foASAL GLEET 1 . 243 



4896. Ozena. 



If after 10 days or a fortnight at the utmost the discharge continues 

 and if the teeth are sound, and there is reason to think that the discharge 

 comes from one or more of the sinuses in the forehead, recourse must be 

 had to trephining without any delay. 



The maxillary sinus should be attacked first, as it is generally the seat 

 of the discharge ; and if so, there is no need of operating on the frontal 

 sinus. 



490. 



The operation is perfectly safe. The pus will flow out ; but if a 

 portion of it is inspissated, it must be picked out by forceps and fingers. 

 The injection of a stimulant will not remove the hardened pus. It will 

 however cause irritation in the sinus. No injection should be allowed 

 except clean warm water twice a day. 



Care should be taken not to allow the skin to close completely the 

 orifice, before the discharge has completely ceased. 



491. 



Before the introduction of mallein, many horses were destroyed for 

 glanders, which were only suffering from ozena. No horse ought to be 

 destroyed until it is proved by trephining that the discharge does not 

 proceed from one or other of the sinuses. 



Polypi in the nose are best removed by the knife, or ligature not by 

 torsion. 



492. Trephining and after-treatment. 



The action of the stimulant will at first excite increased discharge, but 

 it will probably become of a more healthy character. If the discharge 

 continues to increase, the stimulant may be discontinued for a few days, 

 and warm water again used. 



In many cases the lining membrane of the sinus will be found to be 

 greatly thickened, and perhaps a quantity of inspissated pus may be 

 lodged within it, which will be gradually got rid of by the action- of the 

 injection. Care must be taken not to allow the skin to close completely 

 the orifice, before the discharge has for some days entirely ceased. This 

 may be done by inserting a common cork. 



During treatment the patient should be fed well. If the head is hot, 

 it should be frequently bathed with cold water. Mineral tonics should 

 be freely administered throughout. 



