Chronic empyema of the ethmoidal and frontal sinuses, with exophthalmos : operation, death from menigitis, autopsy / by Arnold Knapp.

  • Knapp, Arnold Herman, 1869-1956.
Date:
[1903]
Catalogue details

Licence: In copyright

Credit: Chronic empyema of the ethmoidal and frontal sinuses, with exophthalmos : operation, death from menigitis, autopsy / by Arnold Knapp. Source: Wellcome Collection.

Provider: This material has been provided by UCL Library Services. The original may be consulted at UCL (University College London)

    5/8 (page 215)
    gone; the ethmoidal labyrinth, except for the presence of a few posterior ethmoidal cells, is converted into a bone cavity, showing only an inner and lower wall (middle turbinal). The entire area is lined by a very thin membrane, the old mucous membrane. The bone underneath is smooth. At the edges posteriorly and externally diverticula and septa remain which are smoothed away. The frontal sinus has no lining membrane, and the bone appears superficially diseased, brownish, and can be peeled off like parchment (tabella vitrea). A broad opening is made mto the nose, throughout the middle meatus, and the middle turbinal is completely removed. Anteriorly the nasal process of superior maxilla is partly resected. Some of the posterior ethmoidal cells, situated far back and next to the septum, are apparently dis- eased and are opened up externally. The wound is packed from in front. Sept. 19///.—T. 100.6°. P. 90. Complained somewhat of headache. Vomited a considerable quantity of blood. Sept. 20///.—Complained of her throat and also her stomach. Some headache. T. went up to 103.6°. P. 112. Sept. 2ist.—A. restless night. Complained of pain in the right eye and headache. T. remained at 103°. In the afternoon slightly delirious. Pain in the back of head and neck. Swallow- ing difficult. In the evening became restless and attempted to get out of bed. Sept. 22d. — T. rose to 104°. P- loo- Partly delirious, though answers questions. Very restless, complains of pain in the head. Palpation of back of neck painful. The wound was dressed. Gauze removed. There seemed to be no retention of pus. The cerebral wall of the frontal sinus healthy. The nose was irrigated. In the afternoon the condition has not changed. She has taken nourishment. The left pupil was found dilated. No change in the eye ground. Sept. 23^/.—Restless during the night except when under the in- fluence of morphine. At six o'clock in the morning her condition became suddenly very much worse. Later her breathing was more rapid. T. 106°. Pulse could not be counted, and at 10 a.m. she died. Autopsy, 8 P.M.—After removing the calvarium, the dura ap- peared normal. There was purulent meningitis over the con- vexity, more on the left than on the right side. On lifting the base of the brain, the right olfactory bulb was found imbedded in