改良Proetz法—（附） Proetz法の批判竝にNebulizerの限界

　Proetz氏が1926年副鼻腔内への藥液置換法として所謂Proetz法を發表したが，最近Penicillin等の化學療法劑の進歩に伴い副鼻腔炎の化學療法が勃興し，Proetz法が重視せられる樣になつて來た。吾々は慢性副鼻腔炎の化學療法に，全身療法と局所療法を併用しており，局所療法としてProetz法を行つているが，慢性副鼻腔炎患者にProetz法を行い，藥液が果して問題なく副鼻腔に置換出來るか否かに疑問を抱きこれを検討した。

　その結果本來のProetz法では，副鼻腔内，特に上顎洞に膿汁が殘存している場合には，この膿汁が固有鼻腔に出て來て藥液が上顎洞のみでなく篩骨洞にも置換することを妨げる缺點のあることを發見した。斯くして，この膿汁を自然口から固有鼻腔に吸い出すことを考案し，この前所置を行つて後，行うProetz法により，始めてこの缺點の補われることを認めたので，これを改良Proetz法と名ずけ，茲に其の實驗成績と共に發表する。

　OSAWA AND HIGUCHI made attempts to effect improvement on the efficacy of Proetz' displacement treatment. Using Proetz' method and India ink as an indicator in 22 cases of sinusitis in whom Cudwell-Luc operations were perfromed thereafter, the preseuce of the ink was noted in the maxillary sinus only in 7 cases and in the ethmoids in 13.

　The modification of the method is conducted as follows: the patient's head is turned to one side and lowered in such a way that the ostium of the maxillary sinus which stands uppermost in the upright position of the face now becomes loweremost in its relation to the sinus cavity. And in which position suction is applied fordraining and ridding the sinuses of pus. Following this procedure Proetz' displacement method is applied. Of 23 cases treated in this way and to whom India ink test had been applied the ink was found in the ethmoids in all cases and in the maxillary sinuses in 20. The results of treatment with means of nebulizer is poor indeed in that the discrepacy that exist between the volume of therapeutic agent in the aerosol and the amount of gas with which to deliver that agent is too great; being 1; 50,000.