14. If the external appearance of the nose be altered at all it is in the way of improvement.
It will be seen that the above advantages cancel most of the drawbacks which were formerly so annoying in nasal surgery.
Contra-indications. 1. Elderly people are so accustomed to their nasal obstruction, and its secondary consequences are generally so fully established, that the benefits would be much less marked than earlier in life.
2. Serious or progressive organic disease. This does not apply to quiescent or arrested tuberculosis.
3. Active syphilis.
4. Lupus.
5. The operation should be postponed if the patient shows any symptoms of influenza, or of acute or infectious catarrh.
Operation. Submucous resection can be completely carried out under local anæsthesia, as described on [p. 572]. Killian and others secure local anæsthesia by submucous injection of cocaine and adrenalin (see [p. 572]), but I have found this method alarming to the patient, apt to produce disagreeable palpitation, and not superior to the method of superficial application already described, particularly if sufficient time is allowed for the mixture to act, and if a few cocaine crystals are allowed to dissolve over the site of incision some minutes before starting it.
In nervous subjects it is better to administer chloroform, not so much because of any pain they suffer, but because of the mental strain they are apt to feel in watching the various manipulations.