A very remarkable congenital defect in which the nose is concerned, is that of which the subjects have been called Cyclopian or Cyclo cephaliart monsters. It has been admirably illus trated in a special memoir by Dr.Vrolik,* tvho points out five varieties of it. In the first, the eyes are absent or not externally visible, and the nose is either absent altogether or replaced by a kind of proboscis or snout-shaped member, consisting of little more than skin, and attached above the orbit. In the second there is a single orbit in the middle of the forehead which con tains a single eye-ball, and above which there is sometimes a proboscis representing the nose. In tbe third, the eye appears externally to be single, but is internally double; and with this again.the nose may exist in the form of a pro boscis. In the fourth, the two eye-balls are separated, but they lie in one orbit in contact, or_with only a narrow partition between them, and above them there is a proboscis which, as in the other cases, may be curved either upwards or downwards. In the fifth, the pro boscis, approaching more nearly to the form of a natural nose, has an osseous nucleus, and is directed downwards; and the eye, above which it is placed, is either double or single. In this series, therefore, there is a regular gradation from the natural to the most unnatural condi tion, in regard to both the nose and the eyes. For the eyes, there is in some no eye at all; in some a single eye-ball placed in the rniddle line; in some again an eye-ball, which appears single, contains parts of two; and in some two eye-balls lie close together in a single median orbit. For the nose, it is in some altogether absent; in some it exists in the form of a snout , which is little more than a prolongation of skin; in others it has a more or less well-formed osseous nucleus; in some it is curled upwards and backwards, in others directed obliquely downwards : and among all these there are numerous gradations of deformity. Now, any of these conditions of the nose may co-exist vvith any of those of the eye : there is no regular correspondence between their respective deg,rees of developement. This is confirmed by the cases of the monsters in which the eyes are completely absent, but the orbits are naturally placed and the nose is well formed; and by those others already mentioned, in which the nose is absent, but the eyes and orbits are natural and almost naturally placed. From all these, and from the consuincy of the deformity of the nose %vhen the orbits are united, it may be deduced that the eye and the nose are deve loped independently, except in regard to their position, and that the displacement of the nose, which constitutes one of the chief features of the Cyclopian monsters, is generally the con sequence of the orbits having taken up the place of the nasal cavities. It cannot be said that the displacement of the orbits is the only cause of that of the nose, because there are a few eases in which the nose occupied the Cyclops position, though the orbits had their natural place; and one case in which the orbits and eyes were absent, and yet the nose was elongated like a proboscis and set high upon the forehead. But these do not invalidate the truth of the general deduction already- drawn.
The displacement of the nose is thus ex plained with much probability by the precedent displacement of the orbits, and the latter is probably due to an arrest in the develope ment of the eyes. But the cause of the peculiar deformity of the nose is very obscure. There is generally some degree of relation be tween the appmach to completeness of the nose and that of the brain and its nerves, and espe cially of the anterior Ribes and the olfactory nerves : yet these nerves are sometimes present when the nose is most deformed, and when it has neither ethmoid bone nor cavity, nor even any osseous nucleus ; and in other cases they are absent when there is a distinct though mis shapen external nose. Tiedemann's suppo
sition, therefore, that these, like other malforma tions of organs, depend on a precedent defect in the corresponding nerves or parts of the ner vous centres, cannot be maintained.
Diseases qf the nose.—These are so far gene rally similar to those of the similar tissues in other parts that some of their peculiarities only need be mentioned here.
The skin of the nose is perhaps more than any other part of the face subject to the erup tions of acne, &c. And these acquire a some what peculiar character from the small vessels of the nose being so liable to distension. In the common red nose, all the small veins are usually dilated and in a measure varicose; and even in healthy persons the circulation through the skin of the nose is can-ied on with com paratively little force, if we may judge by the frequency with vvhich it is partially arrested by cold. This dilatation of the vessels and con sequent slowness of circulation not only render the diseases of the nose peculiarly obstinate, but permit them to produce changes of structure which are very rarely found among their defects in other parts. Such is the tuberculated indu ration and thickening Nvith deep red or livid congestion of the skin after long-continued acne, in which all the deeper textures appear to be confused in one hard brawny substance. When this state continues very long and the congestion somewhat abates, the thickened tissues remain, and sometimes grow into a kind of pendulous tumour from the end of the nose. Such tumours, (which, however, tnay form with little precedent acne,) are usually three-lobed, one portion seeming to correspond to the end, and one to the fore part of each of the aim, of the nose. One which I dissected was com posed throughout of a compact, white, fibro cellular tissue, like that of which the pendulous tumours consist which grow from other parts of the skin, and especially from the female labia. It seemed very little vascular,* and the hair follicles and sebaceous glands were enormously enlarged. Some of the latter measured not less than a line width, and their ducts, which opened at the bottoms of deep fossm, admitted full-sized bristles. The same enlargement of these organs takes place in certain large growths of the skin of the scrotum.
The position of the cavities of the nose has been an effectual hindrance to the examination of the changes of structure produced by their ordinary diseases. Nothing is known of the state broug,lit on by repeated colds. While they continue, the mucous membrane is gorged with blood, swollen, and red, so as to close, with the assistance of the increased secretion of mucus, the passage to the pharynx. Probably the MIICOU3 membmne is in time condensed arid thickened ; and from this it may result that in looking over a number of sections of heads, the Schnelderian membrane is found by no means uniform in its thickness, consistence, or vascu liu-ity even on corresponding parts.
Alareschalt ha.s lately stated that, in the examination of eight persons who had had epi taxis shortly before their deaths, he found in a a circumscribed portion of the membrane whic was very congested, and dark red or livid. I two of them this congested part was situate anteriorly, near the junction of the septum an the floor of the nostrils; in the others post riorly on the fold of mucous membrane at t lower border of the inferior turbinated bone.