Brain infection from sinus disease

Although for a long time otitic brain infections have been known’ and studied throughout the world it is only of late that attention has been paid to those of nasal origin, in spite of the fact that such cases have been observed in every large clinic. During a recent ti ip through Europe the writer had occasion to discuss the subject with many of the leading men abroad and was astonished at the large number of fatal accidents that had occurred in many of the prom¬ inent clinics. Alas! these cases are often not reported abroad and seldom in this country. I know of a large number of fatalities in my own city but have yet to see them published. The first question of interest is: In what way is an infection carried to the cranial cavity after any operation on the nose or throat, or even without an operation? There are four possibilities. It may be propagated (1) by continuity; (2) by way of the blood¬ vessels; (3) by way of the lymphatics; and, finally (4) by way of the lymphatic sheaths of the olfactory nerve. Hajek directed attention to the possibility of brain involvement resulting per continuation even though the bones and dura matei may appear intact on macroscopic inspection. In one case published by him he proved the correctness of this statement by microscopic ex¬ amination. He and Ilinsberg also demonstrated the second mode of infection—viz., the transmission of the micrococci through the blood-vessels. Hajek had previously found streptococci in the veins in rhinogenic endo-cranial infection and later this observa¬ tion was corroborated by others. Of great importance as regards the third mode of possible in¬ fection are the experimental researches of Zwillinger of Buda¬ pest on animals and men. His studies on the lymphatics of the up¬ per portion of the nose and their relation to the peri-meningeal lymphatic cavities resulted in the following conclusions presented by Zwillinger at the last International Medical Congress in Lon¬ don and kindly communicated to me by the author: 1. The relation of the perimeningeal spaces of the subdural and subarachnoid space with the lymphatic network of the mucosa of the frontal sinus by way of the nasal mucous membrane in animals