LX. A Review of Sinus-Chest Infections

It is now thirteen years since I first began the study of the relationship of sinus and chest infections. The study began with two sets of experiments performed on living animals, the first to determine the lymph drainage of the accessory nasal sinuses, and the second, the observation of experimental lesions of the lungs produced by the inhalation of fluids from the nose and throat. I have studied a large number of clinical cases during these thirteen years, and a small group of them has been followed for the entire period-that is, from childhood to young adult life. The subject is kept ever before my mind, for I am seeing constantly patients of this type. During the past year, 1931, of 295 new patients with sinus disease seen at the Cleveland Clinic, almost 20 per cent of them complained of cough, while in onethird of these, or nearly 7 per cent of the whole group, cough was the only symptom. The involvement in the chest is based on the infection and enlargement of the bronchial, peribronchial and mediastinal glands. This, in turn, produces irritation and cough, which if prolonged, interferes with bronchial peristalsis, and causes dilatation of the bronchi with retention of secretion. Lymphatic absorption from the antrum, whether of bacteria or of inert substances, is by the way of the submaxillary and internal jugular nodes to the lymph ducts, the great veins, the heart and the lungs. Substances reaching the lungs may, of course, pass on to the general circulation. My original lymph drainage experiments have been referred to frequently in the literature.' The inhalation experiments apparently have not been noticed equally, for they have been men-