MO I 'Til— PA A. 1 TE—XOSE 1 097 



mouth is very limited, extending, in the aduh. from the lower Lord, r of tii.- axis 

 to the middle or lower i)art of the fourth eervioal vert(^l)ra; in the child, <»wing 

 to the small size of the face, it comprises the bodies (»f tlie axis and of the third 

 cervical vertebra.' (Thane and (iodlcc. from Chipault. ) 



TONSILS. — The relations of the tonsils sliouid \n- carefully examined. Tims, 

 they are separated externally by the superior constrictor and pharynjreal aponeuro- 

 sis from the ascendini^f pharyiifical and internal canttid arteries. Th<- extent to 

 Avhich the tonsil is covered by the anterior pillar, how far it ])roject.< U]iwards 

 beneath the soft palate or downwards into the pharynx, have all imi)ortant bear- 

 ings on the mode of removal. Its position corre.«j)onds to the angle of the jaw. 

 When serious haemorrhage follows oi)erations on the tonsils, it usually c<»mes from 

 one of the numerous tonsillar arteries, which is enlarged, and not from tlie 

 ascending pharyngeal or internal carotid. 



The finger introduced downwards at the back of the mouth, especially if 

 the parts are rendered insensitive by cocaine, feels the cinumvallate jtapilhe, the 

 lingual and laryngeal surfaces of the epiglottis, the aryteno-ejiiglottidean folds, 

 with the cartilages of Wrisberg and l^antorini. If the finger be moved upwards 

 behind the soft palate and turned upwards to the base of the .-kull. and tb.ii 

 forwards, it will impinge on the posterior nares. se])arated by the vomer, and, 

 within each nostril, tlie hinder end of the inferior and middle spongy bones; above 

 and behind is felt the basilar process of the skull, the vault of pharynx, and 

 upper cervical spine (fig. 671). 



The size of the nares, one inch l)v half an inch, and the presence of any 

 adenoids, are especially to l)e noted. The richness of the naso-pharynx in 

 glandular structures, its proneness to inliamniatinu. and of this iiiliaiuiiKition tn 

 spread to other parts, — e.g. the tympanum, — are well known. The tinger should 

 be familiar Avith the feel of adenoids — i.e. hypertrophicd post-nasal lymphatic 

 nodules — soft bodies of irregular shape blocking u]) the naso-pharynx. To make 

 out how far this is the case, it is well to take the nasal septum as the starting-point. 



THE PALATE 



Between the diverging })illars of the soft ])alate is the isthmus faucium, 

 bounded above by the free margin of the palate, and below by the dorsum f>f the 

 tongue. Of its lateral boundaries, the posterior ]»illars come nearer each other 

 than tlu^ anterior. In paring the edges of a cleft soft palate, the folloAving 

 structures would be, successively, cut through : i 1 i < )ral muc<.us hk mbram': 

 (2) submucous tissue, with vessels, nerves, and glands; (o) palato-glossus muscle; 

 (4) aponeurosis of tensor palati; (5) anterior fasciculus of jtalato-pharyngeus; 

 (6) levator palati and azygos uvulae muscles; (7) posterior fasciculus of i>alato- 

 pharyngeus; (8) submucous tissue, vessels, nerves, and glands; (9) posterior 

 mucous membrane. The soft ]ialate is thicker than it seems, the average in an 

 adult being a <juarter of an inch. The muscles widening a cleft are the tensor 

 and levator, while the superior constrictor closes it in swallowing. Of the 

 arteries to the palate, the largest is the descending jialatine branch of the 

 internal maxillary. This emerges from the posterior )>alatine canal <lose to the 

 inner side of the la.st molar tooth, and runs forwaril to supply the hard palate 

 Cpaire 49G). 



THE NO^JE 



On the face the outline of the na.sal bones can be easily traied, an<l l)elow them 

 the upper lateral cartilages, flat and also somewhat triangidar. Below these are 

 the lower lateral cartilages, curved and so folde<l back that each forms an outer 

 and an inner plate. Of these the inner meet below the sej^tal cartilage to f<irm the 

 ti]i of the nose, while the outer curve l)ackwards, and. togetlu-r with dense nKi.>Jses 

 of cellular tissue and fat and accessory cartilages, form the ake. 



With the sj^ecidum. especially if the head be thrown back and tlie tip of 

 the nose drawn ui>. the lower j)art of the septum, floor of the nose, and gre.-iter 



