Human anatomy; Medicine -- Study and teaching; Palpation
=Antrum.=--Lift up the upper lip and examine the front wall of the
antrum. The proper place in which to tap it is above the second
bicuspid tooth, about one inch above the margin of the gum.
20. =Posterior nares.=--A surgeon’s finger should be familiar with the
feel of the posterior nares, and of all that is within reach behind the
soft palate. This is important in relation to the attachment of polypi,
to plugging the nostrils, and to the proper size of the plug. In the
examination of this part of the back of the throat it is necessary to
throw the head well back, because, in this position, nearly all the
pharynx in front of the basilar process comes down below the level of
the hard palate, and can be seen as well as felt. But when the skull
is horizontal, _i.e._ at a right angle with the spine, the hard palate
is on a level with the margin of the foramen magnum, and the parts
covering the basilar process are concealed from view.
The head then being well back, introduce the forefinger behind the
soft palate, and turn it up towards the base of the skull. You feel
the strong grip of the superior constrictor. Hooking the finger well
forwards, you can feel the contour of the posterior nares. Their size
depends upon the anterior, but rarely exceeds a small inch in the
vertical diameter, and a small half-inch in the transverse. The plug
for the posterior nares should not be larger than this. Their plane
is not perpendicular, but slopes a little forwards. You can feel the
septum formed by the vomer, and also the posterior end of the inferior
spongy bone in each nostril.
21. =Tonsils.=--Before taking leave of the throat, look well at the
position of the tonsils between the anterior and posterior half arches
of the palate. In a healthy state they should not project beyond the
level of these arches. In all operations upon the tonsils, we should
remember the close proximity of the internal carotid artery to their
outer side. Nothing intervenes but the pharyngeal aponeurosis, and the
superior constrictor of the pharynx. Hence the rule in operating on the
tonsils, always to keep the point of the knife inwards.
In troublesome hæmorrhage from the tonsils, after an incision or
removal, it is well to know that they are accessible to pressure if
necessary by means of a padded stick, or even a finger.
22. =Features.=--A word or two on the lines of the face as indicative
of expression. Everyone pays unconscious homage to the study of
physiognomy when, scanning the features of a stranger, he draws
conclusions concerning his intelligence, disposition, and character.
Without discussing how much physiognomy is really worth, there can
be no doubt that it is a mistake to place it in the same category as
phrenology, since the latter lacks that sound basis of physiology which
no one can deny to the former.
Public-domain text, read in full here on John Shaqi.
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