lxviii INTRODUCTION
school by whom nitrate of silver was used almost exclusively in affections of the larynx for over fifty years. It was Horace Green also who empha- sized the importance of diseased conditions of the tonsil. His instru- ments devised for the removal of the tonsil are ingenious and effective and they have been extensively imitated even up to the present day.
Long prior to his time, however, operations for the removal of large tonsils by various methods had been performed in this country. Before the tonsillotome was suggested the glands were removed with a scissors or bistoury, aided by a vulsellum or tenaculum. It is said that the Ice- landers from prehistoric times have used a small ring-knife instrument for amputation of the uvula. Bell described such an instrument in his "System of Surgery," in 1783. In 1827 Dr. Physick, of Philadelphia, not only improved the uvulatome, but enlarged it for use as a tonsillo- tome. This American invention is perhaps more extensively used, especially in England, than any single tonsil instrument of the present day, under the form known as "Morell Mackenzie's modification." Nothing more satisfactory of its kind has ever been offered.
In 1832 Dr. Fahnestock, of Lancaster, Pennsylvania, devised a tonsil- lotome made upon the ring-knife principle and differing essentially from the instrument of Physick. Under one modification and another this has come into general use throughout the Continent of Europe. Thus, America has furnished the two types upon which the tonsillotomes of the world are at present modeled.
The study of rhinology was practically begun in this country. The most important contributors to it were Harrison Allen, John N. Mackenzie, Jarvis, Bosworth, Shurly, Daly, Bryan and Roe. Long before this Catlin, in 1832, basing his observations upon nasal obstruction in the American Indian, had published his classic treatise upon "Mouth Breathing." The discovery by Jarvis of the part played in nasal obstruction by enlarge- ments of the turbinated bodies marked one of the most important advances of the time. His instrument, the so-called "Jarvis Snare," designed for the removal of posterior hypertrophy of the turbinated bodies, is a remarkable exhibition of the perfect adaptation of an implement to the object for which it is to be used.
Among other contributions by Dr. Jarvis the use of chromic acid as a cauterant in the upper air passages is one of the most valuable.
About this time Bosworth called attention to the importance of ex- crescences upon the nasal septum as factors in causing obstruction and he devised a saw for the removal of septal spurs. Soon afterwards the nasal trephine was suggested by Dr. James H. Goodwillie. The importance of these improvements will be understood when it is realized that hitherto the evils of nasal obstruction had not been fully understood. Its recog- nition has been the means of preventing and overcoming many diseases
