This is also removed and a fresh piece of cotton with the adrenal solution is again pressed against the tissues for another five minutes, and when this is removed it will be found that the parts are perfectly bloodless and totally nines thetic. The operation can then be read ily performed. The duration of its effect depends much upon the method of appli cation. The majority of cases will show some antemitt of the mucosa from one to five hours after the application of the drug. It has no anmstlietie influence, but it tends to prolong the antesthesia of cocaine when combined with that drug. Seymour Oppenheimer (N. Y. fed. Jour., Aug. 18, 1900).
The nasal tube in the wide nostril is not needed more than a day or two, but is kept in the narrow nostril for two weeks.
There is apt to be a slight rise of tem perature the second and third days, and possibly an acute pharyngitis. This operation should not be performed less there is external deformity svhich needs correction. It should rarely be performed if sufficient breathing space can be secured by excising a portion of the septum.
Perforation of the septum in adults not regarded as a serious accident, be cause the supporting structures of the nose are developed and will maintain their position. Ilut in children, Idiere thc nasal structures are imperfectly de veloped and still in the process of growth, perforation of the septum is quite liable to cause II in or de pression of the top of the nose, and par ticularly in the earl ilaginous portion. 'rho intentional perforation of the sep tum, because it is deviated or deformed, should never be resorted to. (1. 1Z00 (N. Y. :Mod. Jour., Dec. 1, '1141.
Perforations of the nasal septum, situ filed near the posterior edge of the car tilage of the septum, and of not too great a size, are seldom of any serious pathological import:Hire. im elass of perforations, however, whielt is deserving of more attention than bag — • • 1 e lvt it en to : the It s• \tensiNe injurie• some irodutttl the etitir•c of opera •••• the -t punt], and in\ olving t -tante in the %timer. Snell an 1., -it is apt to occur during the at ' •• '''L " 1V11101.11 Illcall, 01 till. SaIN• N% • at appear, to be a septa! ridge, but - ••tt i- sharp horizontal de •it fi ot an unusually thin septum.
stead of 11 Flip.' 1011g 1..11t1\% opening. parallel with the floor ••t tte nose. is made between the MO (.1.N it IC,. 111 several eases coming
• 14 rsonal obscrNation in which thi ut occurred. the patient suffered it •risel mptoms of general shock. elute out of proportion to the apparent importance of the injuries inflicted. Dela an f.lour. of Laryn., Feb.. '95).
Two hundred operations for deviated septum performed by Asch's method. )1 these eases, S5 per cent. resulted in the eomplete straightening of the sep tum, while in the remainder some degree delleetion 1N-as retained, but in no ease was this sufficient to cause any steno-is or discomfort; so that in all a cure may be said to have followed, as far as symptoms arc concerned. Perfo rations of the septum occurred in about 2 per cent. of the cases, but they were idy of the size of pin-heads. Mayer • Med. Rec., Feb. 5, '0.•>).
New operation for deviations of the na-al septum consists in sawing a 15 •11aped dap around the deviation, base ipw:.rd, then pushing that flap upward into the unobstructed passage :SO as to rerk the resiliency of the cartilage.
thrn allowing it to drop down over thf- opening like a trap-door. No sup . rt by pins or tubes has usually been required. E. P, Gleason (Phila. Poly linic, No. 34, simplifed operation—a combination f those of Hobert; and Moure. After •-inizing both sides of the nasal sep tum a stout darning needle is introduced, into the free nostril and passed throngh the septum on the concave side anterior to the concavity. Having passed through to the other side iL is then used as a lever to press back the convex part into the eonr.ave side. and is then passed back through the septum so as to retain it in this position. Nitrous-oxide gas is now administered and Moure's shears introduced; the cartilage is cut through horizontally below the deflection, and then obliquely in front of it and above it, parallel to the ridge of the nose, the incisions not meeting below and in front. The cartilage is then manipulated at the incisions so as to encourage overriding, and the needle is left itt sib/ for a week, a piece of rubber tubing being placed over it, to lessen the pressure on the soft parts in front. When the deflection is accompanied by any considerable amount of thickening. this should be shaved off beforehand, preferably at an interval of a couple of weeks, though it may be done at the time. Dundas Grant (Brit. Med. Jour., Ang. 30. 190'2).