i 4 2o HUMAN ANATOMY. 



if the bleeding point is posterior, the posterior nares may be plugged. For this 

 purpose a long silk ligature is passed through the nose to the pharynx and out 

 through the mouth, by means of a Bellocq's cannula or a soft catheter. To the 

 middle of the ligature is attached a plug of gauze slightly larger than the posterior 

 nares, which is then drawn by the anterior end of the ligature into the nasal fossa, 

 which it should tightly fill. 



Postnasal adenoids originate in the normally excessive lymphoid tissue pharyn- 

 geal tonsil of the postnasal space, of which tissue they are a simple hypertrophy. 

 The growth forms a mass in the vault of the naso-pharynx and often extends down- 

 ward and forward, filling up Rosenmiiller's fossae and involving the orifices of the 

 Eustachian tubes. The tonsils are commonly also enlarged. 



The symptoms produced are : (a) obstructed nasal respiration, more marked 

 during sleep, when the mouth is closed by the approximation of the tongue to the 

 palate ; () as a result of this, broken rest and " night terrors" ; and (V) as a further 

 consequence (and also from deficient oxygenation), deterioration of the general 

 health, delayed or arrested growth, and anaemia ; (d) intermittent partial deafness 

 and recurrent attacks of catarrhal or suppurative otitis media ; (/) pigeon-breast from 

 inequality of intra- and extra-thoracic atmospheric pressure. 



The early removal of adenoids that produce any or all of these symptoms is 

 usually indicated, and is facilitated by their friability and by the toughness and den- 

 sity of the submucosa on which they lie, circumstances which permit of their usually 

 easy enucleation either with the fingers or with the adenoid forceps and curette. 



Naso-pharyngeal growths may be either simple fibromata or fibro-sarcomata. 

 They are usually dense, and contain large venous channels, which have no definite 

 sheath and thus do not retract when severed. Incision into them may therefore be 

 followed by severe hemorrhage with no tendency to spontaneous arrest. Ulceration 

 or abrasion of the surface of these growths is not infrequent, and is also attended by 

 repeated and often dangerous loss of blood. 



The nasal fossae, already very narrow, are frequently further obstructed by path- 

 ological conditions, such as deviations of the septum, hypertrophy of the mucous 

 membrane covering the turbinates, spurs on the septum, polypi and tumors. The 

 septum is rarely straight after the seventh year, in about seventy-five per cent, of 

 cases being turned to one or the other side, most frequently the left (vide supra). 

 Both the bony and cartilaginous portions, more especially the anterior cartilaginous, 

 are involved. The deflection is sometimes due to a fracture from blows or falls. The 

 whole nose usually deviates more or less to one side. Spurs on the septum com- 

 monly occur at the junction of the bony and cartilaginous portions. A deviation of 

 the septum does not necessarily mean that the narrowed nasal fossa is seriously 

 obstructed. It frequently, however, comes in contact with the surface of the turbin- 

 ates, and may result in an adhesion or synechia from the irritative inflammation which 

 is set up. Operations are often necessary to correct the difficulties arising from 

 deviation of the septum. The concavity on the opposite side will differentiate it from 

 a tumor. 



Hypertrophy of the ethmoidal labyrinth, or bulla ethmoidalis, is sometimes so 

 far advanced as to obstruct the nasal fossa on that side. The middle turbinate over- 

 lies and yields before this expanded cell, and may even press against the septum 

 to such an extent as to make it bend and obstruct the opposite nasal fossa to 

 a greater or lesser degree. The removal of the middle turbinate is sometimes 

 practiced in these cases (Taylor), or the bulla itself may be obliterated by means of 

 the cutting forceps or curette. Over-development of the bulla ethmoidalis may at 

 times be so great as to occasion obstruction of the upper portion of the corresponding 

 nasal fossa. 



The floor of the nose is the widest part, and slopes gradually backward and 

 downward in the upright position, so that collecting mucus tends to run backward 

 and drop into the throat. Rhinolitlis, which are incrustations usually about a foreign 

 body, are most frequently found in the inferior meatus, which is the largest. The 

 posterior nares are below the level of the respiratory portion, so that any discharge 

 above the middle tnrbinate cannot be blown from the nose. The anterior portion of 

 the inferior turbinate slopes downward and forward, and its anterior end is attached 



