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The vast majority of Cases of Epistaxis displayed a condition of
Telangectasis in one or both "Bleeding Areas" of the Nasal septum, this
being the result of Acute and Chronic Tonsillitis and Nasopharyngeal Adenoid
excess. The condition is frequently cured by removal of such etiological factors
. . . but, as a temporary means of arresting the hemorrhage, I have found
that a small application of solid Silver Nitrate, fused on to the end of a probe,
gave the best results, and could be applied without the use of a local anesthetic,
causing very little inconvenience, or expenditure of time. A few cases have
shown a Pathological nasal septal deflection to be the chief etiological factor,
in that this causes a venous engorgement on the obstructed side.
"It was most instructive to note the mental improvement in children after
Tonsillectomy, Adenoidectomy (sometimes with Nasal Septal Straightening),
the pre operative Aprosexia and lack of attention with deafness, showing
marked diminution
"The operation of Straightening the Nasal septum by simple fracture,
using special forceps, has proved its worth, in that it has completed the cure
of nasal obstruction, already partly effected by Tonsillectomy and Adenoidetomy,
and performed concomitantly with that operation . . . adding but a few
extra moments and no increased severity to the operation. Of course, Submucous
resection must not be attempted, unles it be of a very modified nature,
as such operations on growing tissues are most unwise. In most cases simple
fracture proves sufficient.
"It is instructive to note that there is repeated evidence of the deleterious
effects on the nasal passages, the pharynx and the ears of swimming and
bathing, especially in pubic baths, unless these three regions are already in a
healthy state.
"A large number of children, suffering with Chronic Tympamco-Mastoid
suppuration, are cured by Tonsillectomy and Adenoidectomy, especially in those
cases in which the discharge is co-purulent in character, with no, or very
inactive granulations—thereby showing the absence of gross osteo-myelitis—
but rather mucosal catarrh.
"Many of the cases of Chronic Tympanico-Mastoid suppuration, persisting
in spite of non-operative treatment, show very great improvement after
Conservative Tympanico-Mastoid Drainage, with better hearing in the majority
of the patients, this often being further' enhanced by eustachian catheterisation,
with injection of a special oily solution into the tubes.
"Post-operative treatment in our Speech Clinic is proving of great value,
in that it completes the cure initiated by the removal of the causative lesions,
that have set up the pernicious habit of mouth-breathing, with all its sequele.
And it is interesting to note the beneficial effects of clear nasal passages on
the hearing and aural suppuration—for nasal obstruction is so commonly
associated with nasal catarrh—that involves the eustachian tubes and, therefore,
the tympanic cavities.
"In several cases of Acute Tympanic infection I have used systemic
injections of Penicillin, but, as was found with Sulphamilamides and their
relatives, when improvement did occur it showed itself rapidly; but this effect
was rather illusory (certain types of infection seem to be impervious to these
drugs), and the resistance acquired was but temporary, so that recourse to the
older methods of treatment was necessary. However, the number of patients
thus treated was too small to enable me to make any dogmatic statement on
this matter.
"Transillumination of the nasal sinuses, together with clinical signs in the
nasal passages and pharynx, have shown the presence of Nasal Sinusitis,
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