8o SURGICAL APPLIED ANATOMY. [Chap. vi. 



produced a subcoracoid dislocation of his shoulder 

 (Lancet, 1878). In another case, the ninth rib on the 

 left side was fractured during a fit of sneezing (Med. 

 Times, 1862). Mr. Pitts (Lancet, 1883) has, how- 

 ever, reported the strangest case of all, a case in which 

 all the coverings of a large femoral hernia were rup- 

 tured during the act of sneezing, so that the bowels 

 escaped. 



Some of the lymphatics of the nasal fossae enter 

 certain glands placed behind the pharynx, in front of the 

 rectus capitis anticus major. Hence, as Fraenkel has 

 pointed out, " retro-pharyngeal abscess may arise in 

 consequence of diseases of the nose." Other lympha- 

 tics go to the submaxillary and parotid lymph glands, 

 and it is common to find the former set of glands en- 

 larged in nose affections, especially in the scrofulous. 



The sinuses. These may be briefly dealt with. 

 The frontal sinuses are not present in early youth, but 

 develop as age advances. They are practically formed 

 from the diploe. Large frontal sinuses do not neces- 

 sarily imply large external prominences over the 

 glabella and superciliary eminences. They often de- 

 velop more as the brain shrinks, and appear then to 

 follow, as it were, the receding brain. Bony tumours 

 often grow from the interior of these sinuses, and are 

 known as enostoses. It is obvious that a depressed 

 fracture may exist over a frontal sinus, without the 

 cranial cavity being damaged. In such cases, the in- 

 spissated contents of the sinus have been mistaken 

 for brain matter escaping. Since the sinuses commu- 

 nicate with the nose, much emphysema may follow 

 upon fracture of the sinus wall. Insects have found 

 their way into these cavities. " Centipedes are par- 

 ticularly liable to be found in the frontal sinuses, 

 where they may remain for years, the secretions of 

 these cavities furnishing them with sufficient nourish- 

 ment " (Fraenkel). Larvse have also been found here, 



