SEPTIC THROMBOSIS OF THE LATERAL SINUS [M THE RNITISH CASE III Margaret T., aged 6, had suffered occasionally from earache prior to removal of tonsils and adenoids. A month after the operation, severe earache in left ear. Left tympanic membrane was red and bulging, and was therefore incised. The ear discharged freely, but pain continued and was accompanied by rise of temperature to 1000 each afternoon, fallinig to normal in morniing. No rigors. Alastoidectomy revealed a little muco-pus in cells

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... and aIntrum, and also swollen red mfucosa. Lateral sinus was exposed, and, although it appeared healthv, was incised; it bled freely and contained n10 clot, although the wall was thicker than is usual. As the lower endil did not bleed, after packing off the upper encd the jugular vein was ligatured in the ineck. The case wN,as regarded as a thrombosis of the jugular bull). Notwithstanding those measures, the daily rise of temperature continued. It was unaccompanied by rigor or perspiration. A week later the lateral sinlus was more freely exposed, and the upper end was found to be inflamed and thrombosed to within half an inch of the torctlar. Indleed, the packirng introduced above the clot projecte(iL inito the torcular. Only slight improvement follow%ed, and the septicaemic symptoms cointinued until the chiil died a month later. Immuno-transfusion of 250 c.cm. of blood from the father ha(l no effect. On two occasions 10 c.cnI. of blood from the father was injected intramuscularly, and the first of these injectioins w as follow-ed by a temperature of 105°and rigor oIn three successive days. Then the temperature fell to 100°, and remained at 1000 to 1020, as it had averaged throughout the illness. Although the chil(d was extremely ill during the five weeks, death vas more sudden than wras expected. No post-mortem examination. }3ut for the discovery of a septic thrombus at a higher level than usuial, the case w ould hav,e been regarded as a primary aural bacteriaemia." CASE IV Peter WV., aged 11, had pain in both ears, followed two days later by discharge of pus, which ceased after a -week. Thein he complained of acute pain in the back of the neck, which continue(d for four weeks, and became more acute. He wvas then admitted to hospital, when it was noticed that the back of the neck was swollen anid verv tender on the left side. The swelling was well behind the mastoid region. Both tympaiiic membranes were of normal appearance. Temperat-ure 100°. The only abnormality of the nervous system was double optic neuritis. Mr. Dott determined to explore the cerebellum. A large absc&s 'was discovered among the suboccipital muscles. Streptococci were cultivated from the pus. There was no lesi6o of the cerebellum, but on exposing the laterall sinus from the p)osterior aspect it 'was found to be dilated and of yellow colour, though the outer dural surface was srmlooth. A needle 'was introduced, anda some thin pus w%Nas w-ithdra r,. The sinus wx-as then opened and the pus evacuated. The abscess was found to extend within the sinus for a distrance of 1ll inches, but the limiting clot at either end was not disturh)ed, as there had been no symptom indicative of sinus infection. A steady convalescenice followed, and the optic neuritis disappeared. WVe are indebted to Mr. Dott for perrnission to refer to this unusual case, wvhich vill be reported more fully elsew.Ahere. COMMENTARY Cases I and -; presenited no unusual phenomena. Case Ill may have beeni a case of aural bacteriaemia or septicaemia, in which event the operation of opening the sinus and ligaturing the jugular was ill-advised, although it appears more probable that a partial thrombus was present al' the time, at a higher level than usual. Case iv was rather remarkable, and the sinus condition, which consisted of a collection of pus within the vessel between two limiting clots, might have been entirely overlooked if the optic neuritis had escaped discovery. It illulstrates the importance of complete and thorough investigation of all cases inl which intracranial complication.s are suspected.