Pyrrolidinomethyltetracycline in cavernous sinus thrombosis.

General Examination.-Pulse 86/minm respiration 28/mmn., blood pressure 150/80 mm. Hg. There was no anaemia, cyanosis, jaundice, or lymph node enlargement. The cardiovascular, respiratory, and gastro-intestinal systems appeared to be normal. Neck rigidity was present and Kernig's sign was positive. There was tenderness over both mastoid regions. Total white blood cell count 11 .200/c.mm. (polymorphs 87, lymphocytes 12, eosinophils 1); total red blood cell count 5 mill./c. mm. erythrocyte sedimentation rate 45 mm./l hr. X rays of the skull and orbits were normal. Ophthalmnological Examination.-Both orbital margins were tender, and the eyes and lids immobile. Both eyes were proptosed and both eyelids grossly swollen, the skin being erythematous. Both lacrimal passages were patent. There was gross conjunctival and circumcorneal congestion. The corneae were hazy and insensitive and the pupils dilated and fixed. The iris, lens, and vitreous were normal. Fundus examination showed slight dilatation and tortuosity of the retinal veins. Only projection of light was present in both eyes; hand movements could not be distinguished. Diagnosis.-Cavernous sinus thrombosis. Treatment.-Injections of crystalline penicillin 5 M.U. intramuscularly every 4 hours for 36 hours, and intravenous injections of Reverin 275 mg. were continued for 13 days, followed by 1 tablet Sulphadiazine four times a day for 4 more days. Terramycin ointment 1 per cent. was applied twice a day, and both eyes were covered by a pad and bandage.