CV.ap. VI.] NOSE AND NASAL CAVITIES. 95 



ninth rib on the left side was fractured during a fit of 

 sneezing (Med. Times, 1862). Mr. Pitts (Lancet, 

 1883) has, However, reported the strangest case of all, 

 a case in which all the coverings of a large femoral 

 hernia were ruptured during the act of sneezing, so 

 that the bowels escaped. 



Some of the lymphatics of the nasal fossae enter 

 certain glands placed behind the pharynx, in front of the 

 rectus capitis anticus major. Hence, as Fraenkel has 

 pointed out, " retro-pharyngeal abscess may arise in 

 consequence of diseases of the nose." Other lympha- 

 tics go to the submaxillary and parotid lymph glands, 

 and it is common to find the former set of glands en- 

 larged in nose affections, especially in the scrofulous. 



The sinuses. These may be briefly dealt with. 

 The frontal sinuses are not present in early youth, but 

 develop as age advances. They do not exist before 

 the age of 10 years, but are well developed by 20. 

 They are practically formed from the diploe. Large 

 frontal sinuses do not necessarily imply large ex- 

 ternal prominences over the glabella and superciliary 

 eminences. They often develop more as the brain 

 shrinks, and appear then to follow, as' it were, the 

 receding brain. Bony tumours often grow from the 

 interior of these sinuses, and are known as enostoses. 

 It is obvious that a depressed fracture may exist over 

 a frontal sinus, without the cranial cavity being 

 damaged. In such cases, the inspissated contents of 

 the sinus have been mistaken for brain matter escap- 

 ing. Since the sinuses communicate with the nose, 

 much emphysema may follow upon fracture of the 

 sin us wall. Insects have found their way into these 

 cavities. " Centipedes are particularly liable to be 

 found in the frontal sinuses, where they may remain for 

 years, the secretions of these cavities furnishing them 

 with sufficient nourishment " (Fraenkel). Larvae have 

 also been found here, and maggots that have developed 



