Chemical caustics and the electrocau tery came into vogue soon after Meyer and Lowenberg recommended a purely surgical procedure. If for no other reason than the mere fact that the use of these destructive agents excite an undue and sometimes unmanageable septic reactionary effect, involving the Eustachian and tympanic structures, they should be discarded. Their em ployment is inefficient and dangerous.
Three ca.ses in which there was rapid disappearance of adenoid vegetations. The first occurred as the result of a sharp attack of influenza; a month later an examination revealed that there were no longer adenoids. The second case was similar. In the third ease an attack of influenza was also followed by the com plete disappearance of the adenoids. Nothing indicated the occurrence of local inflammation. It is therefore advisable before operating aften infectious fever to re-examine the naso-pharynx. Chau veau (France Med., Sept, 1, '99).
The operative method is universally employed at present. The instruments first devised for post-nasal adenoid oper ations were thc ring-knife of Meyer and the cutting-forceps of Liiwenberg; the latter of which, or modifications of it, are still used by many operators. -Un scientific and septic as the method may seem, the sharp forefinger-nail used as a curette, at one time quite popular, still holds a position of usefulness in the per formance of these operations. But its sphere is limited and the method cannot be relied upon for thoroughness because experience teaches that recurrence of the symptoms, in the majority of instances, is very apt to occur. liepetition of the procedure is also often necessary. It is only in those cases where the vegetations are soft and not very abundant that the finger-nail operation proves satisfactory. Its utility lies principally in the means it affords in clearing away shreds of tissue that remain after the employment of the forceps or the curette. Adenoid tissue, for example, occupying Rosenmiiller's fossw, recesses into which cutting or scraping instruments cannot satisfac torily be carried, can always be removed in this way. Sometimes after curette ment fringes of vegetations veiling the posterior nares and hanging-, as it were, from the upper margin of the choame, remain and still cause obstruction or furnish a point for redevelopment of the growth. These shreds can be more con veniently got rid of with the finger-nail than by any other means. The nail must
be made sharp and aseptic. Before pass ing the finger into the naso-pharynx it should be immersed in absolute alcohol for a few minutes, which hardens the nail and also aids in freeing it of bacteria. An artificial finger-nail constructed of steel and fitted to the finger is recom mended by some operators. The method is not practical nor satisfactory.
The form of instrument most fre quently used is Gottstein's curette. Many modifications of this instrinnent have ap peared from time to time. The curve of the blade and of the shank seems to espe cially adapt the instrument to the an atomical disposition of the parts over which it must be passed.
Every practical operator will not be content with the possession of one form only; he will bave at hand different sizes with various shapes so as to enable him to make a selection suited to the case in hand. Useful as the Gottstein curette is, still it must not be forgotten that its ap plication is not unattended with danger, especially in the hands of the inexperi enced operator.
The intent of the curette is to lift en inasse the lymphoid tissue from its at tachment by a clean, free cut. Gott stein's curette is a cutting, not a scraping, instrument. On no occasion should it be introduced into the naso-pharyngeal cavity in a dull state. Otherwise the tissues may become mutilated and a grave injury to neighboring organs or mucous membrane resnit. An accident known to have taken place is the detach ment, or stripping-off, of the mucous membrane of the pharynx.
In drawing the curette backward and downward the instrument must be held firmly and guided so as to sweep the curve unimpeded.
case ill the practice of each of the writers in which the cutting portion of a Cottstein curette hroke as pressure was made in the initial step of the operative procedure. In Dr. flolines's case, np• era ted 1111110r general amesthesia, the fragment was extracted by pressing his finger upon one end of the broken blade, so that, it became imbedded in his flesh, enabling hint to withdraw it into the mouth. whenve it WA S removed with forceps. In Dr. Ibirliek's ease. operated upon without amesthesin. the fragment was m‘allowed and passed three days later. IZ. Holmes and If. S. Carnet: ( 1.a ryttgoseope, May. 19011.