the production of evil." And only too true can this aphorism be made to apply to the electrocautery.

3. Another error frequently committed is the removal of ecchondroma or cartilaginous spurs and exostosis or bony spurs from the nasal septum.

When the full-fledged nose specialist opens his office for the reception of patients, the first thing he does is to brandish his bright metallic saw and remove every little excresence he finds on the nasal septum. Even now I can feel the enthusiasm which coursed through every fiber of my being when in the first few years of my practice I could discover a septum spur. But unfortunately some of my patients were made to suffer for this enthusiasm. With more ripened experience I find that fewer spurs should be removed from the septum, and only in those cases where other well-recognized methods of treatment have been used and failed. My reasons for this are, that after a spur has been removed from the nasal septum you are obliged to have scar tissue left as the result, and this will always give the patient a point where mucous and scabs will gather to the constant annoyance of the patient, proving sometimes more annoying than the slight obstruction itself. It is very alluring to the young specialist to do this little operation and thereby pocket a nice little fee, for the hope of material gain is sometimes not the only fault a physician will have.

Frequently too, the physician does not recognize the difference between dislocation of the columnar cartilages and an ordinary ecchondroma, but picks up his saw and removes all anterior excrescences alike, which will ever be annoying to the patient.

Close discrimination and the knowledge of when to operate should be the aim of every physician, be he specialist In a few words I have but a little more to say. More could be said, but I shall desist from further words. The greatest trouble with physicians in general is, I believe, the failure to study minutely the history and symptoms of every case before prescribing or administering treatment himself. The failure to make a proper diagnosis is the cause of most of the failures in a physician's work, and a physician to be successful must be a close, practical and discriminating student. Men who have a large practice are so apt to become routine in their methods instead of studying each individual case, and for this reason they are often unsuccessful when just the opposite could be obtained.

Not long since I saw a paresis of the left vocal cord in a man who had been treated for three months for a chronic laryngitis. His chief symptoms were hoarseness and fatigue after the use of the voice. Now this man had a difficult larynx to examine, but after repeated trials I was enabled to find the real seat of the trouble. In this case the physician who had been treating him recognized the hoarseness, and as it was chronic in character he simply made a snap diagnosis, and so treated the patient without taking the tedious trouble to overcome a laryngeal spasm and obtaining a clear laryngeal picture.

Hence, I say there are fallacies in medicine of two kinds: First, that which is the result of ignorance from the lack of previous training and study, second, that which comes from making a snap diagnosis without studying minutely the

case.

Both classes are guilty, and in the long run the beneficent public will find out the physician upon whom they may depend.

DISCUSSION ON DR. ROY'S PAPER.

Dr. J. M. Crawford, of Atlanta: I have been very much interested in the paper of Dr. Roy. I would object to leaving the spurs that the doctor speaks of; I would remove them, not fearing that the little cicatricial tissue that would be left on the septum would serve as a nidus for secretions. I see no reason why we should not remove these spurs; they are malformations and should be taken away. Again, I do not see why a patient should not be sprayed when he needs it. If it is true that the nasal trouble is due to some other constitutional affection, this, too, should be looked after. Personally, I would most assuredly remove a spur and spray a patient when it was needed.

Dr. Roy (closing the discussion): There is practically no difference of opinion between Dr. Crawford and myself, the only difference being as to when the operation is needed. The point I made in my paper in regard to spurs was this, that in a great many cases it was not necessary to remove them, for the reason that they did not cause the patients any inconvenience or trouble. Many people go through life with nasal spurs or deviations of the septum with very little inconvenience, and because they are there it is no reason why we should remove them. There are many instances in which operations for the removal of nasal spurs have been done without proper discrimination. If there is a small or minute enlargement upon the septum and you remove it, you have a raw surface, you have a cicatricial surface, and practical experience in looking at these cases afterwards has shown me that there is left a cicatricial point where scabs will form and subsequently cause more or less irritation in many of the cases. The point I tried to make and emphasize in my paper was that these spurs should not be removed without proper discrimination; that they should not be removed until other well-recognized methods have been tried. These methods failing and the symptoms not being relieved, one is justified in removing such spurs.

With reference to the use of sprays, I have become firmly convinced that there is such a thing as the spray habit, and that patients become absolutely dependent upon it, and unless they can have an oily menthol spray put up their nasal passages every morning or so they feel uncomfortable. There is no reason in the world why such should be the case. I am not arguing against the judicious use of the spray. As I have said in my paper, the only time that an oily spray should be used is, when there is an acute inflammatory condition, where the membrane is exceedingly sensitive or is congested to such an extent that the least touch of any spray will cause discomfort to the patient. Only in those cases should the oily spray be used. In the other cases a watery spray should be used to cleanse all watery secretions, that is, you may use an alkaline solution first for the purpose of cleansing the nasal mucous membrane thoroughly, then you can follow it with an oily spray and get good results. But to make a practice of spraying out the nasal passages of people with an oily spray, when in many cases it is not called for, is wholly unscientific and not the proper thing to use.

MITRAL STENOSIS.

BY M. F. CARSON, M.D., GRIFFIN.

Stenosis of the mitral orifice is a condition which is often easily diagnosed at the bedside; but nevertheless there are many cases in which its recognition is difficult, if not impossible, and one finds more frequently difference of opinion as to whether mitral constriction is or is not present, than one does as to the presence or absence of any other chronic valvular defects.

Anatomically the results of the gradual thickening and constriction of the mitral valve are reached in the wellknown conditions, the "button-hole" orifice and the "funnel-shaped" orifice. The former generally occurs when the flaps of the valve are pretty uniformly affected, so that the general shrinkage produces an oval or sometime roundish orifice in the thickened curtain. In the case of the funnel-shaped orifice the free edges of the valve are disproportionally thickened and the flaps still jut out into the left ventricle, where the apex of the funnel is seen, while the insertion of the valve in the wall of the heart forms the larger extremity of the funnel.

But such anatomical details are not to be made out ordinarily, and the best physicians are content with the diagnosis of mitral constriction.

When one examines a well-marked case of the disease, we notice on inspection that the apex beat of the heart is in its normal situation, the meaning of this being that the left ventricle is not enlarged; indeed, it may be diminished in