ETIOLOGY, DIAGNOSIS, PROGNOSIS AND TREATMENT OF SPHENOPALATINE GANGLION NEURALGIA

severe cases of toxemia following the use of cocain, nmyl nitrite acts quite well. 1 believe that not more than one out of twenty caseB of suspected cocain poisoning are really true cases of cocain poisoning, especially if one considers the small amount of cocain used in Sehleieh's method of infiltration (1.5 grains to 100 c.c. of water) and that of this solution but a small portion is used, and that a still smaller portion enters the circulation, for the greater por- tion of that injected is held between the mucous membrane and the cartilage or bone.I take exception to what Dr. Ballenger said regarding adhesions, because there are some real adhesions which result in cases of fracture.If one will reason out the pathology of the condition that results from fractures, he will find that a proliferative inflammation fol- lows a new formation of tissue, and with it come the adhesions.On account of the small amount of cocain used, I do not often find it necessary to operate with the patient in the prone position, although I do operate on patients in this position when it is necessary.With the sitting position the operator sees quite well and can do the operation better no doubt than if the patient is in the recumbent position.If the patient manifests any symptoms of cocain toxemia, he should at once be placed in the prone position until the symptoms have passed.I do not like to cut off a dog's tail by inches, but I find that formerly, when we used this com- bination method, wo have a greater degree of reaction and more frequent infections than we have now by the method advocated in my paper.I believe that the tonsils and adenoids should be removed in advance of the septal operation; I think that infection is prone to occur after a septum operation from infected adenoids and tonsils.It is surprising what a large number of patients, adults included, have adenoids or, at least, some thickening of the posterior phnryngeal wall.Some patients whose ade- noids are not particularly large develop an acute inflamma- tion of the adenoids when the nose is packed, infection which had been present, but laten!, lias been awakened and becomes active and from this source the infection spreads to nn accidentally made wound of the septum.