FRACTURES OF THE FACIAL BONES. 103 



The haemorrhage may continue for some hours after such an 

 accident, and, of course — from the sinus being continuous with 

 the nasal cavity — the blood will flow through the nostril. This 

 need occasion no alarm ; the pouring of cold water, both into 

 the sinus and on the face, will generally arrest it ; or two 

 ounces of the tincture of terchloride of iron may be mixed with 

 a bucketful of water, and syringed into the wound by means 

 of an elastic enema syringe. 



I do not recommend the application of poultices to injuries 

 of this kind, nor disturbance of the parts after the first dressing, 

 which must be effective and complete ; but should the swelling 

 become excessive, or a purulent discharge manifest itself, it 

 becomes a duty to apply fomentations of warm water in which 

 a little carbolic acid has been dissolved, and the general treat- 

 ment of wounds which will be hereafter laid down must be 

 resorted to. If at any time the wound assume an unhealthy 

 character, with a thin foetid discharge, caries of the bone is 

 indicated, and this will require the hydrochloric acid dressing, 

 care being taken that the diseased bone receives the application. 

 It must never be forgotten by the practitioner that an injury to 

 any part of the cranium may be much more serious than may 

 at first appear. The effects of the shock, although this is pro- 

 vided for by the double layer of bony plates, may scarcely be 

 apparent; but unexpected symptoms may arise, indicative of 

 severe lesions to the brain and nervous system. 



Fracture of the immediate walls of the cranium may be pre- 

 sent, involving the vessels of the brain, and when such is the 

 case, the termination is generally fatal. 



I have seen the zygomatic ridge broken on its outer edge, 

 the fragments remaining in the wound, and requiring re- 

 moval. 



I have little to add upon fracture of the facial bones. Any 

 of them, where they are exposed to external influences, may be 

 fractured; and should such fractures involve organs or vessels 

 of importance, the case becomes the more complicated. For 

 example, the lachrymal duct may be involved in fracture of the 

 bone of the same name ; the fractured bone may heal, but the 

 duct will be spoiled ; and the lachrymal secretion, instead of 

 being discharged into the nostril, will flow over the face. 

 Again, the parotid duct may be opened in a fracture of the 



