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As to technic, if there is deviation of the septum to the side of the diseased sac, the lacrimal operation should be preceded by a submucous resection of the septum. The easiest approach to the sac is through the thin bone of the anterior ethmoid region. The steps of the operation are as follows : The anterior end of the middle turbinate is removed and the slitting probe is introduced through the cut canaliculus into the sac and on through the nasal duct to the floor of the inferior meatus. Next, the anterior ethmoid cells are exenterated. Then a cut is made in the mucous membrane of the nose along the posterior edge of the ascending process of the superior maxilla, and the probe withdrawn to the upper margin of the inferior turbinate, and when clear of the turbinate the point is pressed upward and inward and made to break through the nasal duct into the nose. The tip of the probe is then slowly forced upward, all the while slitting" the inner wall of the nasal duct. The upward excursion of the probe is finally stopped by the increased resistance of the superior part of the lacrimai bone. Experiments on the cadaver have shown that this manipulation opens not only the nasal duct, but the lower two-thirds of the inner wall of the lacrimal sac. Unless it is the purpose of the operator to exenterate the lacrimal sac intranasally, the operation is finished by inserting the silver style. This may be removed at intervals and cleaned. On evidence of closure of the duct the style must be reinserted.Dr. William B. Chamberlin, Cleveland: One point I did not have time to bring out in the paper is the subsequent closure. This is a difficulty in any endonasal operation. Three of my patients were operated on the second time ; but the secondary operation is comparatively a simple thing. The probe is intro¬ duced through the sac again and at the point of stenosis you can see a slight bulging. It is a comparatively easy thing to resect this with the punch forceps. In the aftertreatment, if one is careful in keeping down granulations, as in any other part, epidermization will not be retarded.In many cases a preliminary submucous resection, espe¬ cially a resection as high up as we dare go, is absolutely essential. It is a sine qua non of the operation.Another point Dr. Mosher brings out in the discussion is the resection of the posterior part of the ascending process of the superior maxilla, which makes a groove for the duct. This is dense, firm bone. It is for the resection of this ascend¬ ing process that West has devised his chisels, and it is for the resection of this process that I have modified his chisels, making them very much thinner, and also putting on the handle, thus enabling one to see every step of the operation. The view is less obstructed than with the West chisels, and you can insert it under the bone, and if it does not make a clean cut the bone may be fractured by a. twisting motion. The forceps are a modification of the familiar Gruenwald forceps for the ethmoid, and are quite as effective as the instrument wh...

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