Seropurulent Maxillary Sinusitis 
in Chronic Lead-Poisoning. 
bi- 
HENRY LEWIS WAGNER, M. D., Ph.D., 
Professor of Rhinolaryngology, San Francisco Polyclinic 
(University ot California) ; 
Fellow of the American Laryngological Association ; 
Mernbre Correspondant de la Soci6t£ Frangaise d’Otologie, 
de Laryngologie et de Rhinologie. 
REPRINTED PROM THE 
Ncte STorfe jfttetilcal Journal 
for August 15, 1896. Reprinted from the New York Medical Journal 
for August 15, 1896. 
SEROPURULENT MAXILLARY SINUSITIS 
IN CHRONIC LEAD-POISONING.* 
By HENRY LEWIS WAGNER, M. D., Pn. D., 
PROFESSOR OF RHINOL ARYNGOLOQY, SAN FRANCISCO POLYCLINIC 
(UNIVERSITY OF CALIFORNIA) ; 
FELLOW OF THE AMERICAN LARYNGOLOGICAL ASSOCIATION ; 
MEMURE CORRESPONDANT 
DE LA SOClfcTfC FRANtJAISE D'OTOLOGIE, DE LARYNGOLOGIE ET DE RHINOLOGIE. 
The advancement made in the study of {etiology in 
diseases of the nasal sinuses has greatly improved the 
methods of treatment. The results in this study are ob- 
tained not only by histological and bacteriological analy- 
ses, including post-mortem examinations, but also de- 
pend upon a careful examination of the whole system. 
The following case fully illustrates the views on this 
subject: 
H. M. (aged thirty-two years; occupation, carriage 
painter for twelve years; parents healthy) consulted me 
a year ago for severe neuralgia of the right supra-orbital 
region. These neuralgic pains had existed for three con- 
secutive years, occurring daily at intervals of from one 
to twelve hours, and consequently the patient was obliged 
to relinquish all work. He was afflicted with hyper- 
* Read before the American Laryngological Association at its eight- 
eenth annual congress. 
Copyright, 1896, Company 2 
MAXILLARY SINUSITIS IN LEAD-POISONING. 
osmia, strong odors of any kind producing pain. Opi- 
ates and various coal-tar derivatives were prescribed by 
his former physicians without any result, and the resec- 
tion of the right supra-orbital nerve even failed to bring 
relief. All teeth in the upper jaw—some of them de- 
cayed and discolored—had been extracted, the source 
of trouble being located there, but no relief followed. 
Examination.—Patient a well-built man, skin yel- 
low in color, flesh lacking in firmness, no syphilis, eyes 
and ears normal, throat showed slight pharyngitis sicca. 
Nose: Left side normal; right, slight hypertrophy of the 
middle and lower turbinated bodies. At the entrance 
of the hiatus semilunaris a crust formed daily, which 
could easily be removed, and a slight seropurulent dis- 
charge, containing Staphylococcus aureus and a few non- 
pathogenic cocci, could only be observed every second 
Epithelium. 
Glands. 
Normal antrum of Highmore. 
or third day. Face: Transillnmination showed little 
difference between the two sides. No external swelling 
of face. Pressure on the snpra-orhital region produced 
no pain. Mouth: Hypertrophy of the right upper gum; 
no blue lead line could be detected. Pressing upon the 
region of the right first molar produced severe neuralgic 
pain. This assured me that the cause of the trouble ex- 
isted in the right antrum. Being unable to probe or 
irrigate the antrum through the hiatus semilunaris, I MAXILLARY SINUSITIS IN LEAD-POISONING. 
3 
entered the cavity through the hard palate under cocaine 
anaesthesia with the aid of a spearhead drill—this method, 
which is quick and painless, I employ frequently—and 
by injecting sterilized warm water a slight seropurulent 
discharge was observed coming from the right nostril. 
Shortly after the patient was somewhat relieved, and I 
decided to open the antrum through the canine fossa. 
This was accomplished under chloroform with a large 
trephine drill. The antrum showed in the lower and 
side walls a peculiar bluish-gray hypertrophy of the mu- 
cous membrane. Probing did not reveal any caries of 
bone, but touching certain places produced severe pain. 
Microscopical examination of the hypertrophy, made by 
Epithelium. 
Blood-vessels. 
Seropurulent maxillary sinusitis in chronic lead-poisoning. 
Dr. D. Montgomery, showed “ loose connective tissue 
infiltrated with much serum and a fair number of round 
cells of inflammation; the piece of tissue had a covering 
of columnar epithelium. There were some micrococci 
in the tissue.” After thorough removal of the hyper- 
trophied tissue, dry treatment with borated gauze gave 
no relief, and also other methods of treatment were un- 
successful. I then decided to examine the urine for albu- 
min, sugar, and lead, none of which were found; but, 
on examining fresh tissue, removed from the antrum, 
I found with sulphide of sodium the characteristic lead 
reaction. I placed the patient at once under iodide treat- 
ment, and in a few days he was relieved of all pain; the 
seropurulent discharge then ceased, and with it the for- 
mation of crusts. 4 
MAXILLARY SINUSITIS IN LEAD-POISONING. 
Traces of lead were now detected in the urine. The 
patient has steadily improved, and has remained ever 
since free from pain. 
In this case we must assign the diseased condition of 
the antrum, including the neuritis of various nerves, to 
the deposit of lead, perhaps as an albuminate. Similar 
conditions have been observed in a few eye cases (Stood), 
where optic neuritis, accompanied by severe headaches, 
was produced by chronic lead-poisoning. 
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