results in septum straightening is that the parts do not remain permanently in position; this, of course, is due to the springiness of the tissues, usually of the cartilage. In Fig. 1 the drawing of the septum represents a horizontal deformity which is to be straightened by an operation.

The points of greatest spring or resiliency will be represented by the apices of the angles, at 1, 2 and 3. In order to overcome this resiliency, I make three cuts, along these ridges, through the entire thickness of the septum extending the full length of the deformity, or a little more if possible. See Fig. 2. See Fig. 2. This I do with a small straight knife with a rather thick blade to give the necessary strength. In most of the cases in children the knife is sufficient to cut through any bone that it may be necessary to divide. If, however, the bone be too hard to be divided by the knife, I use Dr. Asche's punch. The cuts are made from which

ever nostril may offer the greater accessibility, according to the position of the deformed parts. The same general scheme of operating holds good for the vertical deformity.

The septum viewed from the side will then present a series of cuts as shown in Fig. 2, lines 1, 2 and 3. The portions between lines 1 and 2 and between 2 and 3 will then have become two strips which have been cut entirely free except as they remain attached at their anterior and posterior ends. These strips are now freely movable and, on introducing the tip of the finger, are readily adjusted to the same plane as the remaining portion of the septum, or even somewhat beyond so as to make them project into the other nostril. They will of course over-lap by just so much as the broken line 1, 2, 3 (Fig. 1), is longer than a straight line connecting 1 and 3.- Compare Fig. 3. The loosened septum is readily held in a correct position by means of one of Asche's hollow perforated plugs or by a plug of gauze or cotton, Asche's hollow plug, of course, being more comfortable as permitting some breathing through that side of the nose. The plug is

removed and cleansed from time to time, as, in the judgment of the operator, may appear to be indicated; the intervals varying from two to seven days according to the reaction and discomfort following the operation.

This discomfort is lessened, somewhat, by an alkaline saline solution snuffed through the nose several times a day, and by the use of some sticky ointment such as vaseline lead ointment externally and in the vestibule, which does much to prevent the tip of the nose from getting sore. In fact the discomfort which arises from the irritation of the vestibule and external nose is usually the worst that the patient has to suffer.

It is my practice to retain the plug in position from ten days to six weeks, and to keep the case under observation at intervals of three days to two weeks for six weeks longer.

If there be any tendency of the parts to spring back, the plug may be reintroduced.

The irregularity and local increase in thickness of the septum resulting from the overlapping of the parts, I let remain if possible.

If, however, this irregularity seems great enough to require trimming it down, I do it six months to a year later. I never interfere much earlier than this, because I feel that the greater the over-lapping the better are the conditions for a firm and unalterable union. Then, too, the irregularities are found to diminish somewhat as the scar tissue becomes older and firmer.

In this relatively small number of cases, the results have been uniformly excellent and permanent.

The entire operation can frequently be performed in from three to five minutes, either under cocaine or general anesthesia.

I have seen no sloughing or perforation following this operation.

Hemorrhage may be encountered if it be found necessary to cut through the anterior artery of the septum; it is effectually con

trolled as soon as the plug is placed in position, in what was previously the obstructed nostril.

This method I have found serviceable also for the less acutely angular deflections - the sigmoid deformity.

As is obvious from the description, there is no removal of tissue or sacrifice of ciliated epethelium or mucous glands, except where the strips overlap, as shown in Fig. 3. The detached strips, at 1 and 2, unite smoothly, without visible scar; the two overlapping surfaces become quickly adherent to each other with resultant formation of a firm fibrous union.

After the wound is healed there is no crusting.

[In the Z deformity this same principle of operating would require four cuts instead of three.]

St. Louis, Mo., February 20, 1906.

A MODIFICATION OF GRAM'S METHOD.

BY E. F. TIEDEMANN, M.D.

Gram's discovery of his differential stain was a great achievement; but it is not used by the general practitioner as much as it should be, for it is complicated and time-consuming. In order that a method may be generally used it must employ simple and stable solutions and be reliable and quick. I have therefore endeavored to simplify and shorten Gram's method; my experiments have resulted in the method described below.

1. Make a thin smear on a coverglass.

2. Dry in the air.

3. Without fixation, flood the coverglass held by forceps with a 2 per cent. solution of crystal violet (Höchst, pure) in methyl alcohol. Allow the stain to act for 15 seconds; wash off the stain slowly with distilled water, by letting it fall on drop by drop from a pipette; this takes about 10 seconds; then wash both surfaces of the coverglass briskly with distilled water. 4. Flood the coverglass with the following solution:

Iodine

Potassium iodide

Distilled water

Allow this to act for 15 seconds.

1 gram.

2 grams. 100 cc.

5. Pour off the iodine solution and pour on 95 per cent. alcohol at first quickly, then slowly until no more color is given off. This takes about 10 seconds.

6. Wash thoroughly with distilled water and mount in water, or after drying

in balsam.

The Gram-positive bacteria appear bluish-black.

The advantages are: Absence of fixation, the use of a simple

methyl-alcohol solution of the dye which keeps indefinitely instead of the usual aniline water gentian violet solution, which is troublesome to prepare and keeps only for a few weeks, the use of ordinary 95 per cent alcohol in place of the absolute alcohol usually advised, and finally the shortening of the various steps; the entire process is completed within one minute after the violet stain is applied.

Gentian violet or methyl violet may be used in the same manner and strength in the place of crystal violet, but the last named gives the best results.

Methyl alcohol cannot be substituted for ethyl alcohol for decolorizing because it dissolves out all the stain from the Grampositive bacteria.

It is possible to combine the violet stain with iodine in one solution; to stain with this mixture and then to apply alcohol, which will remove the color only from the Gram-negative bacteria. But the results are not so good, and the method above given is already so simple that I do not advise the combination of the violet stain with iodine in one mixture.

Experience has shown that the alcohol removes the stain completely from the Gram-negative bacteria in a few seconds, but will take it from the Gram-positive bacteria only after the lapse of some minutes.