COI,I.ECTlON OF PUS IN THE NASAI, SINUSES. 



Nasal Sinuses, position, orifice, suppuration, symptoms, treatment, tonics, 

 astringents, antiseptics, trephining, significance of the foetor, mode of re- 

 covery. 



In severe coryza the nasal sinuses become implicated as shown 

 by the intensity of the symptoms, the prostration, the hanging 

 head, and the heat and sometimes tenderness between the eyes 

 and immediately beneath them on the side of the upper jaw. 

 These sinuses are large spaces filled with air, situated between the 

 superficial and deep plates of the bones of the face and opening 

 into the nostrils by a narrow orifice in the upper part of the nasal 

 chambers. When pus is largely formed in these it fails to flow 

 out as rapidly as produced, parts with a portion of its liquid ele- 

 ments, increases in consistency and sometimes even undergoes de- 

 composition, so that the discharge from the nostril has a putrid 

 odor. 



The most distinctive symptoms of this form of nasal gleet are 

 obtained by percussing the sinuses, and in those cases in particu- 

 lar in which the accumulation is confined to one side of the head, 

 the contrast between the two sides is unmistakable. By gently 

 tapping the forehead with the middle finger from one eye to the 

 other the flat solid sound on the diseased side is easily distinguished 

 from the clear drum-like resonance on the healthy one. By tap- 

 ping on the bone beneath each eye and just above the ridge on the 

 side of the upper jaw, the difference between the two sides will be 

 recognized in the same way. In some old-standing cases increas- 

 ed tenderness and slight bulging of the bones over the affected 

 sinuses are often superadded to the other symptoms. The eye on 

 the affected side is usually retracted so as to seem smaller. 



Treatment. In some cases the use of tonics and astringent in- 

 jections as recommended for the treatment of ozcena^\!Ci prove suc- 

 cessful, but more usually it is needful to open and inject the si- 

 nuses. 



For this the following articles are required : scissors, a knife, 

 forceps, a trephine or circular saw from half to three-fourths of an 

 inch in diameter and a whalebone or metallic prob. 

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