DIAGNOSIS OF GLANDERS. 170 



and the superficial facial muscles were divided in the line of the second inci- 

 sion down to the maxillary bone. The trephine removed a portion of the thin 

 bony plate covering the sinus ; and through this opening nodules of bone, 

 such as are commonly met with in diseases of the frontal and maxillary sinuses, 

 were discovered, instead of the diseased fangs we expected to find. In-order 

 to remove these nodules, which were very large, it was necessary to make suc- 

 cessive applications of the trephine, chisel, and saw. After the bone was re- 

 moved, a large quantity of highly offensive inspissated pus was scooped out ; 

 but the largest portion was firmly attached to the membrane of the nose and 

 antrum, and required considerable force, and some cutting, to detach it. The 

 surface of the sinus was next ascertained to be uniform, and not to have any 

 uncovered bone. The divided levator labii superioris was then united by 

 suture, and the crucial flaps replaced and brought together. Very little blood 

 was lost. 



16^^. — No increase of swelling had taken place in the face: there was a 

 slight discharge from the near nostril. The ass fed, and was free from fever. 

 A little pus appeared between the edges of the wounds. 



I9th. — Purulent discharge from nostril still offensive — tumour from sub- 

 maxillary lymphatic gland much diminished. Ass fed well. 



26t7i. — Wounds had all healed, save some superfluous granulations, about 

 one-third of an inch broad, between the edges of the upper incision. Dis- 

 charge from nostril less, but still offensive. 



On the 4th of December the discharge had almost entirely ceased, the lym- 

 phatic gland was much reduced in size, and on the 20th of the same month 

 he went away perfectly cured, and had no return of the disease. 



The common notion is — and it is one consonant with reason, and 

 for the most part, I believe, in accordance with practice — that 

 matters coming from the lungs or windpipe through the larynx be- 

 come discharged from both nostrils, or are as likely to find their 

 way into one as into the other : I cannot, however, for my own 

 part, help thinking, that every now and then it happens that a 

 channel on one side becomes so established that all the matters as 

 they issue from the larynx run, sideways, along it ; none, unless 

 through coughing, or other violent emotion, going by the other side. 

 Should this supposition be founded in truth it will serve to place 

 us more on our guard in practice. 



Bearing in mind that neither discharge from the nose, though 

 it be but from one side, nor submaxillary tumour, though it be 

 affixed to the jaw-bone, nor even ulceration of the Schneiderian 

 membrane, unless it be of a certain character, constitutes a case of 

 glanders, it becomes our bounden duty to institute in every 



