1088 THE ORGANS OF SPECIAL SEX8E 



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 hemorrhages 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. 



Foreign bodies, such as boot buttons, are frequently inserted into the nostrils by children, and 

 require some care in their removal, as unskilled attempts only result in pushing the foreign body- 

 farther into the nasal fossa. Bodies which remain in the nose any length of time are apt to 

 set up an ulceration of the mucosa, which may spread to the bone; a unilateral nasal discharge 

 in a child is always suggestive of the presence of a foreign body. A foreign body is best 

 removed under anesthesia, placing the left forefinger in the nasopharynx to prevent the passage 

 of the body into the air-passages, and then removing the foreign body through the anterior naris 

 by a suitable scoop or forceps manipulated by the right hand. 



Nasal i)oli//)ns 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 vas- 

 cular submucous tissue; rarely from the septum, where the mucous membrane is closely adher- 

 ent to the cartilage and bone, without the intervention of much, if any, submucous tissue. The 

 most common seat of gelatinous polyps is probably the middle turbinated process. 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 and carcinomatous, may arise 

 in the nasal cavities and the nasopharynx; 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. They arise from 

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



The nasal passages furnish a secretion of their own and receive secretion from other parts 

 (tears and secretions of the accessory sinuses). The nasal cavities contain the ethmoidal laby- 

 rinths, the lateral masses of the ethmoid (which form the superior and middle turbinated 

 processes), and the inferior turbinated bones. The nasal cavity is surrounded by three pairs of 

 pneumatic spaces, the accessory sinuses. These are the maxillary sinuses (p. 103), the 

 frontal sinuses (p. 79), and the cells of the ethmoidal labyrinth (p. 99). The lacrimal duct 

 opens into the inferior meatus. Inflammation of the air-cells may follow inflammation of the 

 nasal mucous membrane or bone disease. One set of cells or many may suffer. Suppuration 

 may occur; pus may be retained; death of bone may ensue. The most serious conditions may 

 follow (abscess of brain, sinus thrombosis, septicemia), and an operation is necessary to obtain 

 relief. 



THE EYE. 



The eyeball or globe (bidbus oculi) (Figs. 794 and 796) is contained in the ante- 

 rior part of the cavity of the orbit. In this situation it is securely protected from 

 injury, while its position is such as to insure the most extensive range of sight. 

 It is acted upon by numerous muscles, by which it is capable of being directed 

 to different parts; it is supplied by vessels and nerves, and is additionally pro- 

 tected in front by the orbital margins, eyelids, etc. 



The eyeball is embedded in the fat of the orbit, but is partly surrounded by 

 a thin membranous sac, the capsule of Te'non, which isolates it, so as to allow of 

 free movement. 



The Capsule of Te'non (fascia bulbi [Tenoni]) (Figs. 794 and 795) consists 

 of a thin membrane which envelops the eyeball from the optic nerve to the ciliary 

 region, separating it from the orbital fat and forming a socket in which it plays. 

 Its inner surface is smooth, and is in contact with the outer surface of the sclera, 

 the periscleral or suprascleral lymph space only intervening. This lymph space 

 is continuous with the subdural and subarachnoid spaces, and is traversed by 

 delicate bands of connective tissue which extend between the capsule and the 

 sclera. This lymph space forms a flexible pocket, in which the globe rotates. 

 The capsule is perforated behind by the ciliary vessels and nerves and by the 

 optic nerve, being continuous with the sheath of the latter. In front it blends with 

 the ocular conjunctiva, and with it is attached to the ciliary region of the eyeball. 



