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or less constant swelling of the mucous membranes results with accompanying occlusion of the ostia of the sinuses — in a word, the beginning of that vicious cycle of first imperfect ventilation of the accessory spaces, then imperfect drainage of Alli Shop the contents, ex- cessive mucus or pUs formation, frequent colds, etc., each with its own train of symptoms and sequelae. This accessory sinus sequence of events is not, however, the only one possible. Frequently simple pressure of the septum against the middle turbinate will be productive of either constant or periodical attacks of excruciating headache. We all know cases where the simple shrinking of the middle tur- binate with cocaine will instantly relieve a bad headache, and I know several cases of intermittent violent facial neuralgia, one case in particular, that of a friend of mine, a piiysician, where the attack was severe enough to incapacitate him for several days at a stretch, being relieved by submucous re- section of the septum. In his case, there was no sinus disease — it was simply pressure. I had one case of facial tic, where every other form of treat- ment having failed, that portion of his septum which was pressing against his middle turbinate, was re- sected, with relief to date, after one year and a half. That a number of such cases would in all Alli For Sale proba- bility be benefited by surgical treatment of the tur- binates is very likely, but it must be borne in mind that in those cases the turbinate hypertrophy or de- generation is most probably produced by the con- tinual irritation to which they were subjected by a twisted septum, and that any treatment directed to the turbinates, although absolutely essential, and to be carried out in every case, is Alli On Line only of a palliative nature and not at all directed to the primary source of the trouble. Having studied then the case with Alli Price these Alli Ireland points in Coupons For Alli view and after having attempted to establish the normal relations by means of general and local med- Alli Uk icinal means, only to see them either fail entirely or undergo only temporary improvement, Coupon For Alli we are justi- May 22, 191 5.] FISHER: NASAL SEPTUM RESECTIONS. 1059 fied in concluding that a correction of the septum will improve the condition. This, of course, must be taken with the proper amount of reserve. Given, let us say, a case with marked purulent sinusitis with perhaps a threatening involvement of neighboring vital organs, Alli In Canada that was Alli Prices originally started because of a septal deviation interfering with drainage, yet we should no more think of directing our attention at that time to the deviation, than we should go fishing for a diseased tonsil in a bad case of quinsy — other more direct measures are, of course, indicated, which, if successfully carried out, might do away with or counteract the disadvantages of the septal deformity, and the latter might be no longer re- quired, but barring such instances, the operation is usually indicated in this class of cases, subject, how- ever, to the answer of the second question, namely, Are the benefits to be derived worthy of the sacrifices that have to be made ? To answer this, the following points must be con- sidered : I. Are we destroying or hopelessly crip- pling any useful organ? 2. What is the gravity of the operation? 3. What complications may be en- countered or should be expected? The septum undoubtedly performs a very im- portant function during the Price Of Alli early or developmental life of the individual, by acting as a sort of Alli Cost projec- tion force around which the neighboring parts grow, and the removal of any portion of it during that period of life should be undertaken only as a Alli Coupons matter of last resort. Not so, however, with the full grown adult. With him the mucous membrane covering the septum is probably the most important functionally, while as a supporting structure, the bony portion of it beginning under the nasal bone and running posteriorly may be totally disregarded. The cartilaginous portion, however, does help to support the nose, and for that reason should never be removed in toto — in a word, the submucous operation conserves the most necessary structures, that is, the gland carrying and blood containing Alli Sale mu- cous membrane, and sacrifices only portions which are comparatively of lesser Coupon Alli importance. When speaking of the gravity of the operation, it is well to remember that deaths have been reported now and then, and that some few fatal results have occurred in this very Alli On Sale city. I cannot Alli Coupon comment on any of the Alli 120 fatalities, not having had the opportunity of studying any of those cases. All I can say, and wish to do, is to cite my own experiences. Out of one thousand operations, there was not a single death, and in only one instance was the patient suf^- ciently ill to be the cause of any considerable anxiety, and in that case the circumstance might be attributed to the aftertreatment the patient received at the hands of one unfamiliar with the case and this work generally, because of my absence from the city. As to complications, the following were encoun- tered : 1. Perforations of the septum — none. 2. Acute ethmoiditi.s — one. 3. Sinking of the bridge of the nose below the nasal bones — Alli Canada one. 4. Acute infections of the middle ear — four.

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