanation of the simplest forms of 
paretic deafness. 
In the slighter forms, this deafness is curable by early 
attention to the naso-pharyngeal trouble, faradization of the 
tubal muscle, and inflation of the drum. In the more pro- 
nounced forms it is very intractable, and in the majority of 
cases absolutely incurable, going on to profound deafness in 
spite of treatment. 
Here allow me to say that I do not wish to be understood 
as stating that all cases of nasal and naso-pharyngeal troubles 
are accompanied by deafness; but I do say that all cases of 
middle ear disease, whether acute or chronic, suppurative or 
non suppurative, are accompanied more or less by naso-pha- 
ryngeal changes; and I may also add that every case of nasal 
obstruction resulting in "mouth-breathing," and all cases of 
obstruction of the lower nasal meatus, even where the air-cur- 
rent can still pass through the upper passages, will, sooner 
or later, become more or less deaf if the obstruction is 
allowed to remain. 
From the foregoing remarks, you can see the importance 
of a most minute examination of the nose and naso pharynx 
when a patient complains of defective hearing; vice versa, the 5 
importance of testing the hearing, especially of children, 
when there is any interference with free nasal respiration. 
To examine the nose and naso-pharynx necessarily requires 
a perfect knowledge of the anatomy and relations of the parts 
on the one hand, and a familiarity with the post-nasal mirror 
and its rhinoscopic pictures on the other. Merely opening 
the mouth and depressing the tongue will rarely tell us any- 
thing unless we meet with hypertrophied tonsils, or large 
pharyngeal granulations and redundancy of the pharyngeal 
mucous membrane. If we find one or all of these, and have 
defective nasal respiration, we may be sure we have also im- 
portant pathological changes beyond the reach of our un- 
aided vision. 
Anterior hypertrophy of the erectile tissue over the turbi- 
nated bones, deflections of the septum, outgrowths from the 
cartilaginous portion of the septum, and nasal polypi can be 
usually diagnosed by direct inspection of the anterior nares 
with a nasal dilator and a good light. 
But growths from the posterior portion of the septum, 
thickening of the mucosa on either side of the vomer, hyper- 
trophy of the posterior ends of the turbinated tissues, hyper- 
trophy of the pharyngeal tonsil, and lymphoid vegetations of 
the naso-pharynx are only to be diagnosed by the post-nasal 
mirror. Posterior rhinoscopy is not of much service in lit- 
tle children, and here the "tactus eruditus" of the educated 
finger comes into play. By putting one arm around the 
child's neck, with the fingers on the cheek, so as to prevent 
its biting the examining finger, by pressing the soft tissues 
between the teeth at each attempt to bite, we can pass the 
finger up behind the uvula and explore the post-nasal cavity. 
Vegetations feel like a bunch of w'orms; hypertrophy is 
firm and smooth. In larger children and adults, when I 
have any difficulty in getting a post-nasal view, I pass along 
the lower nasal meatus into the pharynx the smallest-sized 
flexible bougie, with a small wire in it to render it firm, and 
draw it out of the mouth, in the same wa^ that Bellocq's 
canula is used. I then withdraw the wire and tie the two 
ends of the bougie together over the upper lip, thus getting 
a good view of the naso-pharynx by this forward traction on 6 
the soft palate. I have been using this method for a number 
of years, and have never yet encountered a case of stenosis 
so great that I could not pass this little bougie. 
The rhinoscopic appearances are unmistakable. In the 
normal image, the posterior wall and vault of the pharynx, 
smooth and free from irregularities; on either side the carti- 
laginous projections of the Eustachian tubes and their ori- 
fices, with the depressions behind them (fossae of Rosenmul- 
ler); the sharply-defined, clean cut, oval openings of the pos- 
terior nares, separated by the septum, with the projections 
from without inwards of the turbinated bones-these make 
up a picture that, once clearly seen, is easily remembered. 
Any deviation from this is an abnormality requiring atten- 
tion. 
Just at the vault of the pharynx, behind the upper end of 
the septum, we may see a smooth lump projecting down- 
wards-sometimes rounded or oval, sometimes pyramidal. 
This is the pharyngeal or Luschka's tonsil in a hypertrophied 
state; for, like the faucial tonsils, whenever it is at all no- 
ticeable, it is more or less hypertrophied. If you will recall 
your experiences of throat examinations, you will probably 
agree with me in saying that in a healthy throat the faucial 
tonsils are no more to be seen than if they had no existence, 
and my experience teaches me the same thing about the third 
tonsil. When hypertrophied, as with the faucial tonsils, it 
may be dense and firm, resembling a fibroid growth, either 
single or tabulated; or soft, forming a reddish granular mass, 
the so-called adenomatous tissue, which hangs down, hiding 
the sharp upper contour of the post-nasal openings, and 
sometimes covering the Eustachian tube orifices. 
Again, the upper oval may be sharply defined; and lower 
down, projecting out from their lower segment towards the 
Eustachian tube orifices, we may see what looks like a mul- 
berry, large or small, as the case may be, or, sometimes like 
a smooth, firm tumor. This is the hypertrophy of the inferior 
turbinated tissue. 
Again, we ma^-find the septum puffed out on either side, 
giving it a thickened appearance, due to hypertrophy of the 
ruuco-periosteum over the vomer; or, the post-nasal opening 7 
may be occluded by a smooth, firm growth, springing from 
the septum-a fibroid tumor ; but this is rarely met with. 
More rarely still, we may find the naso-pbaryngeal space 
partially or entirely filled with a growth springing from the 
muco-periosteum of its roof, and entirely occluding one or 
both post-nasal openings, and pressing on the Eustachian 
tube orifices. ' 
Sometimes several of these pathological conditions will be 
present in the same case. All of them must be done away 
with to restore normal nasal respiration and prevent or di- 
minish existing deafness. 
Nasal polypi, although producing nasal stenosis, do not act 
so deleteriously upon the hearing as the above changes, be- 
cause they usually spring from the upper or middle meatus, 
and what breathing room remains is in the lower and most 
important channel, but I have had patients with polypi to 
complain of occasional ear-ache. It is difficult to fix any cer- 
tain causation for these growths and hypertrophies in the 
nose and naso-pharynx, though they occur during and possi- 
bly as a result of the changes that take place in the mucous 
membrane and its annexa in chronic naso-pharyngeal ca- 
tarrh. The early occurrence and history of adenoid tissue 
points to heredity as a factor in its production, and it fre- 
quently results from the exanthematous diseases. I have 
quite a number of cases on my record-book of "suppurative 
aural catarrh" resulting from scarlet fever, which showed 
the complication of adenoid vegetations in the naso-pharynx, 
and I have observed that the treatment of the local ear dis- 
ease is more rapidly and favorably efficacious after the remo- 
val or destruction of this tissue. In fact, I consider the 
treatment of any naso-pharyngeal trouble quite as important 
in suppurative as in non-suppurative middle ear disease. 
The treatment of these growths and hypertrophies means 
their extirpation. Aly main dependence in such treatment 
is the galvano-cautery, for there is no case to which it is not 
applicable-a remark which does not so readily apply to the 
knife or cold snare, which I sometimes make use of. 
Anterior turbinated hypertrophies, I destroy by removal with 
Jarvis' snare, or, better, by burning longitudinal furrows in 8 
them with a galvano-cautery knife. In the absence of these, 
I have found glacial acetic acid a useful local application in 
shrinking them. When quite soft, I have known glycerole 
of tannin sufficient for the purpose. I have also seen them 
subside spontaneously where they existed in connection with 
posterior hypertrophies or adenoid tissue, when the latter 
were removed. 
In posterior turbinated hypertrophies, I usually apply the gal- 
vano-cautery or Jarvis' snare. The latter instrument I have 
found more useful here than in anterior hypertrophies, be- 
cause it does not give the same amount of discomfort as when 
used to remove the latter. 
Deflections of the septum, if only slight, should be let alone; 
but if sufficient to cause stenosis, any accompanying hyper- 
trophies should be removed, the deflected portion perforated 
with a punch or button-hole forceps, originally designed by 
the late Dr. Bolton, of this city, (the original forceps being 
now in the possession of Dr. Brock, of Richmond,) and sub- 
sequently modified by Dr. Steele, and then forced back into 
proper position by plugs or by laminaria flat tents. These I 
have found very useful for dilating purposes in the nostrils, 
frequently an apparently marked hypertrophy disappearing 
under the influence of the pressure alone. 
Outgrowths from the septum can be cut ofi' by a bistoury 
or snare, or shrunken by the galvano-cautery. Caustic ap- 
plications are of no service. I removed, a short time ago, a 
fibroid as large as a hickory nut, springing from the septum, 
and the deafness in the case Avas evidently caused by the 
resulting nasal stenosis. I have appended the case to this 
paper. In another case, also accompanied by chronic adhe- 
sive processes in the tympanum, a cartilaginous projection 
from the septum had, by its pressure on the turbinated struc- 
tures, set up ulceration. I cut ofl' the projection with a bis- 
toury and re-established nasal respiration with the laminaria 
dilators, when very marked improvement followed the aural 
treatment, which up to that time had only negative or tran- 
sient results. 
Adenoid or lymphoid vegetations, I always remove with the 
cutting forceps as far as possible, and then burn with the gal- 9 
vano-cautery or with chromic acid. Although these vegeta 
tions usually appear in childhood and disappear about ado-- 
lescence, there are exceptions. I have two patients under 
treatment at present, in one of whom the trouble did not 
appear until he was twenty-one or twenty-two years of age; 
and in the other, a young lawyer of Richmond, who has suf- 
fered from nasal stenosis more or less all his life, and although 
nearly thirty years old, I discovered post-nasal vegetations to 
be the'cause of his trouble. Their removal with forceps and 
cautery is resulting in a very rapid recovery. But even if it 
were true that they always disappeared about adolescence, 
the fact that their presence may interfere with ventilation of 
the drum, or may keep up the catarrhal condition that, by 
extension to the drum, will produce "deafness," is sufficient 
ground to insist on their early extirpation, because the deaf- 
ness may in time become incurable from the radical changes 
that would take place in the tube, drum, and drum-head. 
In all post-nasal operations, except in small children, I tie 
up the palate, as above suggested, so as to see as much as 
possible what I am doing. We cannot watch the cutting 
forceps when applied, but we can see very well where to 
apply them. In using the snare, however, or galvano-cautery 
knives or points, I can see the instrument the whole time; 
and the same may be said of applying chromic acid, which I 
generally use to the stumps of any growth after operation. 
No other caustic I have ever used has given me such entire 
satisfaction as chromic acid, because it has a decidedly caustic 
effect on the parts, does not spread when properly applied, 
and is almost free from pain. If there is any marked pain, 
it is instantly relieved by a warm-water douche or applica- 
tion. That, when improperly used it may produce symptoms 
of poisoning; or, if swallowed, will cause irritation of the 
stomach and vomiting; or, because workers in bichromate 
of potash sometimes have ulceration of the nasal mucous 
membrane and perforation of the septum, are no objections 
to its proper and judicious use. Poisoning from its use is 
easily prevented by carefully touching the parts with warm 
water as long as the water becomes tinged. A simple warn- 
ing to the patient not to swallow during the application is 10 
sufficient to prevent its entrance into the stomach; and as to 
the ulceration and perforation of the septum, we have the 
same results among workers in arsenic and in the manufac- 
ture of feathers and mirrors from the use of bichloride of 
mercury. In fact, anything that causes ulceration of the 
mucous membrane over the septum will produce a perfora- 
tion, because the cartilage derives its nutriment from its 
mucous covering; but the perforation is limited in extent 
and no deformity results. If such workmen would wear 
cotton or wool pellets in the nostrils, there would be no such 
result from their work. All persons working where there is 
irritating dust or fumes should wear such pellets as a propha- 
laxis against catarrh and its complications.* 
The treatment of the deafness resulting from these various 
causes should be conducted on ordinary otological princi- 
ples-cleansing of the naso-pharynx by antiseptic sprays, 
with appropriate applications to combat the catarrhal condi- 
tion; inflation of the drum cavity by Politzer's bag or by the 
catheter; internal medication, according to the accompanying 
symptoms and constitutional affections; regulation of the 
digestive and uterine functions; and sometimes change of 
scene and release from work and mental worry. But it can 
be readily perceived that without first relieving the nasal 
obstruction by operative interference, we can not apply these 
principles of treatment. We can not apply cleansing sprays, 
nor use Politzer's bag, with any satisfaction, and frequently 
we cannot even pass the catheter. 
The cleansing sprays I use are composed of Listerine'7 
made by Lambert & Co., of St. Louis, Mo., diluted with an 
aqueous solution of bicarbonate of soda-one part to six. I 
consider Listerine a very valuable agent, because of its anti- 
septic and stimulating influence upon the mucous membrane. 
" Chloral-thymol," made by Mr. Blair, a chemist of Rich- 
mond, diluted in the same way, is also valuable, and the 
same may be said of carbolic acid, which I usually employ 
in the form of " Dobell's Solution." The two former are 
*1 have also been using chromic acid as an application to pappillomatous 
growths in the larynx for several years. In enlarged tonsils, however, I have 
tried it to no purpose. 11 
pleasant applications, and both are undoubted germ de- 
stroyers-a fact of some importance in the selection of 
cleansing applications in catarrh. In some cases I spray the 
parts with a mixture of fluid Cosmoline and oil of eucalytus. 
After a thorough cleansing of the naso-pharynx, I make 
use of Politzer's bag in both suppurative and non-suppurative 
ear trouble;-in the former to drive out the secretion from 
the drum cavity into the external meatus, when it can be 
readily removed, and the ear packed with boracic acid pow- 
der; in the latter, to prevent or break up intra-tympanal ad- 
hesions. I use the compressed air apparatus to produce 
more forcible inflation when the ordinary pressure from a Po- 
litzer bag is not sufficient to affect the adhesions. 
In some cases, especially where intra-tympanal secretion 
can be diagnosed with certainty, or even when the symptoms 
and appearances lead me rationally to such a conclusion, I 
perform paracentesis of the drum-head and wash out the 
drum cavity. In more advanced cases, when no change in 
the hearing or the subjective symptoms results from the 
naso-aural treatment, if there is distressing tinnitus and gid- 
diness, I have resorted to "tenotomy of the tensor tym- 
pani," but with little expectation of improving hearing. I 
only do it as a last chance when all other means fail me to 
relieve the noises or giddiness. 
The following cases are added in exemplification of the 
facts stated in this paper: 
Case 1. Fibroid of Septum Completely occluding Left Nos- 
tril, with accompanying Left-sided Deafness.-A colored wo- 
man about fifty years of age came to the Eye and Ear In- 
firmary November, 1883, complaining of difficulty of breath- 
ing through the left nostril, with noises in the head and deaf- 
ness in the left ear. The nostril was perfectly occluded by 
a smooth ovoid red mass, firm and resistant to the touch; 
the post-nasal mirror showed the mass just within the post- 
nasal opening, extending outward from the septum and 
pressing on the anterior lip of the Eustachian tube. After 
considerable difficulty, I succeeded in passing a wire around 
it, and by careful traction with a Jarvis instrument I suc- 
ceeded in cutting through it. I was obliged, however, to 
remove the tumor with a hook, as it fitted so tightly in the 
nostril. It was as large as a hickory-nut, and was attached 12 
by a broad base to the back part of the septum. Micros- 
copic examination showed it to be composed of dense fibrous 
tissue. Cauterization of the place of attachment with chromic 
acid, and treatment of the aural trouble, resulted in a perfect 
cure. 
Case 2. Aural Disturbance, Eye Trouble and Anomalies of 
Sensation in the Cheek due to Rhinoliths.-Mrs. F , forty- 
eight years of age, came to me some months ago, complain- 
ing of general discomfort on the right side of the face and 
head. She had for a long time suffered with alternate numb- 
ness and neuralgia of the right cheek, with occasional tin- 
nitus aurium and slight defect of hearing, and with disturb- 
ance of vision and discomfort in the right eye. She had 
recently consulted an oculist in Baltimore, who prescribed 
glasses and some internal treatment. She could see better, 
but still had more or less discomfort in the eye. In my 
routine examination of the nose, I noticed a considerable 
stenosis of the right nostril, due to what seemed to be a 
swelling on the floor of the nostril, and to a projection or 
outgrowth from the cartilaginous septum, just above the 
swelling, the twro abnormalties completely blocking the lower 
meatus. I first cut down through the mucous membrane 
covering the swelling on the floor, and my knife grated on 
a hard body. With probe and forceps I succeeded in enu- 
cleating what looked more like a piece of slag from an iron- 
furnace than anything else, weighing 14 grs., and which I 
took to be a rhinolith. In like manner I cut in and removed 
the projection from the septum, which proved to be a similar 
body, weighing 5 grs. Both seemed to be encysted or sac- 
culated, as it were, with a growth of healthy-looking tissue 
over them. Their removal, followed by a two-weeks' after- 
treatment, resulted in entire relief of all the symptoms, which 
have not appeared to this date. 
Case 3. Naso-pharyngeal Tumor causing Complete Nasal 
Stenosis on Both Sides and Chronic Suppurative Aural Catarrh. 
T. F , twenty-one years of age, came to see me last June, 
to be treated for obstruction of the nose, associated with sup- 
purative aural catarrh. The nasal obstruction had existed 
for about eight years, gradually growing worse. After nasal 
stenosis was established, he had frequent attacks of slight 
ear-ache and deafness, which developed into a chronic dis- 
charge from both ears. Anterior rhinoscopy showed both 
nostrils to be occluded by a firm red mass, which seemed to 
project into the nasal passages from the post-nasal space. 
On the right side examination with a probe could be made, 13 
but any such attempt in the left nostril was followed by pro- 
fuse and alarming haemorrhage very difficult to arrest. Pos- 
terior rhinoscopy revealed the whole post-nasal space above 
the level of the soft palate to be completely filled by a smooth 
reddish mass, somewhat larger on the left side, and tapering 
off to the right, where the posterior part of the vault could 
be seen. After several ineffectual attempts, the wire slipping 
off each time I applied it, I succeeded in getting Jarvis' 
snare around the mass through the right nostril, and by 
keeping it close up to the septum, succeeded in cutting off a 
piece about fhe size of a hazel-nut, which re-established 
vreathing through the right nostril. I then discovered the 
bomer to be driven considrably out of the median line by 
pressure from the left, thus narrowing the right post-nasal 
opening. I discovered that what I had removed was merely 
a projection, lapping around the posterior aspect of the 
vomer, from a tumor growing from the left side of the naso- 
pharyngeal vault, the major part of which was tightly wedged 
in that side of the cavity, and passing into the left nostril. 
Every attempt at putting a snare around it was unsuccessful, 
and followed by dangerous haemorrhage. So I tried to 
shrink it with the galvano-cautery by burning grooves in it, 
both anteriorly and posteriorly. After several applications 
this was succesful to such an extent as to enable me to pass 
the wire snare of the galvano-cautery around it and cut it 
through close up to the vault, with the wire at a red heat. 
I think he may be saved from a return of the growth by an 
occasional application of the cautery to the seat of the tumor 
until complete healing has taken place. But the noticeable 
feature of his case, in exemplification of the statements in 
this paper, was that his deafness and ear trouble, which had 
formerly been intractable to treatment, disappeared rapidly 
after nasal breathing was re-established. _ 
I could offer many other cases in point among those'more 
commonly met with, but preferred to record the above three, 
as they are somewhat uncommon. 
410 E. Grace St., Richmond, Va. LITHIA WATER 
The Great Specific for Bright's Disease of the Kidneys, the 
Gouty Diathesis, Stone in the Bladder, etc. 
BRIGHT'S (CHRONIC) DISEASE OF THE KIDNEYS.-Case of Mr. , 
of Virginia, stated by Dr. G. Halsted Boyland, late Prof. Surgery, Balt. 
Med. Col., late Surgeon French Army (Decorated) Member Am. Med. Asso. 
" Mr. suffered with Chronic Bright's Disease of the Kidneys. The urine contained 20 
per cent, of Albumen, and was heavily loaded with casts. There were decided symptoms of Ure- 
mic Poisoning, intense frontal headache, double vision, flushed countenance, general nervous irri- 
tability, and well marked Cerebral Hyperemia. 
"In this condition he was sent to the BUFFALO LITHIA SPRINGS, where he remained five 
weeks, drinking from eight to ten giasses per day of the water of Spring No. 2. At the expiration 
of this time the amount of Albumen was reduced to a minimum, no casts could be discovered, there 
was an entire disappearance of the other threatening symptoms described and complete restoration 
of the general health." 
BRIGHT'S DISEASE OF THE KIDNEYS, GOUT, AND STONE IN 
THE BLADDER.-Case of Mrs. , stated by Dr. David E. Smith, of 
Bronxville, Westchester, New York : 
" Mrs. was subject to severe attacks of Gout, a consequence of an inherited Gouty Diathe- 
sis, followed after some time by Stone in the Bladder. The limbs were very (Edematous, so 
much so as to pit readily on pressure with the finger, leaving an indentation long after its removal. 
The urine was loaded with the Urates and twenty-five per cent. Albumen, and the microscope 
revealed Casts, showing unmistakably, as I thought, Bright's Disease of the Kidneys. I pre- 
scribed the BUFFALO LITHIA WATER, Spring No. 2, which afforded prompt relief in the Gouty 
Affection, and resulted, in a few weeks, in the passage of a Stone three-eighths of an inch long 
by one-lourth of an inch in diameter. Under the continued use of the water the urine has been 
relieved of Albuminous Impregnations, and restored to a normal condition; no Casts can be dis- 
covered; the (Edematous condition of the limbs has been relieved, and the general health of the 
patient, to a great extent, restored." 
BRIGHT'S DISEASE OF THE KIDNEYS, UREMIC POISONING, &o. 
A case stated by Dr. John W. Williamson, Boydton, Va. 
"Several years since, when a resident of the State of Tennessee, my wife suffered from well-defined 
Bright's Disease of the Kidneys, resulting in Urtemic Poisoning. After a signal failure of 
every remedy suggested by several eminent medical men, and when her condition was regarded as 
well nigh hopeless, trial was made of BUFFALO LITHIA WATER, Spring No. 2. The result was 
relief from the threatening symptoms so prompt and decided as to be almost incredible to any but 
an eye-witness. 
" She continued the use of the water for several months, making a complete recovery, having no 
return of the malady, and is now in good health. 
"I will add that in diseases of this character I know of no remedy, either among Mineral 
Waters or Medicines, at all comparable to this Water. 
BRIGHT'S DISEASE OF THE KIDNEYS.-Case of Mr. , stated by Dr. 
Z. M. Paschall, Oxford, N. C., Member of Medical Society of North Carolina. 
" I spent the summer of 1880 at 'the BUFFALO LITHIA SPRINGS, and while there witnessed 
the marked beneficial action of this water in a case of Bright's Disease of the Kidneys. Mr. 
, the sufferer, reached the Springs in a condition of emaciation and extreme exhaustion. The 
Urine was heavily charged with Albumen, and its specific gravity decfdedly below the healthy 
standard with general (Edema and Comatose symptoms. In three weeks there was evident im- 
provement, which continued during a stay of two months at the Springs, the Urine becoming free 
from Albumen, natural both in appearance and quantity, and regaining to a great extent a healthy 
density and a disappearance of the Dropsical symptoms. In the meantime there was great im- 
provement in the general health, the patient gaining some twenty-five pounds in weight, and leav- 
ing the Springs in a comfortable condition." 
Water in cases of One Dozen Half-Gallon Bottles, $5.50 per case. 
Springs Pamphlet sent to any address. 
PURCELL, LADD & CO., - Richmond, Va. BX.AIR'S 
CHLORAL THYMOL. 
Is an active Germ-Destroyer and a thorough Deodorizer. 
It contains no violent poison. 
It has an agreeable odor. 
Its mode of use is simple. 
It can be applied with safety to diseased cavities and surfaces. 
It has given entire satisfaction as an antiseptic and deodorizer 
in lying-in rooms, in gynaecology, in surgery, and in cases of 
cancer and urinary overflow. 
It has been used with marked success in preventing the spread 
of scarlet fever and diphtheria. 
In typhoid fever, erysipelas, and small-pox, its use is valuable, 
not only in helping patient but in protecting the attendants. 
For promoting the comfort of sick rooms and arresting the prog- 
ress of contagion, it is probably the most efficient, conve- 
nient, and elegant article in use. 
Space allows an allusion only to certificates we have received from physicians: 
Dr. T. B. Ward, St. Vincent's Hospital, Norfolk, says: "I have used your dis- 
infectant at St. Vincent's Hospital with great satisfaction." 
, Dr. W. 0. Baskerville, Oxford, N. C., " has used Blair's Chloral Thymol in 
puerperal cases with a great deal of satisfaction; has found it to be an efficient 
deodorizer and antiseptic, and a good prophylactic against puerperal fever." 
Dr. G. W. Harris, Richmond, Va., says: "It is a most effective and agreeable 
preparation for elegant purification of apartments occupied by the sick, and espe- 
cially serviceable in cases of fever and contagion." 
Dr. C. H. Chalkley, late Physician to the Small-pox Hospital, says: "In the 
treatment of small-pox I have used Blair's Chloral Thymol quite extensively. In 
removing bad odors from the rooms, clothing and person it is excellent. It seems 
to act chemically upon bad odors, destroying them and not simply disguising 
them." 
Dr. William Perrin Nicolson, Professor of Anatomy and Dean of the Faculty 
Southern Medical College, Atlanta, Ga., says: "The preparation (Chloral Thymol) 
has the advantage of being itself not unpleasant in smell, and it seemed to be 
of benefit to the skin of my hands. * * * Again, I repeat that I know of noth- 
ing that has so well served to overcome the odor of dissecting hands as your 
prophylactic and disinfectant." 
From Hunter McGuire, M. D. : "Blair's Chloral Thymol is the best disinfec- 
tant that I have ever used." 
Dr. John R. Wheat, Medical Superintendent Retreat for the Sick, Richmond, 
Va., says: "As a prophylactic in epidemic contagiums I believe it to be of very 
great value, not only in protecting attendants (nurse and doctor), but in the treat- 
ment of the disease and arresting its ravages. I used it in the fever ward with 
three well-marked cases of typhoid, and I believe with decided effect." 
Dr. Jacob Michaux, of Richmond, says : "I have used Blair's Chloral Thymol 
Disinfectant in all the cases of scarlet fever treated within the last year, and I 
have treated a good many, and have not had a second case to occur in any of the 
families. " 
PURCELL, LADD & CO, - Richmond, Va. WOW-MAP WATER. 
DIURETIC, ANTI-DYSPEPTIC. APERIENT. 
The attention of the Medical Faculty is called to this Water and the Testimo- 
nials published below. It is offered to the public in the full confidence that it will 
be found a valuable remedial agent in the class of diseases which its analysis 
indicates. The low price at which we have placed it upon the market brings its 
use within the reach of all classes of patients. 
PRICE, 25 Cents per Gallon. 
PACKAGES EXTRA, as follows, viz.: Patent Boxed Demijohns, 
packed, ready for shipment-1 gallon, 85 cents; 2 gallons, $1.15; 3 gallons, 
$1,50; 5 gallons, $1.80. 
The water will be supplied to consumers, who furnish their vessels, as hereto- 
fore, but they must send them properly packed, otherwise they will be charged 
for packing. 
Of all the Lithia Waters found in Virginia, none yield more satisfactory thera- 
peutic results than the "Wolf-Trap," supplied by Purcell, Ladd & Co. Its diu- 
retic properties are greater by half than any other known to me. It is a most val- 
uable agent in the treatment of Dyspepsia, Albuminuria, and all forms of Kidney 
and Bladder derangements. Only yesterday a lady told me that when suffering 
from " flatulence after eating," a single glassful would relieve her like magic. 
George Ross, M. D., 
June 1, 1881. 701 East Franklin street, Richmond, Va. 
Richmond, Va , June 30th, 1881. 
Having used the "Wolf-Trap" Water freely with my patients and in my family, 
I desire to place on record my appreciation of its marked virtues in digestive trou- 
bles and affections of the kidneys. Among the many cases I might quote, I recall 
that of the poor patient, Simon Gladman, who was suffering from cancerous 
disease of the stomach, and whose praises of the Water were loud and repeated, 
as it soothed his suffering and prolonged his life-enabling him to take and retain 
nourishment, which, without it, would be rejected by the stomach at once. 
Very respectfully, John Knox, M. D. 
Messrs. Purcell, Ladd & Co. : Dear Sirs,-In response to your inquiry, I would 
state that I have used the "Wolf-Trap" Lithia Water a great deal, and esteem it 
very highly in dyspeptic troubles. It is also a fine diuretic, especially in cases of 
irritation of the bladder from sympathy with uterine or rectal troubles. 
I am, very truly, yours, &c., J. N. Upshur, M. D., 
615 Franklin street, Richmond, Va. 
PURCELL, LADD & CO., 
Agents for Virginia Springs Water. 
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