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The Rabbi now wiped the infant's genitals and neighboring parts with a napkin, and the penis itself with the carbolic solution, using considerable care in getting it clean.
The prepuce was pulled well down over the glans, and the instrument for the purpose of holding it placed in position. One quick cut of the sharp knife did the work, and the shortened prepuce was pushed well back upon the penis, the sponge of vinegar and water being at once applied over the whole with the right hand, while the left grasped the penis firmly at the frænum. Application of the tincture of arnica was next made, and the bandages slowly and carefully applied in a circular manner, the glans being left uncovered.
The bandaging being satisfactorily done, the child was placed upon a napkin, folded in a triangle and applied in the usual way. Another napkin was bound around over the first to keep the whole in place. The cloths from the glass of water were then placed over the penis, and the operation itself was over.
There was a gold-embroidered scarf which various ones wore during the ceremony; but up to this time at least they seemed to feel free to converse on any subject, as the youth who held the baby gave his opinion of certain plays which he had attended.
Another man now put on the scarf and held the baby while a glass of beer was given to the Rabbi, who held it in one hand and a book in the other; and standing before the child he chanted away at a break-neck speed, with more or less assistance from the others, though their efforts were dwarfed by his, decidedly. At length the Rabbi, who had at the beginning of this part of the ceremony wet his right forefinger in his mouth (whether to turn the leaves of his book, or for some occult purpose, I do not know), dipped this finger in the beer and placed it in the child's mouth, after which the man with the sugar-teat did his duty. Amidst the chanting of the assembly the child was conveyed by the principal to the arms of a woman, who retired with it, and the ceremony was over. The principal, the fat youth, and the Rabbi retired, while the rest of the company sat down to a table spread with cake and liquors. Of these good things I was cordially invited to partake; but I satisfied myself with a small piece of cake, and, on the plea that professional business demanded my attention, I begged to be allowed to withdraw. They very kindly excused me from further attendance, though evidently much distressed on account of the pleasures which I was obliged to forego.
I was much pleased to have had the opportunity to witness so ancient a ceremony, and to observe that it had not escaped the antiseptic tendencies of the age.
STENOSIS OF THE NOSE.
BY D. G. WOODVINE, M.D., BOSTON, MASS. [Read before the Massachusetts Homeopathic Medical Society.] Stenosis of the nose we understand to be a narrowing of the nasal passage below the normal size, even to occlusion.
There are a variety of causes which may bring about a narrowing of the post-nasal passages, while another train of causes may produce an occlusion without a narrowing of the passages. One cause of narrowing of the post-nasal passages may be said to be the too early removal of the primary incisor' teeth of the upper jaw. This may be done accidentally, or through ignorance. It is true that a child may accidentally fall and knock out two, three, or even four of the upper primary teeth, and, as a consequence, we may have a contraction of the jaw, and on the appearance of the secondary teeth they will overlap each other, or else they will come in sidewise. Again, it may be induced by the too early removal of the teeth, when they decay early, and parents think that they are unhealthy if allowed to remain, and consequently insist on having them removed, frequently in spite of the advice of the dentist to the contrary. When the teeth loosen early, ignorant and meddlesome persons sometimes take upon themselves the important duty of removing them. These unfortunate circumstances are all likely to occur to children during the period of primary dentition. Similar accidents may also occur occasionally during the early period of second dentition, for even in the latter case the patient has not arrived at maturity, and there is likely to be a contraction of the upper jaw and a narrowing of the roof of the mouth, making a deep groove in place of what would otherwise be a broad and flatter surface. It is patent what would be the effect upon the nasal passages where such an accident occurred. The perpendicular capacity of the nares would be reduced as well as the lateral diameters, which would materially interfere with the breathing capacity of the nose.
Direct blows upon the nose may result in deviation of the septum to a variety of extent. The most common form of deviation of the septum is the S-shaped, or bulging out of the septum to one side or the other, closing, practically, the nostril in which the bulging occurs. This is practically a temporary occlusion, which may be temporarily removed by forcing the end of the nose around in the direction of the bulge, when the air will readily pass through the nostril, as long as the end of the nose is held in this position.
Temporary tumors of the septum may occur, so says Choin, On Diseases of the Throat, as a result of blows upon the nose. These
are of an ecchymotic character, which, if properly and early treated, are not likely to last long. The colloid tumor of the septum is of a jelly-like character; but, like other tumors, obstructs the nasal cavity, and thus narrows the breathing capacity of the nose. Cartilaginous tumors, or hypertrophy of the septum, may occur as a result of injury to the nasal septum. Obstructions to the nasal cavity, called foreign bodies, are sometimes of a very serious character. These may be divided into two classes ; one consisting of bodies introduced from without, and the other consisting of calcareous concretions in the nasal fossa.
Edema of the septum, as described by Choin, may become a means of decided narrowing of the nasal passage.
Tumors of the nasal passages, such as polypi, single or multiple, may so obstruct the nasal passage as to greatly interfere with nasal respiration ; not by narrowing the passage, but by either partially filling up the passage, or by packing the passage so that it is completely occluded. The polypi, which are found in the nasal cavity, are of the mucous or gelatinous, fibrous or granular character. Another variety are the malignant tumors, which are not as common.
Occlusion of the posterior nares may be congenital, as reported by Choin and Dr. Carl Emmert, who had each a case in his practice. We have seen one case of occlusion of the posterior nares resulting, according to the statement of the patient, from a very severe attack of acute pharyngitis, in which the veil of the palate and the soft palate became adhered to the posterior wall of the pharynx. In this case there was not a particle of air that passed through the nose into the pharynx. In another case there was a very small, opening, the veil of the palate being adhered. A third case was evidently the result of secondary syphilis. In this case there was destruction of the tonsils and the pillars of the fauces, and mostly all the soft tissues of the pharynx. Where the soft palate should have been there was an aperture about the size of a buck-shot, and this was closed up by a false palate, which some ingenious dentist had devised to aid the young man in talking. This last case was one of the most remarkable that we ever witnessed. In all these three cases it was distressing to see them attempt to remove any secretion from the nostrils, especially in the case of complete occlusion of the nares.
Adenoid growths in the posterior nares, or on the posterior wall of the pharynx, may greatly interfere with nasal breathing; also very much hypertrophied tonsils. In these cases there is great distress in breathing at night, when the patient is asleep. The patient lies with the mouth wide open, because he cannot
breathe through the nose at all when lying down. The result is that, after the patient has been asleep for a few moments, the mouth and throat become dry, which gives rise to feelings of great discomfort, uneasiness and involuntary muscular demonstrations, which finally result in awakening the patient, and frightening the parents, so that a perpetually anxious feeling exists in the mind of the attendant during the whole night. The patient no sooner gets over one attack than he falls asleep again only to repeat the same experience. The writer has known of several cases where the child has been a constant source of anxiety for a period of five years, during which time the parents said that they had not experienced a single night of perfect rest such as people ordinarily enjoy. Such cases demand prompt treatment to relieve the patient; also for the sake of the parents. Where there is hypertrophy of the tonsils in the worst form, that is where they are enlarged to such an extent that they are brought into close proximity in the median line, there is no way of making an examination of the posterior nares by means of the rhinoscope, and, consequently, the adenoid growth may for the time being be overlooked. The method of treatment followed in the college dispensary is, first, to remove the tonsils by means of the tonsillotome, then let the parts heal; after which, if there be no relief from the difficult breathing, you will be almost sure to find adenoid growths in the posterior part of the pharynx or nares. If they are found on the posterior wall of the pharynx they can be most readily removed by the finger nail of the index finger of the right hand, or by the use of the post-nasal forceps. If they are in the posterior nares, or some other growth is obstructing, they are best removed by means of the écraseur, nasal forceps, or nasal scissors.
In cases of accidental closing of the posterior nares by adhesion of the veil of the soft palate and the soft palate itself, the passage may be easily reopened by passing a bougie through the nose from the front to the posterior portion until the curved end may be seen pressing against the pharyngeal obstruction ; then the curve-pointed bistoury, with the cutting edge protected by means of adhesive plaster, leaving about a quarter of an inch at the point uncovered for use, firm but gentle pressure being made upon the bougie in order to make its presence prominent behind the adhesive veil; just below this point, the point of the bistoury should be pushed through the tissues, in the direction behind the end of the bougie. The opening should be made only large enough to allow the end of the bougie to pass through ; then the tisues may easily be dissected upon either side, or on the side through which the bougie has been passed, when the bougie may be removed and passed into the other
nostril, and the other side dissected up in the same manner as the first. When the tissues are thoroughly dissected up, the parts should be kept separated by means of pledgets of lint drawn up into position by means of the Belocques' canula, in the same manner as in plugging the nostrils for epistaxis, the ligatures attached being tied together in front of the septum.
In the case of secondary syphilis there was so large a destruction of the parts that an operation was not considered advisable. In this case, as before stated, the opening through the posterior nares was about the size of a buck-shot, and this was closed by means of the artificial palate. This was held in place by a hardrubber plate, in which there was an air chamber for suction ; and while this was worn the patient could talk quite well, but could not breathe through the nares, which made him appear very awkward. This difficulty was overcome by drilling a hole through the hard-rubber palate, about the size of a post-nasal aperture, which did not in the least interfere with the air chamber, and consequently was a great blessing to the patient in allowing the air to pass through the nares during the process of talking
Edema of the nasal septum may be relieved by puncturing the mucous membrane of the septum, and following the operation with occasional doses of apis mel. internally.
Tumors of the septum resulting from accident, such as severe blows upon the nose, have required puncturing, and the application of a weak dilution of arnica or calendula, as the case might require.
Tumors of the nares, such as mucous polypi and fibroids, we have been able to remove by means of the nasal forceps or the écraseur. In regard to the internal treatment we have not been as successful. It has been our practice to give pulstilla, calcarea carb., or sanguinaria Canadensis, as we thought the case required, to prevent a return of the tumor, but without any apparent effect.
Deviations of the septum which have been the result of injury we have been able to correct by the use of the double crucial, knife, or punch. This punch is carried along into the groove of the deviated septum, and at the same time the smooth jaw of the forcep is carried behind the extreme point of bulging, and carried up well into the nostrils, then the handles forcibly pressed together, thus punching completely through the septum, then draw the knife toward us and punch again ; after this is done, take Adams' forceps and forcibly straighten the septum and maintain in position with a . plug of absorbent cotton pushed into the nostril where the stenosis occurred from the bulge.
We have found the following method the best way to prepare