890 THE ORGANS OF SENSE. 



syphilitic necrosis, or imperfect development of the nasal bones in cases of congenital syphilis, or 

 a lateral deviation of the nose may result from fracture. 



The skin over the alee and tip of the nose is thick and closely adherent to subjacent parts. 

 Inflammation of this part is therefore very painful, on account of the tension. It is largely sup- 

 plied with blood, and, the circulation here being terminal, vascular engorgement is liable to occur, 

 especially in women at the menopause and in both sexes from disorders of digestion, exposure to 

 cold, etc. The skin of the nose also contains a large number of sebaceous follicles, and these, as 

 the result of intemperance, are apt to become affected and the nose reddened, congested, and 

 irregularly swollen. To this the term " grog-blossom ' ' is popularly applied. In some of these cases 

 there is enormous hypertrophy of the skin and subcutaneous tissues, producing pendulous masses, 

 termed lipomata nasi. Epitheliorna and rodent ulcer may attack the nose, the latter being the 

 more common of the two. Lupus and syphilitic ulceration frequently attack the nose, and may 

 destroy the whole of the cartilaginous portion. In fact, lupus vulgaris begins more frequently on 

 the ala of the nose than in any other situation. 



Cases of congenital occlusion of one or both nostrils, or adhesion between the ala and septum 

 may occur, and may require immediate operation, since the obstruction much interferes with suck- 

 ing. Bony closure of the posterior nares may also occur. 



To examine the nasal cavities, the head should be thrown back and the nose drawn upward, 

 the parts being dilated by some form of speculum. It can also be examined with the little finger 

 or a probe, and in this way foreign bodies detected. A still more extensive examination can be 

 made by Rouge's operation, which was introduced for the cure of ozaena by the removal of any 

 dead bone which may be present in this disease. The whole framework of the nose is lifted up 

 by an incision made inside the mouth, through the junction of the upper lip with the bone ; the 

 septum nasi and the lateral cartilages are divided with strong scissors till the anterior nares are 

 completely exposed. The posterior nares can be explored by reflected light from the mouth, by 

 which the posterior nares can be illuminated. The examination is very difficult to carry out, 

 and, as a rule, sufficient information regarding the presence of foreign bodies or tumors in the 

 naso-pharynx can be obtained by the introduction of the finger behind the soft palate through 

 the mouth. The septum of the nose may be displaced or deviate from the middle line : this 

 may be the result of an injury or from some congenital defect in its development. Sometimes 

 the deviation may be so great that the septum may come in contact with the outer wall of the 

 nasal fossae, and may even become adherent to it, thus producing complete obstruction. Per- 

 foration of the septum is not an uncommon affection, and may arise from several causes: syph- 

 ilitic or tubercular ulceration, blood-tumor or abscess of the septum, and especially in workmen 

 exposed to the vapor of bichromate of potash, from the irritating and corrosive action of the 

 fumes. When small, the perforation may cause a peculiar whistling sound during respiration. 

 When large, it may lead to the falling in of the bridge of the nose. 



Epistaxis is a very common affection in children. It is rarely of much consequence, and 

 will almost always subside, but in the more violent haemorrhages of later life it may be 

 necessary to plug the posterior nares. In performing this operation it is desirable to remember 

 the size of the posterior nares. A ready method of regulating the size of the plug to fit 

 the opening is to make it of the same size as the terminal phalanx of the thumb of the patient 

 to be operated on. 



Nasal polypus is a very common disease, and presents itself in three forms : the gelatinous, 

 the fibrous, and the malignant. The first is by far the most common. It grows from the 

 mucous membrane of the outer wall of the nasal fossa, where there is an abundant layer of 

 highly vascular submucous tissue ; rarely from the septum, where the mucous membrane is 

 closely adherent to the cartilage and bone, without the intervention of much, if any, submucous 

 tissue. Their most common seat is probably the middle turbinated bone. The fibrous polypus 

 generally grows from the base of the skull behind the posterior nares or from the roof of the nasal 

 fossae. The malignant polypi, both sarcomatous or carcinomatous, may arise in the nasal cavities 

 and the naso-pharynx ; or they may originate in the antrum, and protrude through its inner wall 

 into the nasal fossa. 



Rhinoliths, or nose-stones, may sometimes be found in the nasal cavities, from the formation 

 of phosphate of lime upon either a foreign body or a piece of inspissated secretion. 



THE EYE. 



The eyeball is contained in the cavity of the orbit. In this situation it is 

 securely protected from injury, whilst its position is such as to ensure the most 

 extensive range of sight. It is acted upon by numerous muscles, by which it is 

 capable of being directed to any part ; it is supplied by vessels and nerves, and is 

 additionally protected in front by several appendages, such as the eyebrow, eye- 

 lids, etc. 



The eyeball is imbedded in the fat of the orbit, but is surrounded by a thin 

 membranous sac, the capsule of Tenon, which isolates it, so as to allow of free 

 movement. 



The capsule of Tenon (tunica vaginalis oculi) may be regarded as a distinct 



