478 Journal of Applied Microscopy. 



Excluding the seven cases with mucoid exudate, the bacillus of diphtheria was 

 present on both sides in all but three cases, and in two of the latter it was 

 present on one side, the pneumococcus being found on the other. In the third 

 only the streptococcus was found. In two cases, the diphtheria bacillus was the 

 only pathogenic organism present ; pyogenic cocci or the pneumococcus were 

 associated with it in all the other cases. . The streptococcus occurred in nine 

 cases, the staphylococcus pyogenes aureus in three, the albus in two, the 

 pneumococcus in three, and the colon bacillus in four. Of the seven cases of 

 mucoid accumulation, two were sterile ; one contained the streptococcus ; one, 

 the staphylococcus pyogenes aureus ; one, the diphtheria bacillus alone ; and 

 two, the latter organism associated with the streptococcus and pneumococcus 

 respectively. An infection of the sphenoidal sinus was also present in two cases 

 of double antral empyaema. In one, with a cloudy serous fluid, the streptococcus 

 and the bacillus of diphtheria were found ; in the other, with a thick yellow pus, 

 the streptococcus alone. Of five cases with infection of the antrum on one side 

 only, two contained the bacillus of diphtheria and the staphylococcus pyogenes 

 aureus ; one, the latter organism with the streptococcus and the colon bacillus ; 

 one, the diphtheria bacillus alone ; and one a variety of non-pathogenic organ- 

 isms. In two cases, in which only the sphenoidal cavity was involved, the 

 streptococcus was present in the one case, causing a general infection ; in the 

 other, infection of the middle ear. 



In the two cases of diphtheria with measles both antra were involved, the 

 diphtheria bacillus and the streptococcus being found in both. In one of these 

 cases both middle ears were purulent, and contained the same micro-organisms 

 as the antra. In three of the five cases of diphtheria with scarlet fever the antra 

 were normal ; one contained the diphtheria bacillus with some unrecognized 

 bacteria in one antrum. In the second case one antrum furnished cultures of 

 the streptococcus, the other of the streptococcus and the staphylococcus pyogenes 

 aureus. In this case the sphenoidal and ethmoidal sinuses were involved and 

 contained the streptococcus. Cultures from the middle ear showed the diphtheria 

 bacillus and the streptococcus. 



In one of the four cases of uncomplicated scarlet fever the antra were found 

 to be normal ; in one, a double empyaema, the streptococcus and the staphylo- 

 coccus pyogenes aureus and albus were found ; in the third case the staphylo- 

 coccus pyogenes aureus and albus, and the bacillus pyocyaneus were found ; 

 in the fourth case one antrum was involved which furnished cultures of the 

 streptococcus and a short diplo-bacillus. Cultures of the streptococcus were 

 obtained from the middle ear in both cases where there was infection on both 

 sides. 



Conclusions. — In fatal cases of diphtheria and scarlet fever, infection of the 

 antra of Highmore is quite common. The micro-organisms commonly found 

 are the diphtheria bacillus, the pus cocci, and the pneumococcus. In the cases 

 reported the inflammatory changes in the antra did not produce sufficiently 

 marked symptoms to attract attention during life. There is also, in many cases 

 that recover, reason to believe that the accessory sinuses are often involved, 

 some cases recovering without ill effects, in others subacute or chronic diseases 



