A DUE appreciation of the importance and results of intra- nasal surgery, and the duty incumbent upon us as practitioners of medicine to render to our patients the most efficient service in the most efficient way, prompts me to say a few words in reference to the reduction of hypertrophied tissue in the nasal cavity and pharyngeal vault. The methods heretofore employed have been those of the snare; actual cautery, or chemical cauterization; and while useful, and in many cases necessary, they do not fill the requirements of all cases.
There are many instances coming under our notice in which we realize the importance for a reduction of hypertrophied tissue, but do not think best to operate. In this very cases I have found a treatment, namely, massage, midway, as it were, between operation and cauterization to be of great advantage.
As a result of nasal stenosis, we necessarily have a turgescence of the vessels which supply the mucous tissue. Hyperaemia means increase of nutrition, loss of tonicity of the vascular walls, and thickening of the intra-venous structure, all of which, sooner or later, means true hypertrophy. Just at this stage does massage win its greatest laurels, although I believe it to be available in the later stages.
The effect of massage is to produce a stimulation of the capillaries, thus restoring in part the normal condition of the tissues. Clinically, as a result of this rejuvenation of the tissues, we find cataracts disappear, old ulcerations heal, neuralgia relieved or cured, stiffened joints made supple, and deposits and thickenings absorbed. That the effect of massage is to produce absorption, may be proved by the experiment of von Mosengeil. Mosengeil, taking a number of rabbits, injected into the knee-joints of each a solution of India-ink.
At intervals massage was practiced upon the right knee, while the left remained untouched. After twenty-four hours the animals were killed, and the parts inspected. The left knee-joints were distended with fluid, while the right side, which had been manipulated, showed an entire disappearance of the substance injected. The lymphatics on the right side, however, were filled with particles of India-ink, while the corresponding side revealed no such appearance. The evident conclusion is, that massage produced absorption.
Gerst, who has given the subject of massage considerable attention, reports a number of cases of naso-pharyngeal-catarrh, etc., which have been cured, and claims for the manipulation a decrease of redness and tumefaction of the mucous membrane, a disappearance of heat and pressure, and relief from the embarrassed respirations-a most important object to attain.
It is not my purpose to prolong this paper by, the relation of cases treated by me, and the effects produced; it is sufficient for the present to say that, although my experience has not been as extensive as it might have been had I improved the opportunities presented, nevertheless I am sufficiently pleased to recommend it to the members of the Congress. At present the instrument used by me is a probe nine inches long, and three-sixteenths of an inch in diameter at the handle, tapering to a point one-sixteenth of an inch in diameter, which is surmounted by a bulb. The method of manipulation consists of a series of short, quick raps against the mucous membrane, aided by a slight rubbing movement.
Sneezing at once occurs, and is to be prevented by pressure on the upper lip. Tolerance is, however, effected usually by the second or third sitting. One of the greatest, difficulties standing in the way of the use of massage or three minutes, and the operator gives up in disgust. It has occurred to me, as well as to others, that an attachment could be readily made to the Garey vibrometer, by which these movements would be regular and graduated, and rendered much more effective. Such an attachment has been recommended to the vibrometer company, and they have seen fit to adopt it, with a promise of its early appearance.
What I claim for massage of the nose and throat is not a cure in all cases, but in that class of cases, in which connective tissue, changes have not undergone great alterations, but where, as yet, there is hyperaemia of the parts, with consequent turgescence. I trust the importance of the subject will appear to you to be sufficient to induce further inquiry and investigation; if so, I shall have accomplished the purpose of this brief paper.
