PURULENT INFLAMMATION OF THE SINUSES. 323 



PURULENT INFLAMMATION OF THE SINUSES— 

 MENINGO-ENCEPHALITIS. 



24. Seven-year-old mare, affected with double-sided purulent 

 inflammation of the sinuses. Left in hospital on the 2nd January, 



The left inferior maxillary and frontal sinuses had been trephined, 

 despite which the affection of the sinuses became complicated with 

 brain disease. The mare, was sent to the School on the evening of the 

 2nd January, and had travelled a distance of five miles at a walking 

 pace. 



State on Examination. — The trephine openings in the left frontal and 

 inferior maxillary sinuses were still open ; their margins were soiled 

 with pus, and from both nostrils escaped a purulent ill-smelling dis- 

 charge, more abundant on the left than on the right side. The left 

 submaxillary gland was swollen, lobulated, and the size of a small nut. 

 When placed in a box the mare appeared exceedingly depressed. The 

 eyelids were swollen and half closed, and vision was interfered with, 

 principally on the right side. During the night the animal took only a 

 little mash. 



Next morning the condition was more serious. Prostration was 

 even more marked than on the preceding evening. The mare moved 

 with great reluctance ; the gait was slow and uncertain, movements 

 were irregular, and the limbs became flexed at every step. When 

 returned to its box the animal suddenly showed alarming symptoms 

 without any apparent cause ; it rolled about, recovered itself, and 

 leaned against the wall with the front limbs crossed. In about ten 

 minutes it made a few more uncertain steps, again dropped back 

 against the wall and fell heavily, stretching itself on the left side, and 

 showing great excitement, which was succeeded by a period of coma. 

 At this time the temperature was 39'2° C. ; respirations 22 ; pulse 78 

 per minute. 



For some hours phases of excitement alternated with periods of 

 coma. During the former the animal sometimes lay on its chest, the 

 front of the head pressed on the ground ; sometimes completely on its 

 side, the head and limbs being constantly in motion. 



Treatment. — Hypodermic injection of morphine and chloral ene- 

 mata. During the afternoon the coma was only interrupted bypassing 

 fits of excitement. Respiration and circulation became more and 

 more rapid, the temperature rose to 39"8° C. The animal died during 

 the night. 



Autopsy. — The abdominal viscera showed nothing abnormal. The 

 right lung, however, contained two small centres resulting from chronic 

 pneumonia. 



The head was detached from the body and sawn through longitu- 

 dinally near the middle line. On examining the sinuses the mucous 

 membrane was found inflamed, thickened, and covered with yellowish- 

 grey putrid pus. 



In the antero-inferior part of the cranium the meninges were 

 inflamed, infiltrated, thickened, and bathed in a sero-purulent exudate 



