l:as hien written about the ad V of first taking away the mucous before excising the cartilage in ILr Not to sacrifice mucous membrane, hut thus far attempts in this direction hive not been very successful. When the nasal saw is used the patient's head shhuld be turned toward the affected -;de in order that the convexity of the ._artila,c_re may be made as prominent as possible. The beginning of the incision can be made with the saw almost at right angks to the septum. After the cutting has been commenced the s.aw can gradu ally be turned so that the teeth are downward. 'When the cut has been car ried down to the sutural line and the bone is reached, time will be saved by finishing, the incision with nasal scissors an3 removing with forceps. Thorough wa,hing of the nose before the operation r,,,ptired, but after the section has been -!orripleted it is better to keep the wound ,overed with compound stearate of zinc and boric acid for at least two or three days. Attempts to keep the nasal pas -3geS in anything like an aseptic condi t.;nn will prove a failure, and there is much more likelihood of s.eptic symp tr.ms when the nostrils are frequently v.-ashed than when the nasal wound is protected by boric acid or some other equally-g.00d germicide.
After using the powder a few days, the nasal passages.- can be washed and oiled. The scar-tissue at the point of sawing- can be made moist and slippery by resorting to mas.saging with a stimu lating disinfectant, such as boroforma lin.
I use the cautery Or chromic acid only when there are small points to be re duced. Asch's operation, in which the septum is cut through and forcibly car ried to the median line, is indicated when the partition is so thin that it can r.ot be sufficiently excised and so it be comes necessary to carry the entire sep tum in the median line. Two different shaped scissors are employed, the one to cut through the bent septum in a hori zontal line, the other at right angles to the first cut in a vertical line; the four points are then pushed through from the convex side into the concave side, so that the redundancy of tissue can overlap in the wider nostril. The entire partition is then forcibly carried to the median line with a large pair of flat-bladed for ceps, and the septum is retained with cork or celluloid nasal tubes, which can be removed daily, and the nasal passages cleaned. The bleeding is profuse when the cutting is made, but usually ceases quickly. The local application of a so lution of suprarenal extract may be used to prevent this, however.
Aqueous extract of suprarenal capsule is a powerful local vasomotor constric tor, and a contractor of erectile tissue; it is safe to use in a very considerable amount, without dangerous or deleteri ous effects locally or as regards the general constitution. These effects can
be produced any number of times with out entailing any vicious habit, either in the tissue or in the individual. It seems to heighten the effect of any drug used locally after it. In acute conges tion, it ha, its widest application and greatest opportunity for good, but iu certain chronic conditions of the hay fever type. when redundant tissue seems prone to develop, it can be relied upon. H. I.. Swain (Med. Record, May, '98).
Use of the supraienal gland, in the form of an aqueous extract freshly pre pared, advised. Ten grains of the dried gland mixed with 2 drachms of water and filtered will form a 10-per-cent.-solu tion filtrate. This aqueous extract is the most powerful astringent known. It has been of great value in treating in flammatory- conditions of the eye. For inflammation or congestion of the mu cous membrane of the ear it is of great value, as well as for inflammatory con ditions of the nasal passage. It has been used to advantage for stricture of the urethra, for certain skin diseases, for pernicious arum-ilia, for Addison's disease, for exoplithalmic goitre, and as a tonic to the heart-muscle. It is Lest admin istered by placing a feW, drops of the extract on the tongue. Bates (Med. Record, Oct. 8, '98).
In all cases where the turbinates have been cauterized with electricity the op erations have been followed without the loss of blood. Removal of spurs of the septum have become under its use prac tically bloodless. The nose is cleansed with an alkaline solution; a 4-per-cent. solution of eucaine is then applied upon a pledget of cotton, which remains in situ for five to six minutes, then removed; this is followed by a 4-per-eent. solution of the suprarenal capsules applied to the surface in like manner. W. F. South hard (Pacific Med. Jour., Nov., '98).
Suprarenal extract has two distinct actions on the mucosa of the respiratory tract: it blanches the tissue, and at the same time constringes it. The blanching effect is not so great in the larynx and pharynx as in the nasal cavities. The drug acts only on mucous surfaces, and its influence is absolutely local: no tis sues are affected except those in contaet with the drug. Personal mode of appli cation is as follows: The parts to be operated upon are covered with a pledget of cotton saturated with the adrenal, which is allowed to remain for five min utes. This is removed and a solution of cocaine or eimaine of whatever strength desired is applied in the same manner for a similar length of time.