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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

the plugs Take a fine steel probe and moisten it, and wind on the end an amount of cotton sufficient in length and thickness to completely fill the nostril, and carry it on the probe to the position you desire. This will require a little force in order to hold the septum in its proper place. After this is accomplished the probe should be given a turn or two in the opposite direction from which it was turned in winding on the cotton; this will liberate the probe, and it can be easily removed, leaving the cotton firmly fixed. Another method I have tried, which I did not like nearly as well; that is the solid ivory or hard-rubber plug, which is difficult to hold in position, and is more painful to the patient. I should have stated that this operation is performed under the influence of ether.

We have never met in practice the concretions to which reference has been made; but the foreign bodies from without have been numerous, such as shirt and shoe buttons, tacks of various sizes, bits of sponge, wads of paper, beads, peas, beans, kernels of corn, etc. A skilful use of the probe in the nares when foreign bodies are lodged there is of the utmost importance. A few months since a patient was sent to me for the removal of a polyp, and, on examination with the probe, I stated that I did not think that the child had a polyp, but that some object had been pushed up the nose. The parent was very sure that I had made a mistake, until I introduced a small-sized curette in the direction of the middle meatus, carrying it well back; then pressing the end of the instrument down upon the object, and drawing it forward, a piece of foul-smelling sponge was removed about the size of the end of my thumb. Another case of interest was a little girl who came with her mother, with the left nostril highly inflamed, and smelling badly. The nostril was examined with a fine steel probe, the end of which was protected with cotton, and we found something which showed some resistance, and which seemed to fill the passage, as the child could not force air through the nostril. After trying several times to bring the object forward without success, the mother, protesting that the child had never done such a thing as to put anything up her nose, we finally took a Belocque canula and gently pushed the object back into the pharynx, and the child spat it out. On examination, this was found to be a wad of common wrapping paper tightly rolled.

Tacks have been about the worst objects to remove, especially the large stair-carpet tack, about an inch in length; these become incrusted and fixed crosswise in the nostril, and frequently remain in the nose for a long period. The course to pursue in such a case is to take a blunt-pointed, flexible probe and try and learn the form of the object by carefully following its outline;

then disengage the point and remove with the nasal forceps. For the removal of smaller, round objects the small curette has been used more than any other instrument, and with better

success.

In cases of threatened deformity from the too early removal of the primary or secondary teeth, the case should be put under the care of a good dentist. Where the deformity has already become pronounced, proceedings should be undertaken to correct the deformity by such appliances as are used in the dental art. If these are persisted in the deformity may be wholly overcome. The reasons for the most of the operations on the nose for stenosis of the nose and the occlusion of the passages are, first, the benefits the child gains from them, in being made so much more comfortable, and in enjoying better health; second, the improvement in the voice and speech, and the better appearance in the school-room and in all public places. The child's opportunities for advancement in many directions are greatly increased by opening the nares.

GANGRENE FOLLOWING THE STING OF AN INSECT.

BY N. R. PERKINS, M.D.

[Read before the Massachusetts Homeopathic Medical Society.]

June 22d, 1889, 4 o'clock P. M., I was called to see Mrs. B., aged 30, married, and the mother of two children. From her I learned the short history of the case. About three hours previous, while she was at work in the garden, she felt the sting of an insect on the back of the neck. Soon her face began to swell, and in a short time her eyes were closed, her ears swollen enormously, features distorted beyond recognition, her hands and arms were swollen from finger tips to the elbow, but no other parts of the body were involved. By the next morning the dorsal aspect of the hands and fingers were assuming a dark, mottled appearance, also the pinna of the ears. The swelling of the face had abated a little; temperature and pulse normal. On the previous evening had prescribed lachesis, and enveloped the hands and arms in cotton, and directed that they be kept warm with bottles of hot water. This prescription was continued. On the following morning the line of demarcation had formed, beginning at the wrist joints and extending around the hands, midway between the dorsal and palmar sides of each finger, to the wrist, embracing the dorsal surface of each wrist and hand. Separation soon began, and the skin and cellular tissue sloughed off over the back of the hands and fingers. The necrosed tissue was cut away as fast as it separated. Poultices were used of slippery-elm bark, made with infusion of eucalyptus leaves. Granu

lations were healthy, and in a short time healing had completely taken place. Lachesis was given in water every two hours, until the necrosed tissue had all been cut away.

Query. Was this the sting of an insect? If so, why was necrosis of tissue caused from it? And why was the circulation cut off from this particular locality, i.e., back of hands and wrist?

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The report of the annual meeting of the Maine Homœopathic Medical Society, held June 7 and 8, has been delayed by the absence of the secretary at Washington, in attendance upon the American Institute of Homoeopathy.

This meeting of the Maine Society, marking, as it did, the completion of the first twenty-five years of its existence, the second day was given to its celebration, and the president's annual address was largely statistical, historical, and biographical. The society has been called during the past year to mourn the death of two of its members, W. S. Howe, M.D., of Lewiston, in August, 1891, and F. A. Roberts, M.D., of Waterville, in May, 1892. These are the first losses by death the society has sustained in several years. Resolutions were passed expressing the society's loss, and sympathy towards the bereaved families.

Seven physicians were elected to membership, as follows, viz., Edwin H. Durgin, M.D., of Searsport; Roscoe L. Graves, M.D., of Saco; L. C. Jewell, M.D., of Cape Elizabeth; W. Scott Hill, M.D., of Augusta; R. L. Dodge, M.D., of Portland; A. D. Bowman, M.D., of Mechanic Falls, and Arthur L. Parsons, M.D., of Bucksport.

The meeting was opened with an invocation by Rev. Henry Blanchard, D.D., followed by the roll-call, showing the presence of twenty-three members. There were also present five applicants for membership, and several visitors.

There were present, as delegates from the Massachusetts Homœopathic Medical Society, Dr. J. H. Sherman, of Boston, and Dr. W. K. Knowles, of Everett. This visit of Drs. Sherman and Knowles was very pleasant to us, both from old associations and because of the mark of fellowship between the two societies. To the elder delegate, Dr. Sherman, the society voted, unanimously, the title to honorary membership. Dr. Sherman's address on the status of homoeopathy in Massachusetts was full of interest.

Papers from the several scientific bureaus were read, as

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