e
anterior ethmoidal veins, and under these circumstances the blood
flows downwards between the middle turbinal and the septum. Before
steps are taken to arrest the bleeding, the interior of the nose
should, if possible, be inspected and the bleeding point sought for.
As a preliminary to the use of local applications, the nose should be
washed out with boracic lotion or salt solution to remove all clots
from the cavity. In many cases this is all that is necessary to stop
the bleeding. If the bleeding is not very copious, it may be stopped
by grasping the alae nasi between the finger and thumb, or by spraying
the nasal cavity with adrenalin. If the blood is evidently flowing
from the olfactory sulcus, a strip of gauze soaked in adrenalin,
turpentine, or other styptic should be packed between the septum and
middle turbinated body. If recurrent haemorrhage takes place from the
anterior and lower part of the septum, the application of the electric
cautery at a dull red heat, or of the chromic acid bead fused on a
probe, is the best method of treatment. Plugging of the posterior
nares is rarely necessary, as, in the majority of cases, an anterior
plug suffices. In bleeders, the administration of sheep serum by the
mouth has proved efficacious.

#Suppuration in the Accessory Nasal Sinuses.#--As already stated, the
presence of pus in the nose should always direct attention to its
possible origin in one or more of the accessory sinuses, especially if
the discharge is unilateral. The condition is usually a chronic one,
and may be present for months, or even years, without the patient
suffering much inconvenience save from the presence of the discharge.

If on examination by anterior rhinoscopy, pus is seen in the middle
meatus, suspicion should be aroused of its origin in the maxillary
sinus, frontal sinus, or anterior ethmoidal cells, as all these
cavities communicate with that channel. If, on the other hand, the pus
is detected in the olfactory sulcus, attention must be directed to
the posterior ethmoidal cells and sphenoidal sinus (Fig. 267). Further
evidence of its source in the last-named cavities may be gained by
finding pus in the superior meatus above the middle turbinal on
examination by posterior rhinoscopy.

As the anterior group of sinuses is most frequently affected, and of
these most commonly the _maxillary sinus_, attention should first be
turned to this cavity. Pain, tenderness on pressing over the canine
fos