into the profession by Dr. Halsted, but that his experience with the instrument demonstrated its worthlessness. Where time is an important element, as it always is more or less in these operations, an end-to-end anastomosis with the Murphy button can be done in a very few minutes. The Murphy button to date has given better results, and has been more largely used, than any other mechanic device. The LaPlace intestinal anastomosis forceps, however are even more ingenious than the Murphy button, and the operation may be done almost as quickly as with the Murphy button, and without the disadvantages of pressure necrosis and its consequent dangers, even though remote they be, or the leaving of a foreign body within the intestine. Theoretically, this instrument seems to be a decided step forward, and it has been used very successfully, both on the lower animals, and on human beings. A Meckel's diverticulum should be cut off, and the resulting opening in the intestine closed in the usual way. Obstruction due to general peritonitis does not offer very much to the surgeon. Without operation, however, the condition is absolutely hopeless. Where the cases are seen early, and the general condition permits of operative interference at all, brilliant and gratifying results may be obtained. The faithful, conscientious surgeon will not withhold his helpful hand in desperate cases for the sake of his statistics. Each life thus saved is as a brand snatched from the burning, and is a surgical triumph far-reaching in its consequence. NASAL OBSTRUCTION AND ITS INFLUENCE. BY J. LAWTON HIERS, M.D., SAVANNAH, GA. Mr. President and Gentlemen of the Medical Association of Georgia: In presenting this subject, it is not my purpose to cover the entire field which may or could be accredited to so important a subject, but to deal only with some of its most prominent clinical aspects which we meet with, almost daily in our practice. In considering the causes of nasal obstruction it will be found that there are many. Among the most frequent with which we have to deal are adenoids, nasal polypi, nasal spurs, deflections of the septum and hypertrophies of the turbinate bodies. One or more may be found in the same case, and may be of sufficient proportions to produce a complete or partial occlusion of the nasal fossa. Occasionally slight obstructions produce very alarming symptoms. That we may better demonstrate this subject I have selected a few cases from my note-book which I will present for your consideration. Case 1. Miss H., aged twenty-two, apparently in perfect health, called to see me on September 1st, 1895, complaining of a distressing buzzing noise in her right ear. An examination of the external auditory canal showed the tympanum to be rather opaque, and contracted. An examination of the post-nasal space revealed a fibrous polypus about the size of the average pecan nut, attached by a small neck to the posterior end of the right inferior turbinate bone. The free end of the growth lay against the meatus of the right Eustachian tube, and with but little trouble the growth was removed with a cold wire snare, and with some after-treatment for about ten days, my patient was entirely relieved of her tinnitus aurium. Case 2. Mr. B., aged twenty-six years, occupation, merchant. Called to see me May 4th, 1896. Complaining of a nasal obstruction, and occasional attacks of spasmodic asthma, averaging about four to five attacks a month. An examination of the nares revealed the presence of several mucous polypi in each fossa, which I immediately removed under cocaine anesthesia. I saw the patient about one year subsequent to the operation, and he stated that his nasal respiration was still entirely free, and that he had not been troubled any more by the asthmatic attacks, proving beyond a doubt, that the polypi was the cause of his asthma. Case 3. March 9th, 1897, Rosa R-was brought to me by her father, who stated that for about two years she had been suffering with, and under constant treatment for catarrhal bronchitis. She was emaciated and anemic, with a very feeble appetite. Family history good. Her breathing was entirely through the mouth, and she wore a very labored expression on her face. An examination of the post-nasal space proved it to be entirely filled with adenoid vegetation. An operation was advised and accepted. On the following day the family physician was called in to administer the chloroform, and I removed the entire growth; after which I prescribed for her a saline antiseptic spray, and the family physician put her on a constitutional treatment of elix. iron, quinine and strychnia. Her nasal respiration was fully restored, the appetite became good, and by the end of the third week her bronchitis was entirely cured. The constitutional treatment, however, was kept up for a month or more. There has never been a recurrence of the growth, and she is to-day healthy and robust, and is fast developing into womanhood. Case 4. August 10th, 1898, Mr. W., thirty-seven years, occupation, clerk, suffering with aggravated tinnitus aurium, was referred to me by his family physician for treatment. On examination I found the tympanum in a collapsed condition, and the ossicles fixed. The aerial conduction was almost entirely wanting, and the bone conduction reduced at least fifty per cent. An examination of the nares revealed an enormously large left inferior turbinate bone, which of course was augmented by the presence of a catarrhal affection. A saline spray was prescribed and the catarrh benefited, but the tinnitus continued unchanged. I inflated the tympanic cavity several times, and when I found that it was impossible to reduce the dislocated ossicles I advised their removal, which was declined. I applied the electro-cautery to the enlarged turbinate, which was effectual in reducing its size, and restoring normal breathing, and within six weeks the tinnitus was entirely relieved, and since that time has never returned. Case 5. September 19th, 1898, Mr. M.-aged fortytwo, merchant, was referred to me by his family physician. On examination I found him suffering with an acute suppurative otitis media, and a hypertrophic rhinitis, with a polypoid degeneration of the anterior end of the middle turbinate bones which interfered materially with free nasal respiration. I saw my patient daily, but with little improvement in his ear trouble. On October the 7th I secured his consent to remove the anterior end of the left middle turbinate, which I did with a cold wire snare, under cocaine anesthesia, and within three days the suppuration ceased in the corresponding ear, but continued in the other. On October 12th, I removed the anterior end of the right middle turbinate in same manner as in the other side, and within ten days thereafter I was able to dismiss my patient entirely cured. |