pus was evacuated. The cavity was treated by the usual method of douching with warm boracic-acid solution until the fluid came away clear and gently curetting the walls with pledgets of cotton; the wound was packed with iodoform gauze. During the operation the pulse rose to 88 and improved in quality; the patient regained color; she laughed and talked with no suggestion of discomfort, although about an hour was taken to complete the gentle evacuation.

The wound was dressed daily. On the third day the pulse had dropped again, and when the packing was removed there was a gush of fully six drachms of pus from a second cavity that was found to lie above and posterior to the original one. This was treated as the former one had been, but drainage by soft rubber catheter was substituted for the gauze.

From this time on convalescence was uninterrupted and the child is now, after ten weeks, running around with healed wound and apparently well.

Subdural abscess or limited leptomeningitis is rare, and its relation to cerebral abscess has not often been definite. It seems fair to claim that here the two lesions were consecutive and the brain-lesion caused by the infection from the surface, although no continuity could be traced. The tegmen, as studied from both sides at the first operation, seemed intact.

OSTEOMYELITIS OF THE SKULL WITH EMPY.

EMA OF THE NASAL ACCESSORY CAVITIES;

THROMBOSIS:

SINUS
AUTOPSY.

PYÆMIA; DEATH;

BY DR. ARNOLD KNAPP.

(With three illustrations on Text-Plates VI. and VII.)

M. M., twenty-one years old, an Irish servant girl of good family history, began to suffer from nasal occlusion and discharge five years ago, on the right and, shortly after, on the left side.

She later suffered from headache and the nose externally slowly broadened out. She began treatment six months ago; at least fifty polypi were removed from the nose, but with only temporary relief. She was then referred to me by Dr. C. B. Meding of this city.

On admission: September 8, 1802. Poorly-nourished young woman with a typical frog-face deformity. The nasal processes of the superior maxillæ are pushed forward and out and are situated about in the centre of the cheek. The lachrymal groove is occupied by a bony swelling, the displaced inner wall. Posterior to this, the internal orbital wall is pushed outward and prominent. The eyes are normal. On examining the nose, both nasal cavities are enormously dilated; the lower meatus is broad and the inferior turbinal is small and pressed against the outer wall. Above this, the nasal cavities are completely filled with a mass of polypi, hypertrophied nasal tissue, and thick white pus. It is impossible to locate the path of the pus as there are no landmarks. On the left side the polypi extend into the naso-pharynx. No history of syphilis. Right old otorrhoea.

Operation: September 9, 1902. Morphine-ether narcosis. Incision beneath right eyebrow and along side of nose to floor of orbit.

After retraction of the orbital contents the periosteum is found so thin over the os planum as not to be identified. The bone itself showed two openings in about the centre, round and smooth, evidently pressure-atrophies. The tendon of the superior oblique lay bare. There was no orbital tissue between the eyeball and the os planum.

On making an opening over the naso-frontal duct, pus from the frontal sinus appeared. The floor of the sinus extended out for three-quarters of the orbital roof and was removed. The mucous membrane was found partly detached, greenish, and covered with granulations. After removing the lachrymal bone and os planum, polypi were encountered, but no pus. The ethmoidal labyrinth was like a cyst. The changes were most in anterior part of nasal cavities. Polypi anterior to the head of the middle turbinal were removed; then, with the curette, the entire mass occupying the ethmoidal lateral body was removed. Moderate bleeding, controlled by packing. Sphenoidal opening not identified, nor were posterior extremities of turbinals removed.

The patient stood the operation without much shock. On the following day there was some fever. T. 104°, P. 120, and the region about the incision became very much swollen, red, and painful, suggestive of erysipelas. The tumefaction, fever, and symptoms, however, disappeared in three days. At first there was no discharge from the nose. Later there was a slight discharge and the nose would become occluded with very large crusts. The wound-healing progressed favorably until September 22d. There was some swelling about the wound, and the region of the left frontal sinus was very tender. The patient complained of headache and of the teeth being sore. Some granulations at the edges of the wound were removed, together with some polypi which had formed in the nose externally above the inferior turbinal, internally on the septum, and posteriorly, covering the sphenoidal cavity. An attempt was made to remove these with a curette, but without much success on account of the pain. The swelling about the wound increased, the picture of cellulitis appeared, the periosteum seemed lifted up from the frontal bone, and the suppurative process extended to the other orbit. Free drainage externally was established and a tube inserted. The patient suffered, from time to time, with very severe left-sided headache, which would persist day and night. The left nasal cavity was completely occluded and there was a large quantity of purulent