524 DISEASES AND INJURIES OF THE FACIAL KEGION. 



wholly filled with matter resembling porridge, commingled with 

 small particles of oily matter. 



" If the practitioner suspects these structures to be in the 

 above condition, or that the sinuses contain such materials as 

 I have described, he will hesitate before he commences his 

 operation ; for if his experience corresponds with mine as to the 

 result in such cases, he will come to the conclusion that they 

 are incurable. For my own part, if I felt satisfied that the 

 pathology of the disease in any case that was presented to me 

 corresponded with the above description, I should certainly 

 decline to have anything to do with it in the way of treatment ; 

 but as it is difficult to diagnose such cases with any degree of 

 certainty, a prognosis is worth but little. Our investigations, 

 therefore, should be extended beyond a mere surface examina- 

 tion. I will suppose that the evidence is sufficient to convince 

 the practitioner that the sinuses are diseased, but the precise 

 nature of the affection he is unable to determine. Wliat course 

 under such circumstances should be taken ? I should advise 

 that one or more of the sinuses be opened ; which can easily 

 be done with a small trephine or even with a gimlet. Having 

 now examined the walls of the sinuses, the lining membrane, 

 and some of the material which they contain, he will be prepared 

 to advise what course should be adopted. If the character of 

 the disease should turn out to be simple in its nature, and that 

 there is a fair chance of its being treated successfully, he will 

 have partly accomplished the operation for the cure thereof; or 

 if, on the contrary, he considers the affection to be incurable, he 

 will be prepared to advise that the patient be disposed of or 

 destroyed, as may be deemed best. 



" Disease of the sinuses is sometimes complicated with one of 

 a similar character of the nasal passages ; indeed, it will be an 

 extension of the affection from one part to the other, or it may 

 have commenced simultaneously in both cavities. 



" The symptoms indicative of the nasal passage as w^ell as the 

 sinuses being affected are as follows : — The discharge, which is 

 never very copious, is nevertheless continuous ; the breathing is 

 embarrassed, particularly if the opposite nostril is closed, when 

 a considerable impediment will often be evinced, and percussion 

 gives a dull sound over the whole of the side of the face. 



" If the mucous membrane of the nasal passages, when thus 



