I do not advocate the free use of the galvanocautery on the septum, but in stead, a verv carefully localized applica tion may be made at a single point to cartilaginous or bony excrescences no larger than a good-sized pea. One puncture in the centre ef such a swell ing will reduce them sufficiently.
A word should be said in regard to the important part of restoring the nasal mucous membrane to its normal smooth ness and moistness after operative work.
Connective tissue is not mucous mem brane, but it can be sufficiently polished —so to say—that the surface will not cause secretions to accumulate. Friction ten or twelve times over a granular cica trix with a disinfectant such as boro formalin or borolyptol causes the sur face to become perfectly smooth and moist.
For the reduction of anterior turbi nated swellings the snare is at present very infrequently used. In the older days intumescent enlargements were re moved by means of the transfixion needle and cold snare, but this has been proved to be unnecessary. Occasionally inferior-turbinated swellings progress until pediculnted papillary hypertrophies are present. The neck-like attachment of such swellings invites the use of the cold snare, but the scissors do the work much more quickly and painlessly, al though the bleeding is more profuse.
In the vast majority of cases, however, the condition found zit the anterior end of the inferior turbinated is of the in tumescent variety, and such erectile swellings may be reduced by applica tions of chromic acid or by the galvano cautery-puncture. In iising the galvano cautery too much caution cannot he nsed to employ it at a low grade of heat (cherry red) in erder not to destroy too greatly the part to be reduced or to scorch the neighboring tissues.
Deformities about the septum should c I fore any surgical work!,r,c;L I t.)ward the turbinated t. turbinated enlargements areN,r% quenth only the result of irrita t. ,,t I bv abnormalities of the quit].
I u rt,:ard to the posterior ends of the turbii at«I bones, there are very few soft t.--1 e lapt.rtrophies which cannot be re lli.e.1 ,ull'cientiv by means of chromic .• It is difficult to apply the snare t tl.e pstirior ends of the turbinated
s, and no one but a skilled opera t• r succtssful. Nothing is to be said in favor of the galvanocautery in this rqrion, and there is apt to be ublesiune bleeding if we use cutting ins:ruinous. When. therefore, inferior (..r turbinated hypertrophies are ' prt.sent posteriorly. as shown by the rhin)seopie mirror, a 4-per-cent. solution of cocaine should be applied to the post- • nasal pharynx and soft palate, and the self-retained palate-hook used to draw e soft palate well forward so that there ample space to allow the chromic acid to be placed upon the posterior ends of the turbinals. With the palate forward, 7he patient himself can depress his t, ngue with a spatula, while the oper athr, holding a mirror with his left hand, ..an with his rig.ht reach the posterior yr.ertrophies.. (For enlargements of the middle turbinated body SCC ETHMOIDITIS ..1 der and POLYPI in this ar t;ele.) In regard to the medicinal treatment -f chronic rhinitis there is a tendency atw.ng patients who consult rhinologists t.) overwash the nostrils. I do not mean that the nas.al passages should not be kept clean, but that in chronic rhinitis of the moist type it is seldom necessary- to use nasal douches continually twice a day for months. Constant washing, and e-peeially with stronr_dy pungent solu tions, produces an irritation which tends to prolong hypersecretion. Often have I seen very abundant secretion cease al most entirely as soon as the washing was stopped. Where the nasal discharge is very thin—almost entirely serous—as it is in certain irritable forms of chronic rhinitis, a slightly astringent powder— boric acid, subnitrate of bismuth, with a few grains of powdered alum to the ounce—will often stop the secretion and contract greatly-congested mucous sur faces.
Post-nasal -washing by skillful hands is preferable to anterior nasal douching; and next to this the nasal douche-cup, when the patient has been impressed with the importance of keeping the mouth open and not swallowing. The cheap nasal atomizers sold are frequently of no use except to force air into the nostrils.