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WORLD AT WAR
REALITY BLEED BOOK 6
 J.Z. FOSTER
JUSTIN M. WOODWARD
 CONTENTS

Prologue
Chapter 1
Chapter 2
Chapter 3
Chapter 4
Chapter 5
Chapter 6
Chapter 7
Chapter 8
Chapter 9
Chapter 10
Chapter 11
Chapter 12
Chapter 13
Chapter 14
Chapter 15
Chapter 16
Chapter 17
Chapter 18
Chapter 19
Chapter 20
Epilogue

American Weaponry
Soviet Weaponry
What’s Next?
Hold the Line
Earth Siege
About J.Z. Foster
About Justin M. Woodward
Winter Gate Publishing
Dedicated to the human race, who will never blink an eye at making
a bad situation worse through petty bickering.

We love you all.

 PROLOGUE

T he A merican forces in South Japan had designed a strategy

specifically for the aggressive North.
Tripwire.
The general idea was that should blood be spilled along the
border of North and South, Americans would be involved.
Dead Americans.
The design was simple enough. Tripwire just meant Americans
were mixed in with South Japanese forces on the border so that if
the North Japanese attacked—which they were always threatening
to do—Americans would die.
And the mighty and horrible war machine of America would have
the justification it needed for conflict.
Dead Americans automatically put the United States into a state
of war.
Tripwire was a bomb set up to deter North Japan. It had been a
fairly effective deterrent for the North Japanese, who for decades
seemed all too willing to engage in border conflicts.
It was not an uncommon thing, in decades past, for South
Japanese soldiers to be grabbed while on patrol and dragged off to
some horrendous end, or simply shot dead with no real concern of
return fire.
Tripwire was an effective strategy.
But at this moment, the genius of the idea didn’t sit well with
Robert Corbin, because it was his turn for tripwire.
 His body to bleed.
A commanding officer had explained it to him once. “Sure, you
want to shit your pants while you’re looking out over the
demilitarized zone. But they don’t want to do anything. They might
take potshots at any of the South Japanese walking patrols, but
those pricks don’t want our asses bearing down on them.”
When Corbin joined the army, he imagined he was going to end
up in Syria shooting at terrorists, or possibly in South America
fighting drug lords—instead they handed him papers with his
deployment orders.
South Japan.
He couldn’t have been happier.
The land of pretty girls, short skirts, and easy duty.
And tripwire.
That was the thing about South Japan. It was a wonderful place
to serve out your duty, even with the occasional shift on the border.
He loved the food, too. No one cooked noodles like the Japanese.
Too bad he had a rifle in his hands and not a pair of chopsticks.
The border between the South and North was the most heavily
militarized place on the planet.
The South had technology, a functioning economy, and a two-
year military draft for all boys eighteen years and older.
The North had starvation, weapons of war, and entire control
over its citizens’ lives.
All that stood between them was a flat, heavily mined piece of
ground that fogged in the mornings.
This was one of those mornings.
Corbin squinted through his binoculars across the demilitarized
zone. He couldn’t see shit. Not with the fog as thick as soup. Just
barren ground and patches of barbed wire.
Well, not entirely barren.
There were those trees—twisted, ugly things. Corbin could never
remember their names. They grew at jolting angles and had red
leaves that curled and shriveled in the summer and fanned open in
winter, seemingly as a big middle finger to all things natural.
 He’d heard some botanist’s explanation for it once, but the
concept and details flowed in one ear and out the other. Who gave a
shit about the natural life cycle of trees anyway? He preferred what
his Japanese friends had told him.
“It’s the blood,” they’d said. “Those trees have soaked up so
much it turned them unnatural.”
Unnatural was one word for it. Corbin had a different one.
Evil.
The whole place felt evil. So much so that Corbin’s duty was just
to stand here and be the first to die if killing started.
“Shit.” He lowered his binoculars, letting them hang loosely to his
neck.
“Don’t like the peace and quiet?” That was Patterson, Corbin’s
battle buddy. Right now the bastard was sitting back in a chair with
his feet up, pretending like he was enjoying every minute.
Corbin shook his head. “Hell no. I’d much rather be back on
base, taking my leave in Osaka. Instead I’m out here, scratching my
ass and waiting for something to kill me.”
“Easy money though, right? They don’t give you shit out here.”
Patterson faked a yawn.
“Fuck no, they don’t. They just put you out here in a forty-year-
old concrete bunker and say good luck.” Corbin huffed and looked
through his binoculars again. “The least those bastards could have
done was give us CAG.”
Patterson laughed and gave an exaggerated scratch between his
legs. “CAG? You want to wear that shit out here? I like being able to
scratch my balls when there’s an itch or they stick to my leg. There
hasn’t been an American killed on the border in twenty years. You’re
just—”
“The fuck?” Corbin cut him off.
Out of the corner of his eye, out in the fog, he was sure he saw
something stir.
Patterson quieted too.
Corbin squinted through the binoculars again.
He wasn’t sure if he was seeing anything or not, but he thought
he could see black metal with an odd shine to it.
 “Something is out there.” Corbin didn’t make a move.
“Like hell. Give me those.” Patterson thumped his hand down
onto the console and held out his hand for the binoculars.
Corbin didn’t hand them over; his eyes were glued.
Something stirred and one of the trees shook, its branches like
fingers clawing at the air.
“Maybe just. . .” Corbin whispered.
But it was more wishful thinking than anything else.
The black metal moved, and the fog sifted around it. A hulking
robotic beast stepped into view, mud slipping off its mechanical legs
with each step.
Tankers.
“Call it in! Call it in now goddammit!” Corbin dropped his
binoculars and snatched his rifle.
But as one tanker exited the fog, another stepped behind it, and
then more dark shadows formed. Maybe a dozen in all.
Corbin’s eyes widened. If they were close enough for him to see
them now, then they were target cleared for combat.
The bipods on the rifle clicked as he snapped them forward and
set the rifle on the concrete edge of the bunker to take aim.
Patterson screamed into the radio while Corbin’s rifle bucked in his
arm as he unleashed a volley of shots, more warning than anything
else.
The bullets slammed on the tanker with no real penetration or
purpose.
It only served to let the tankers know where they were.
It seemed that all of the tankers leveled their large drum rifles at
Corbin’s bunker. They began to turn with a quiet whine.
With Patterson still screaming into the radio, Corbin leaned up
from his rifle and took a resigned breath. It was the last he would
ever take.
The tankers unleashed, and the heavy rounds tore through the
bunker.
It was in those last few seconds that Corbin realized he’d fulfilled
his purpose.
They’d blown the tripwire.
 1

T ripwire is activated . American troops are engaging.

John Winters had gotten the call a short time ago.
A simple thought had rolled through his head.
Those dumb bastards.
It was only dumb bastards who started wars. Any sane or
rational man would do all he could do to avoid conflict.
John knew war. He’d seen war. He’d lived war.
He’d been young once, and he’d been a dumb bastard himself
and enlisted for all the wrong reasons. He’d been a Marine—is a
Marine, as the Corps saying goes: Once a Marine, always a Marine.
He’d served in Southern Africa during the Red Intervention—a
wave of civil wars and conflicts aimed at installing Communist
leaders. America had gone into the conflicts limp wristed and half
armed, afraid that if they moved in too strongly, they might trigger a
Soviet response.
All they really succeeded in doing was prolonging the conflicts
and lengthening the suffering.
God in heaven, he could still smell the burning flesh.
He didn’t talk about that part of himself. Not with his wife, not
with his daughter, and not with anyone who hadn’t been there.
No one who hadn’t also smelled the bodies cooking could ever
understand.
John would never talk about that time, but it shaped his life. He
had made a commitment to himself and God above.
 He would never start a war.
But if he found himself in one?
God help his enemies, because he would not be restrained. He
would not send Americans to war on a half measure.
And he would always remember that smell.
Now he was gearing up for his fifth meeting of the day.
That was one constant in Washington, no matter how far up the
ladder you climbed—an endless parade of meetings. He was nearing
exhaustion.
Everyone was. That much was obvious as they sat around the
table of the President’s situation room. Only a select few were
invited to help President Warren make his decisions.
John was one of them.
The dull gray paint and simple vid-screen inset on the north-
facing wall betrayed the seriousness of the room. There was a
weight of presence. They all felt it. Too many early meetings and
late-night discussions.
Too many things going wrong in the world.
The world’s at war.
That’s what John’s assistant had said to him.
World War Three.
God help us all.
Every member of the president’s team was scrambling.
They were all tired.
The world was teetering on the decisions of men and women
with red eyes of exhaustion.
Except Richard John Roles.
He was as bland faced as ever, a chin carved out of stone with
eyes to match.
“The Soviets are blaming us for the unrest.” Roles clasped his
hands in front of him, a red file folder gripped in one hand. “But
they’re denying any nuclear weapon was used inside Moscow.”
McAndrews, the chief of staff, scoffed, his tie and neck collar
uncharacteristically loosened. “Goddamn Russians. Leave it to them
to think they can just pretend a nuke didn’t go off.”
 John leaned closer to the table. He might be tired and his eyes
red, but his tie was still straight. “That’s not just it. They’re ordering
us to close the consulate in Ukraine. They’re giving us twenty-four
hours to close up, and then they will escort the staff to West
Germany.”
John’s tie might have been straight, but Vice President Cassie
Amana still had her hair fixed and makeup on. “And the defector is
still there, isn’t he? Do they know he’s there?”
“Oh, I wouldn’t presume to know what the KGB does or doesn’t
know, but my guess?” Roles frowned as if deciding between two
choices on a menu. “Probably.”
President Warren took a deep breath, quieting the room. “Always
safer to bet the KGB does know. We might lose the kid. Do you think
he’s worth the effort?”
“Yes,” Roles said flatly.
There was a pause, and then McAndrews fanned out his hand.
“Care to elaborate for us simpletons?”
“This defector.” Roles looked down at some of his notes. “Marat
Ivanov. Has extensive knowledge of what was going on in a black-
site bunker. His testimony to the ambassador matches that of Ms.
Winters and the other survivors of Felicity. I want to know as much
of what was going on in that bunker as possible. I want to know of
the communications and how precisely the gate came on.”
Even hearing her name—Ms. Winters—made an itch crawl up
John’s back. He didn’t like for Roles to even think about her. The
man hadn’t so much as glanced at him when mentioning his
daughter, and whether intentional or not, John wasn’t sure
Amana cut in. “To be clear, you’re saying an alien force came out
of the bunker and is currently invading Moscow?”
Roles tipped his head. “That’s the leading theory, but it’s hard to
say since our satellite imaging is lukewarm at best. It seems to me
that whatever came out of that bunker caught the Russians by
surprise. Whether they’ll get a handle on it or not. . .” Roles smiled
politely, though there was no warmth. “. . .remains to be seen.”
“Christ almighty.” President Warren shook his head. “Leave it to
the Russians to deny not only a nuclear incident but an alien
invasion. What the hell are we getting into?”
“Alien invasion.” McAndrews echoed the words. “Doesn’t seem
real.”
Roles tightened his lips. “Oh, it’s real and certainly of concern.”
John let out a breath. “I’m still getting caught up on things, but
the Soviet response to all this is disunified. We’ve got them blaming
us for what’s happening and demanding we shut down our
consulate. They’ve also contacted our offices to negotiate about the
Japanese war. They want to settle it.”
“Settle it?” McAndrews frowned. “The goddamn North Japanese
are the ones who invaded. How the hell are we supposed to settle
it? Give the Emperor back? Better to ask the South Japanese to cut
their thumbs off.”
President Warren rubbed his chin, considering things while the
others talked.
Amana cleared her throat. “You aim to negotiate when you’re
losing. The North Japanese are insane. It seems the Soviets don’t
expect them to win the war. That and the Soviets are too distracted
by what’s going on in Moscow to want to deal with it.”
McAndrews nodded. “To hell with them. With the North killing
Americans, we’re fully justified under conventions to engage. If the
Soviets don’t want to fight, so much the better. We can sweep up
Japan while the Soviets are distracted with Moscow.”
“Wait.” John held up his hand. “We shouldn’t be so eager to let
this play out. We don’t know what we’re dealing with.”
“Here’s what we’re dealing with, John.” Amana turned to face him
squarely. “A once-in-a-lifetime opportunity to seize the moment in
the Cold War, possibly even end it. Sooner or later, the Soviets will
figure things out and deal with whatever those things are, and we’ll
have squandered the opportunity.”
“I’m not so certain they’ll get a hold of things,” Roles said. “I
don’t think we know anything at all about those creatures.”
McAndrews crossed his arms. “I’m just as curious about aliens as
the rest of you—and I’ve read the same reports as everyone else—
so you tell me where I’m wrong. They’re little more than hard-to-kill
animals. Big beastial things that hunt and kill with their hands and
teeth. They’re strong, but they have no weapons, no ships—they’re
dumb. Certainly a problem to be caught with your pants down like
the Soviets, but no match for aircraft and armies. Am I wrong?”
Roles shook his head. “Dumb is not a word I would use.”
“Then what would you use?” Amana gestured toward
McAndrews. “He’s right.”
John’s voice grew irritable. “Dumb, no. Unknown and dangerous,
yes. If you’ve read the reports then you know what they did on
Felicity. You know they took people over and were strong enough to
break CAG. It would be a mistake to underplay these things.”
Amana took in a breath and tipped her chin. “John, I know it was
your daughter on Felicity. I’m sure it was horrifying to hear about
what she went through. I’m certain it was a highly dangerous
situation. But you have to understand, the Soviets have perhaps the
greatest land army in the world, and Orbital CORPS has long since
fallen out of combat readiness. They were poorly equipped.
Additionally, Felicity was a failing station, and they were entering
into an unknown situation that we—”
“Did you see the pictures of my daughter?” John’s words came
out sharper than he intended. “Those demons practically destroyed
her. They got inside her mind. She saw ungodly things there.” He
looked around the table. “Don’t look a gift horse in the mouth. Is
that what everyone is thinking? We can’t turn our backs on these
things. We can’t grin and rub our hands together while the Soviets
try to nuke them.” He thumped a finger on the table. “The Russians
dropped a nuke on Moscow. We need to be eyes wide open here.”
“John?” President Warren held up a hand, motioning down.
“We’re all on the same team here. Everyone understands. Honest to
God, can you give me a better option? What would you suggest?
Sending in American troops to help the Soviets in Moscow?”
John let out a breath. God, he was wound up like a spring about
to snap. He’d let it take control. The best he could do was shake his
head.
President Warren nodded. “Sometimes there are no good
options. The South Japanese won’t give the Emperor back, and the
North Japanese will kill themselves trying to get him. If the Soviets
are distracted, then the best we can do is try to make things quick.”
He turned to Roles. “The North Japanese have been on wobbly legs
for years. Isn’t that right?”
Roles nodded. “Correct.”
“No one is ignoring the threat, but our hands are tied as far as I
can tell.” President Warren nodded, his decision made. “We’ll
authorize American forces to enter North Japan. We’ll close the
consulate in Ukraine and refuse to negotiate on Japan, but we’ll
make it known through the back channels that we don’t want to
press things further. If we scare the Soviets too much, things might
get out of hand after they get control of Moscow.”
John nodded but couldn’t stop the lingering feeling.
They were making a mistake.
 2

M arat ’ s cigarette jittered in his hand as he nervously twitched. How

could he not?
Everything was going to hell again.
Through a window to the hallway, he could see, flustered men
and women running around the consulate, destroying sensitive intel.
Someone had started a fire in a metal garbage can in the room
across the hallway, and people were bringing in shredded documents
by the boxful.
The smoke poured out of an open window, but people still
covered their faces when they went inside.
Marat was sure the sprinkler system would kick on at any
moment, but it must have been turned off. No one seemed to give a
shit about the fire hazard. The Soviet Union had demanded the
consulate in Ukraine to close, and it was top priority for the
Americans not to leave a single thing of value.
“Don’t listen to all that,” the blue-eyed ambassador, William Hart,
said with a smile. He waved at the window behind him. It was as if
the chaos was all no big deal to the handsome American. He
reminded Marat of a big, rugged cowboy straight out of some old
movie.
Marat took a deep breath and looked down at the table. He’d
been chain smoking shitty cigarettes and drinking shitty coffee for
the last few hours.
 But these would be the last cigarettes he ever had if the KGB
found him here, so shitty or not, they’d have to do.
His coffee shook as he brought it up to his lips. He took a sip. It
had long since cooled.
“Here, friend.” Hart slid a flask from his jacket and screwed off
the top. “This’ll take the edge off.” He poured a healthy dose into
Marat’s coffee cup.
Marat watched greedily for the man to pull away, and then
downed it, more booze than coffee at this point.
Hart slid the flask back into his jacket and shrugged. “So, where
were we? Some dumb bastard turned the gate on, right?” Hart
grinned, seemingly unaware of a man who ran screaming through
the hallway, his box of documents already on fire and smoking.
“No, no, no.” Marat shook his head furiously. “No one turned the
gate on. It came on by itself.”
Hart frowned, as if he didn’t understand. Though Hart’s Russian
was good, it wasn’t perfect.
“Yes.” Marat, eager to have someone understand, flared his eyes
open. “The gate came on by itself. We didn’t turn it on.”
“Just on its own?” Hart asked in Russian. “Without anyone in
your base pushing a button?”
Marat nodded. “They instructed us on how to build the gate.
They must have turned it on from their side.”
Hart frowned again, then nodded.
Marat didn’t blame him. How could he explain properly to
someone who hadn’t been there?
Those mindless, terrible creatures had spoken to them in Russian
and described how to build the gate.
What they’d said? How they described their world? What they
suggested their intentions were? Marat was not privy to such things,
but he had heard the rumors.
They spoke Russian.
Marat swallowed hard and rested his elbows on the table. “I
believe we built an exit portal. Listen to me, you are understanding
me clearly.” Marat struggled on a tense smile, an attempt to show he
wasn’t panicking. “Somehow they knew our language, and
somehow, I believe, they tricked us into making the gate so they
could come through. How? Why? I don’t know.” He licked his lips.
“But I am sure the government will seal them up and pretend it
never happened.”
Hart’s face softened with sympathy. “I suppose you didn’t hear.
It’s too late for that. It’s already spread into Moscow. Government
forces are battling it. That’s not the official line, but that’s what I’ve
heard. That’s about all I know, though.” He shrugged, holding his
palm up. “Your comrades don’t reveal much.” He tipped his head
forward, as if he were ready for business. “Now though, how far
along were the Chinese and Iranians?”
Marat shook his head. “We did not share everything, and what
little we had, I was not privy to. I only communicated with my
counterparts on computer system algorithms.”
Tightening his lips, Hart said, “I think we need to tell them to
unplug the damn thing then, yes?” He made a motion as if
unplugging a vacuum.
Marat nodded and opened his mouth to speak just as the door
burst open.
“Sir!” A dark-skinned woman entered the room. She spoke
frantically, and Marat struggled to understand. He hadn’t had an
English course in years and was rusty.
“No.” Hart jolted his head in her direction. “You tell him that…”
The words muddied into an incomprehensible mess, but Marat was
fairly sure Hart was telling her to destroy everything.
The woman said something else, glancing toward Marat before
heading out.
Marat felt like his eyes were so wide they might roll out of his
head. “What? What did she say?”
Hart grinned and waved a hand in the woman’s direction.
“What?” Marat insisted.
The ambassador chuckled and leaned back in his seat. “She said
your comrades have surrounded the consulate and are demanding
we exit now. Don’t worry.” He waved a hand at Marat. “It’s only
bluster, my friend. Maybe they’ll raid us, but I’m certain they’ll give
us at least that initial twenty-four hours they announced. Plenty of
time to burn everything, shoot nails through our hard drives,” he
made a pop noise and mocked shooting the table with his finger,
“and get on out of here.”
Marat’s whole body trembled, and he stuck the cigarette back
into his mouth and sucked in a lungful of smoke.
“Easy.” The ambassador motioned with a hand. “Take a deep
breath. You know, you’re a pretty smart guy for someone who smells
like he shits in the woods. After we get you to America, we’ll set you
up nice.”
Marat flicked his gaze toward the man. Was he right? Would
Marat actually make it to America?
He prayed—oh God, did he pray—he would.
Marat chewed his lip. “Where are you from in America?”
Hart smiled wide and looked upward as if recalling a fond
memory. Behind him, a man ran by, a nail gun in one hand and a
long extension cord wrapped around the other. Two others ran
behind him, all shouting.
“The great state of Texas,” Hart said in English before flipping
back to Russian.
Marat had heard of Texas. He’d seen a handful of American
movies, all bought illegally on the black market and punishable by a
lengthy labor camp stint if he were caught. But he came from a
more well-to-do family than most, and such infractions were rarely
looked into deeply.
“In Texas. . .” Marat leaned tight against the table, his shoulder
shrinking in. “Are the girls pretty?” He rubbed his face. “And blonde
like the movies?”
“Oh, sure, we’ve got all kinds. Blondes with busts, just like in the
movies.” He mocked a gesture as if holding a large pair of fruit in
front of his chest. “But let me tell you.” Deadly serious, he leaned in
and put an elbow on the table, one hand gestured Marat forward.
He paused as someone went screaming by the room again. “Pretty
blondes aren’t the be all, end all of American girls. We have them all
shapes and sizes.” He snapped his fingers looking for an expression
in Russian before switching to English. “Melting pot of the world,
friend. Now Latina girls.”
 Marat frowned, not out of disbelief, but of deep interest. He
leaned closer to the table.
Hart switched back into Russian as he dug his wallet out. “Now
this one is mine, so don’t you get too excited.” He opened the wallet
and showed a beautiful woman smiling. “My wife back home.”
Marat leaned closer still, his eyes wide and interested.
Perhaps a bit too interested, as Hart laughed and pulled back. He
slapped a hand down on Marat’s shoulder. “Comrade, my wife has
friends. You help us out with this whole little mess here.” He waved
a hand in the air. “And I’ll be sure to introduce you to some.”
“Americans,” Marat switched into his English.
He needed the practice didn’t he?
“There is uhh. . .” He chewed his lip, looking for the words. “No
problem mixing blood?”
Hart frowned.
“Mixing, ehh. . .” Marat held a palm up as he tried to find the
right words in English. “Mixing the colors?” He pointed toward Hart’s
wallet and then Hart.
“Oh!” Hart laughed. “Well, first off, buddy, we don’t call it mixing
colors. That shit will get you slapped in the mouth.” He grinned. “But
don’t worry, you’ll get it.”
Marat grinned again. He couldn’t help it, he liked Hart. He was a
charming man.
That moment of calm passed as someone tore into the room
across from them and blasted the fire with an extinguisher.
Hart tightened his eyes at Marat and held up a finger. He stepped
to the door and stuck his head out. “The fuck? Get that going again
and. . .” The words became incomprehensible to Marat again.
Just as Hart turned to sit back down, the man across the hallway
relit the fire in the trash can.
Marat dropped his shoulders once more and switched back to
Russian. “KGB might know I’m here.”
“Oh, I’m sure they do.” Hart nodded. “Best to always assume
KGB knows everything. Here’s the thing, though,” he pointed his
thumb at his chest, “I’m not just the ambassador but the CIA chief
in the Soviet Union, so don’t you worry. . .”
 The trash can fire flared back up again, and the man lighting it
stumbled back. Someone yelled at him.
Hart grinned. “. . .we’re professionals.”
 3

D own deep within the flesh of the Archon, inside the folds of his
brain, strange chemicals mixed and churned. Pockets of air had
formed within the soft tissues, and they squeezed portions of his
brain. Occasionally, those air pockets popped, sending the air to
burst through the surface, while internal acids and fluids hurried to
fill the voids with his brain.
Such transformation had squeezed away rational thought.
He was insane.
A mad, diseased god.
But he was aware of everything. He knew and felt even those
pockets of air in his brain. Unlike humans, all of the Archon’s body
and its functions were known to him.
It was the hollows of his mind that were a mystery.
As he walked, the ground near him blackened and twisted,
radiation pouring from him like some ungodly battery, a plague
carrier sickening those around him.
All but the strongest cronux gave him a wide berth, for if they
came too close, the radiation fried their internals and left them a
withering husk.
When the nuclear weapon fell on him, he was not destroyed.
But he was changed.
The bomb’s fire had scorched his internals and boiled his brain. It
had sizzled and crackled with hellish heat, and when his flesh reknit.
..
 There were others inside him, some with voices insane with rage.
Though he endured, his brothers—children?—had died in the
fires. Their bodies were frail compared to that of a god’s, but
somehow, their voices had entered into him.
Not the hive mind—the one he had experienced since birth—but
a new thing entirely.
Voices that did not just obey, but that could speak.
And they whispered lines of madness and rage.
But insanity? Rage? They were vague concepts, taken from the
meat of men and women as he crouched over their bodies, digging
through the contents of their skulls. He scooped out their pink,
bloody brains and shoveled the bits into his mouth. As he chewed,
oils ran down his lips, and all that he was expanded in thought and
understanding.
Sparks and flashes of knowledge popped within him, a new
comprehension of things, but scattered and elusive.
Trains. Bicycle. Office. Airport. Vodka. . .
Each bite, each gulp, and he knew more of the world and the
people within it.
But sometimes?
Strange things happened.
A short time ago, the Archon had come upon a tank. It had rolled
over cars, a loud churn-churn-churn-churn as the machine crushed
its way forward, accompanied by a squad of men. The Archon had
fallen upon it, killing the men with ease and then working his way
onto the machine. He was too quick for the machine to be of much
concern.
And then? All at once. . .
He was in another place entirely.
Had time stretched? Had the memories melded?
Or had he simply blacked out?
Such moments came and went. They were more a curiosity than
a concern.
He awoke already on the march. Radiation poured from him and
scarred the landscape around him. The snow, what remained after
so many trampled feet, had darkened and blacked, and trees scarred
black, while the flesh of the dead shriveled and crisped.
His children flowed near him afraid of the plague he carried,
though the Harbinger marched close to his side—a powerful servant,
keeping a watchful eye on its master.
A bulbous thing with short legs and a thick, glistening hide
skittered toward the Archon. Its skin was thick enough that the
radiation sizzled its wet flesh but did not kill it. The Archon had not
willed its creation, but the hive had felt its need and it had adapted.
The creature amplified his abilities. It connected minds with the
Archon, and he felt his thoughts stretch even farther and more
clearly.
It was his herald.
Such was the way of things. They were a race, ever changing
and evolving.
His thoughts now reached toward even human minds. He could
not enter them, but he could see them as one sees breath in cold
air.
Millions of minds still in Moscow. Hiding in dark corners, some
fleeing the city.
The Archon commanded a wing of his children to swarm the
paths of exits and consume all.
But he wanted to know more. Each of those minds held thoughts
and knowledge he could learn from.
Each was a gift.
The Archon was calm, a being seeking understanding and
knowledge. He wanted to know the world he would soon rule.
Everything he did was essential.
All would be taken. All would be consumed.
Everything had purpose.
This was not done for sport or out of interest.
It was simply the new way of things, same as the old way of
things.
The strong ate the weak.
The Archon, calm and commanding, made his will known, and his
children swept through buildings, seeking lives to take.
 But a cloud rolled inside his brain. The Archon was calm and
curious as it flooded over him.
And now he was the other.
He was insane.
Gone was the seeker of knowledge, the king who had come with
a tactical interest.
He sought a new thing all together.
Misery.
And the world was new to him, as if given color.
The screams and chaos echoed through the streets. Buildings
burned while aircraft flew through the air, dropping bombs and firing
upon his children, all in an attempt to end the inevitable even as
horrible green lighting cracked overhead and snow dusted the
streets.
Soldiers screamed and fired their weapons, flashes of light
amongst the burning buildings. The Archon’s children flowed into the
street, their numbers multiplying with every moment, the newly
devoted.
The soldiers fought like mad, killing cronux, but theirs was a
failing war. For every one of theirs killed, a new voice joined the
Archon’s devotion.
Dead soldiers had joined the faith, their bodies now hollowed
temples for the new religion. Now powerful, reaching tentacles
squeezed through cracks in their armor, sometimes providing a new
leg where one had been torn off or a third arm for which to reach
more screaming enemies.
The sea of his children parted, and a man was dragged toward
him. The Archon’s children clawed at him, drawing sharp groves
across the armor. The man turned and thrashed and looked for a
way out, his weapon long lost.
The Archon felt a strange warmth. He enjoyed this. It may have
been the first thing he ever enjoyed.
His children knew this instinctively and offered the man up as
tribute. So loyal were they, that they dragged the man to the
Archon, knowing their bodies would be deformed and destroyed by
the plague the Archon now carried.
 His smaller children curled and shriveled in waves, the last dying
at the Archon’s feet.
He grabbed the man and hoisted him up. The man screamed and
beat at the Archon, but it was of no consequence.
With ease, the Archon cracked open the man’s helmet and tore it
off, tossing it aside.
The man’s horrified face gasped for breath, for the air choked
with radiation. His skin began to darken.
The Archon watched the man struggle to live.
This was not tactical. This was not for knowledge.
It was simply enjoyable.
 4

F ive levels below ground , in a research and development facility

somewhere in East Texas, Alice Winters began to undress.
Her plane had left Washington with a direct flight here.
Alice’s ass hadn’t been in the seat for more than three seconds
before she started to second guess everything.
What about Eli?
She loved her son, but sometimes she felt he’d be better off
without her.
How could someone so horrible raise a child?
Everytime she looked at him, she saw Tommy’s eyes and wanted
to cry.
She had started down that spiral of thoughts, which never ended
well, but Moller had strolled in, looking excited and not at all like the
young, nervous communications specialist who had once been
stationed on the Perihelion.
“I was assigned as your intelligence coordinator, Winters. Roles
pulled me off duty and sent me here.”
She had reached out and squeezed Alice’s hand. It was nice to
see a friendly face.
But that had only lasted for the plane ride.
Now Alice was alone, in a cold and empty cell that made her bare
skin prickle.
She let out a breath and shook her head.
What evil bastard told me to undress but didn’t turn the heat on?
 She folded her clothes and left them against a gray, featureless
wall.
A computer voice spoke in a lovely, feminine voice. “Please step
into the sensor booth.”
In the center of the room was a small booth similar to the
scanners in airports—a large, glass cylinder atop a white, glowing
pad two steps up from the ground.
Alice glanced at a camera in the corner, its glass lens rotating as
it tightened and focused on her.
She felt like an insect stuck in a jar.
Strangely, the most embarrassing thing wasn’t being in her
underwear, but exposing the black, synthetic skin weave on her left
arm. Everything from the elbow down had been replaced, and on a
military budget that wasn’t concerned with cosmetics but only
functionality. Her arm was clearly artificial. She’d hid it the best she
could for the past few years, but there was no hiding it in this cold,
naked room.
Moller had told her what was going to happen just before they
landed.
“We’re getting you CAG.”
Alice climbed the short set of stairs and stepped onto the
glowing, white pad. It lit up green beneath her feet and analyzed
her body positioning, weight, and balance.
A screen readout inside the booth ran lines of data as an lined
image of her began to form from the feet up.
Two mechanical arms descended from the top of the booth and
unfolded.
“Please raise your arms and widen your stance,” the computer
system said.
Alice stepped out shoulder length and raised her arms. The
mechanical arms whined as sensors on the ends fanned back and
forth with strings of green light gliding over Alice’s body.
The computer screen chirped as more lines of data entered into it
and the white shape of Alice took greater form.
It left little to the imagination as it outlined even the curves of
her breasts and ass. The glowing lines ended at her elbow.
 They only wanted an organic readout.
All at once, the arms stopped, folded back together, and slid into
the ceiling compartment.
“Please exit the sensor booth and return to the waiting station.
Thank you for your cooperation.”
“No problem,” Alice groaned as she stepped down the stairs.
The camera lens followed her.
God, she felt like a lab experiment. Everyone was trying to poke
and prod her just to see what would happen.
She might have given it all up and gone back home if not for
Moller.
If she could get through everything, why couldn’t Alice?
You can do it.
A few moments later, the door rose on the far wall of the room,
and a team of white-clad scientists rolled in a table with fresh CAG.
Alice could tell it was new by the shine on it. She’d never worn
new CAG.
This armor was in shades of a dull purple, the color of the
newest generation of CAG. Why the military had chosen this, she
had no idea, but it was the standard before being repainted for
specific zones of conflict.
She’d seen pictures and read about the new armor before, but
she’d never seen it in person. The helmet was different from the one
she’d worn on Felicity. There wasn’t a glass screen to see through,
but thin, glossy slits where micro-cameras led directly into an
internal video feed. There were no glass vision ports like older
models.
This had been designed to minimize weakness.
The scientists wore respirators and goggles, as if they were
afraid to breathe the same air as Alice.
She curled her lip as they closed in. She glanced at the camera.
“What the hell is the deal here?”
This time it wasn’t the computer’s voice but Moller’s. “It’s
protocol that everyone wears contamination-proof gear while in the
fitting station. Do not be worried.”
 “Everyone but me, I guess.” No use in being modest here with
her clothes off and synthetic arm exposed.
The closest scientist’s voice buzzed through her respirator. “We’re
going to fit the suit for you. Just relax and let us get it on.”
Alice was used to having help with her CAG. It was impossible to
fully suit up alone, but she never had a team of people pawing over
her.
They helped her into a gray, skin-tight undersuit, which was
covered with white lines of circuitry. Then they fit the armored
pieces on.
The CAG clicked as magnetic locks sealed and the suit
pressurized against Alice’s body. The armor was swollen in odd
places, but the scientists grabbed what looked like large, cordless
screwdrivers and inserted them into points on the suit.
The screwdrivers whined and twirled, causing the armor to
tighten and lock. The CAG fit perfectly onto her frame. One scientist
called out numbers and readouts from the screwdrivers while
another checked them against his datapad.
They locked everything tightly against her body except the
helmet. It was still sitting on the table, staring at Alice, waiting
patiently for its turn.
It was so clean she could see her reflection in the glossy slits.
Another scientist lifted the helmet. “Please take a breath. It takes
a moment to connect.”
Alice held a breath as they set the helmet over her face. It
widened at the neck but tightened with locking magnets when it
connected to her suit.
A second passed in complete darkness, and Alice let out some air.
It felt hot and stuffy, but she could swear the circuits on her skin suit
were beginning to buzz and move.
Her screen turned on, and targeting sensors flashed against the
scientists. A thin readout on the side of her vision analyzed
environmental data with readouts of oxygen levels, temperature,
and compression levels.
“How does that feel?” the scientist with the datapad asked.
 Alice swiveled her head. She heard the faintest of mechanical
buzzings as internal mechanisms worked and flowed against her
body. The screen adjusted and brightened to pull in ambient light as
she looked at dark corners.
“Like a second skin.”

D uring their flight across the Atlantic, Moller had sat across from
Alice and informed her of the mission details.
Marat Ivanov.
The details were sketchy, but apparently he was the lone survivor
of the Moscow Mistake, which was the name for the incident.
Moscow Mistake.
Sounded so trivial when it was said that way.
Moller didn’t have much on him, but apparently he was holed up
in the U.S. consulate and being interrogated by a professional there.
Moller had leaned close. “We’re going to get him across the
border, Winters. Then we’re going to find out what he knows and
see what we can do.”
What we can do.
That thought had run through Alice’s head for sometime now.
What the hell was it that Roles expected her to do?
She had no idea, but still, she wanted to be close. It was as if her
body understood the mission even if she didn’t. A secret held inside
her that even she didn’t understand.
Landing in West Germany had made her all the more eager.
They’d only been there a short time, but it seemed like weeks
already. From what she heard, that was the standard experience.
She was aware of the treatment course that was necessary when
landing near the border of East and West Germany.
It had taken a series of nuclear weapons to make Nazi Germany
give up the ghost during World War II, and decades later, East
Germany was still little more than a long stretch of irradiated
wasteland with patches of people scrounging out a meager existence
and a few central hubs of activity, like Berlin.
Alice read an article a few years back of a farmer kneeling in his
field, his head in his hands crying as a mysterious gray-white soup
bubbled up from the soil.
That same article had quoted the General Secretary of East
Germany on the state of things. “Our citizens are happy. We have
purpose. We live a life of honor and duty!”
After much negotiation between the East and West, a few
crossable border points had been constructed, and towns sprouted
up around them. More on the West German side than the East,
which preferred to keep interactions down for propaganda purposes.
But when they’d arrived, Alice had seen some East Germans. A
scant few were allowed to traverse the border to work in western
factories, one of the few sources of hard income for the poverty-
and-radiation-sick East.
It had been raining the night their plane landed. Though short
exposures to the radiation might be fine, the rain amplified things.
Alice had to wear the new CAG, but she didn’t mind. The sleek suit
of armor had functions that made her last CAG look little better than
a calculator.
But there, stepping into West Germany with her headset warning
her of the irradiated rain peppering her armor, she saw some of
those honorable East Germans crossing under the gates of the great
border wall.
They’d glanced at her. Pitiful, miserable looks.
Her breath choked in her throat as she realized the stark contrast
of her suited weapon calibrated to keep her from even minute
radiation exposure and the people starving and unable to afford
food.
The world was a cruel place.
Alice always found it strange that a country struggling to find out
why gray-white soup flowed out of the ground and destroyed crops
also seemed to have endless funds for walls and guards.
She hadn’t watched the people long or even attempted to
interact. In decades past, even approaching the border wall could
get you shot, but now the guards seemed to tolerate it so long as
there was no communication.
Alice didn’t know much about the history of Germany during the
Cold War, but she knew a little. There was a time where the Western
allies ran half of Berlin, deep within the Eastern lines, but the Soviet
Union had blockaded and starved it out, forcing the West to back
out. There had been a brief discussion of a massive resupply by air,
but the logistics were too hard to work out.
Now what happened in the East was little more than rumor with
the occasional picture or story making its way over. Instead, the
Berlin Wall had been so effective that a massive barrier of concrete
and chain-link fence was erected across the entire border.
But that misery of the East wasn’t her fight, she’d turned away
from them and headed toward the border clinic.
Though her CAG could withstand the radiation, she still required
chem treatments. That meant she spent most of her time now
sitting in a holding room being treated to endure the lingering
poisons in the air.
It left her and the small team that had travelled with her
exhausted. They spent most of their time in their individual rooms
rather than talking.
She hadn’t even talked much with Moller since they landed.
Something was off about Moller, though Alice was still glad to
have her around. It was just hard to connect. More than a
personality shift, it was as if Moller were a different person entirely.
Near-death experiences can do that to you.
For three hours a day, for the past few days, Alice was led into a
chem lab where they hooked up intravenous lines that pulled out
and put in a cocktail designed to fight radiation poisoning.
“Everyone undergoes the treatment,” the doctor said. She didn’t
catch his name, but his face was etched into her mind. Tall and
gaunt, with eyes seemingly sunken into his head. His skin was just a
tad too pale and his lips a bit too pink, like a badly painted portrait.
She had to wonder if he still had all his original teeth, and if this
whole business of chem treatment was just for show.
 She often imagined that doctor going home and smiling into the
mirror before pulling out another tooth. So was the way of life for
those on the border she supposed, treatment or not.
But was she really so concerned with the doctor and his teeth?
Or was it just that she wanted to think about anything other than
how she’d left Eli?
“Cora, I’m going to need you to watch him,” She’d said in a
phone call, minutes before she went in for the CAG fitting. “Can you
do that?”
“It’s not Eli I’m worried about, Alice,” her step-mother had said.
“It’s you.”
There was a tone to the words, a way that it was said.
You’re the one who scares me.
Now, sitting in her bed she wished she could think of anything
else beside that phone call.
“Mom? Where are you going?” Eli had said, his voice confused as
she explained she was going away.
“No,” she said out loud, interrupting the memory. There was only
so much self abuse she could put up with in a day.
She stepped out of her bed in her private recovery room and hit
the door-open button.
The door paused, speaking first, “It’s recommended you receive
ten hours of sleep when undergoing—”
“Shut the fuck up.”
“—ation treatment.”
Alice rubbed a tangle of hair from in front of her face and
stepped out into the hallway. The clinic must have been designed by
the same bastards who built Felicity, as the hallways had similar,
inward-slanting walls and long windows, as if anyone had any real
interest in taking a look at the depressing landscape.
It was raining again. Germany seemed to have rain more than
anywhere else Alice had been. It seemed being poisonous rain just
made it all the more likely to happen.
She stepped to a window and looked out. A train was in the
process of pulling in. Other than the daily workers, it was the only
thing that went in or out of the border. The Soviet Union had an
extensive train system that rivaled and surpassed anything the West
had.
She’d heard Soviet leaders praise it while in committees and
conferences, using it as proof of the superiority of their system.
It didn’t matter how many people starved so long as the trains
ran on time.
The West had tried to match them with their own system, but
the railways in the European Federation and in the U.S. just never
measured up.
Of course, the Soviets had cars and roads, but the trains were
what kept the blood moving. Though it was no secret that it was
much easier to control movement when someone had to scan before
getting on or off a train.
That was the real purpose.
“Hey.” Moller’s voice came from behind.
Alice looked at her. While Alice was in loose-fitting sleepwear,
Moller still had her officer’s jacket zipped up.
Regulation.
“Can’t sleep either?” Alice asked.
Moller shook her head and joined Alice to watch the train come
in. “You know, you come out here and you think about all the
problems we have back home. . .”
“But you can still get a hamburger when you’re hungry?” A weary
man stumbled from the factory and headed toward the train.
“Yeah,” Moller said.
Alice nodded. “Puts things into perspective.”
Men filed onto the train. A few minutes passed before lights
started flashing and the train quickly took off.
Who knew where the men lived? The trains in the territories of
the Soviet Union moved so quickly their homes could be hundreds of
miles from the border and still be back for work the next morning.
Moller cleared her throat. “I’ve got some bad news, Winters. The
Russians are blaming us for what’s going on in Moscow. They’re
ordering the closure of our consulate in Ukraine. They’re going to
empty it out and then escort our personnel to the border.”
 “Shit,” Alice hissed. “What about Marat? Do they know he’s in
there?”
Moller gave a slanted grin. “Best to assume they do. But the East
Germans are giving us clearance to send in a recovery team for the
staff so long as they escort us. But only three people.” She turned to
Alice with a hard look. “More of a gesture than anything else.”
Something stirred in Alice. She glanced back at Moller. “You know
I’m getting tired of sitting here, right?”
Moller huffed. “I was able to negotiate CAG, but no weapons.
We’ll have to go in unarmed.”
“Marat Ivanov. Do you think he’s worth it?”
“Only man alive that worked on the systems. Apparently, he was
a programmer. Who knows what they hooked up there. He might be
the only man alive who can tell us how to turn it off.”
Alice shifted her weight and looked back out the window.
“Well, I always wanted to try out one of those Soviet trains.”
 5

M iles W estwood leaned forward and placed his hands on his knees,
trying his best not to get sick all over his and Kevin’s feet. How he
found himself in the back of a filthy Mongolian flatbed truck was still
something Miles struggled with.
Was it all worth it? Had he dragged the kid into it for no good
reason?
Miles closed his eyes as the truck went over a large bump. “Ugh.”
The sound escaped his mouth involuntarily, as if it were the
undeniable precursor to something much worse.
Don’t puke.
Miles had always been prone to carsickness, but never so much
as this very moment. Was it maybe his nerves?
Guilt?
No. The kid sought me out, not the other way around. And I
should damn well do my best to remember that.
“How much farther?” Kevin’s voice startled Miles. He hadn’t heard
him speak in some time.
Miles glanced around before throwing his hands up. “No idea.”
Kevin sighed. “I thought you said you’ve been this way before.”
“No, I said I knew a former Soviet official who lives in Ereen. I
did not say I’d ridden in the back of a manure truck across
Mongolian countryside to visit her.”
Kevin sat back and crossed his arms, bouncing a little on his seat
as the truck crossed another pothole. For dozens of kilometers now,
it seemed all they had passed on this God-forsaken road were herds
of cattle and other farm animals, with the occasional wheat field
here or there. The scenery wasn’t bad, but the road needed serious
work.
“Well, you certainly didn’t have any trouble finding someone to
drive us to Ereen. Sorry if I assumed you’d done this before.”
Miles grinned. The urge to be sick had finally passed. “Don’t get
me wrong, mate. I have done this before. Many times.” His smile
faded as a flash of a memory crossed his mind.
Brad Tierney.
Miles’s old cameraman and friend. They’d crossed many borders
together illegally; they’d perfected it as if it were their own strange
art.
The best stories required a little rule breaking.
Sometimes rules could get you into a lot of trouble, and at the
heart of it all, that was what interested Miles. But he’d failed as a
journalist by every stretch of the imagination.
Because truth didn’t pay the bills.
People wanted the bizarre. The unexplained.
They wanted chaos, but only from sources outside of human
nature. People weren’t interested in human nature.
“Miles?”
He blinked. “The point is, I’ve got no idea how much farther.
You’re the one with that. . .thing you put on your head. Can’t you
look it up or something?”
Kevin looked down at the device peeking out of his backpack and
rolled his eyes. “This thing is not just any thing. Okay? It’s a four-
thousand-dollar supercomputer I saved eight years for. And I’d
rather not power it up right now as there is no power source nearby,
and frankly, I have no way of knowing when I’ll find one.”
Miles laughed. “Four thousand dollars seems an awful lot of
money for a funny-looking headset you can’t even use.”
Kevin dug his hands into the backpack and pulled the green-and-
black helmet out and set it over his head. “Fine, smartass. You win.”
He fastened the chin strap and slid the metallic visor over his eyes.
He pushed a button on the side of the helmet, which issued a series
of beeps. After a moment, he said, “Calculate distance to Ereen,
Mongolia.”
Miles waited. He’d begun to wonder if the driver was driving
especially rough because he thought Miles was too cheap.
The device on Kevin’s head beeped loudly and announced:
Cannot locate cellular or radio signal. Please try again later.
“Dammit,” Kevin nearly shouted. “Piece of shit is supposed to
work anywhere.”
Miles laughed. “I’m sure we’ll be there any minute.”
Kevin pushed the visor up and blinked against the bright light of
the setting sun. “How do you know?”
Miles pointed ahead of the truck. “Because that’s Ereen just
ahead.”

M iles and K evin hopped out of the back of the dirty truck bed and
thanked the small man behind the steering wheel who drove off
without so much as a nod.
Kevin looked at Miles who shrugged. “People are strange around
these parts,” Miles explained. “Ereen is considered a bit sketchy, and
that’s putting it lightly.”
Kevin nodded slowly. “Great. So we’re going to get killed before
our grand adventure even begins.”
Miles turned around and looked at the city of Ereen, with its
lighted border fence and various flags and signs posted about the
entryway. “We should be fine. People in Ereen aren’t out to get you.
Quite the opposite, in fact. Most are here to help, but not without a
price.”
Kevin thought for a moment. “So it’s a smuggler’s hub?”
“More or less. It’s a lawless territory that’s essentially self-
governed. All that matters is we can get into Russia through Ereen.
Just keep your hands to yourself and your eyes on the ground and
we should be fine.”
 “Oh, is that all?” Kevin pulled on one of his backpack straps. “And
what about my rig or your camera? How do I know nobody will steal
them?”
“How do you know a monkey won’t fly out of my ass?”
Kevin turned and began walking toward the gate into the city,
shouting back over his shoulder, “I don’t!”
“Exactly,” Miles said. “The world is a mysterious place.”
The two of them rounded a corner and found a small crowd
standing near the gate into Ereen. Standard armed guards stood
where they usually were—two on each side of the gate—but the line
wasn’t moving as it normally did. It appeared a fight had broken out
if the shouts and jeers of the crowd were any indication.
“Essentially self-governed, eh?” Kevin nodded toward the
commotion.
“It doesn’t concern us,” Miles snapped. “Now do as I said and
keep your eyes down before we find ourselves in real trouble.”
Kevin looked away from the crowd, clutching his backpack straps
tighter. “Sorry.”
Miles worked toward the edge of the crowd, doing his best to
avoid everyone around. “Don’t sweat it, kid. Just try to keep up and
do as I do and you’ll be fine.”
Kevin rolled his eyes. “There you go with this kid business again.
I really don’t get it, mate.”
“Fuck you! You’re nothing but a fucking piece of shit, commie.”
The curse rose above the crowd as if amplified by a megaphone.
Shit. We need to get out of here.
The crowd roared with curses and shouts amidst the sounds of
flesh pounding into flesh. Then came the crash of a bottle breaking.
“Why don’t the guards do anything?” Kevin asked as they pushed
farther through the crowd toward the gate.
A terrible scream filled the air, and Miles imagined at least one of
the men had been stabbed at the very minimum. “Not their problem.
It’s that simple.”
“When does it become their problem?”
Miles looked up at the guards. The fight had caught their
attention, of that there was no doubt, but they hadn’t budged from
their positions at the gate. “It becomes their problem when that sort
of nonsense tries to enter their city.”
Kevin rubbed the back of his neck absentmindedly. “I don’t know.
This is starting to look worse by the second.”
Miles glanced away from the fight and toward the gate, lost in
thought. “Listen, kid. You sought me out with information about a
gate, aliens and the like. Did you think this would be easy when you
agreed to come with me?”
“No.” Kevin sighed. “I don’t know. Let’s just keep going.”
Miles could tell something was wrong—maybe the kid was
getting cold feet—but now wasn’t the time for that.
They approached the guards. The men wore regular street
clothes, but each brandished a red sash across his chest. One of
them—a tall, pale man with a puffy mustache spoke: “What is your
business in Ereen?”
Miles took a step forward and outstretched his hand, but pulled it
back when the guard looked down at it without so much as blinking.
“Right. Er, I’m Miles Westwood, you know, from Westwood’s Wild
World?”
The guard’s expression didn’t change in the slightest, and Kevin
shifted nervously.
Miles flashed a grin. “Don’t watch much tele? I understand,
mate. Pure rubbish, all of it.” He reached toward his back pocket and
immediately wished he hadn’t. All four guards shouted and aimed
their guns at Miles and Kevin.
“Whoa, whoa.” Miles held his hands up. “I just want to show you
my identification badge. I’m here to see Ivanka Sokolov. She is a
dear friend, and we have business.”
Calling Ivanka a dear friend was a stretch, but it was the only
card Miles had to play. Besides, he did have an identification card
that he received from Ivanka herself—though Miles had always
suspected Ivanka was only interested in being on Miles’s show.
She did have a flair for the dramatic.
The guard stepped forward and snatched the I.D. card from Miles
with a large, gloved hand. He tilted his head back and wrinkled his
nose as if he’d smelled something foul. Then, without another word,
he nodded toward the two guards on the other side of the gate and
handed the card back to Miles.
The gates opened slowly, and a second guard waved them
through with one mechanized hand, adding, “Do not cause trouble.
If you do, I will know.”
Miles nodded slowly. “Right.” He laughed. “No trouble here, mate.
Isn’t that right, Kevin?”
Kevin’s eyes went wide. “Uh, right.”
The guard grunted and stepped aside.
The loud boom boom boom of dance music playing through
tinny, garbled speakers. Ereen was small, but dense—packed with
hundreds of shops, all built side by side and stacked on top of each
other, some as many as five stories high. This was a territory unto its
own, and it had done well for itself—though it wasn’t exactly utopia.
The place was filthy, the air around them thick with smoke and
smog. Miles turned to Kevin. “Stay close to me, mate. Like the guard
said, we don’t want any trouble.”
Kevin barely seemed to hear Miles, his face aglow in the soft
neon light from an overhead shop. His eyes were cast in the
direction of the closest shop window. “Holy shit. I can’t believe it.”
Miles hardly had to ask what had Kevin dumbstruck.It was right
there in the window—one of the computer headsets like Kevin had in
his pack. This one appeared to be much nicer, a newer model with
chrome exterior and more gadgets—the functions of which Miles had
absolutely no idea.
Miles also saw the price underneath. “Forget it, kid. It’s not what
we came for. Besides, it’s the price of a small car.”
“It can do much more than any stupid car.” Kevin’s eyes hadn’t
left the device in the window. “That right there is the supercomputer.
I’ve read about it, but it’s not supposed to be on the market for at
least another year.”
Miles nodded. “Sounds about right. Ereen is known for getting
pretty much everything first, since there are no laws against this sort
of thing here.”
Kevin turned to Miles. “I have to have it. With that, we would
never have to worry about connection strength or utility. I could
hack into President Warren’s wristwatch if I wanted to.”
A small bell chimed, and a huge brute of a man stepped out of
the shop. He was just as dirty as the rest of Ereen and dressed in
little more than filthy rags. “You going to buy or just stand there and
stare?” The man’s Russian accent was heavy, much like many of the
people here.
Miles stepped forward. “We were just leaving, thank you.” He
turned away from the man, not realizing Kevin wasn’t following him.
“How did you get that?”
Oh no.
It was the one thing the guard had asked of them—don’t cause
any trouble. Kevin didn’t seem to realize what he’d just done. More
specifically, what he had likely rightly accused the man of.
“What did you say to me, boy?” The shopkeeper grabbed Kevin
by the shirt, tearing the fabric near the collar with a loud rip.
Kevin’s eyes were wide. “I. . .”
“Please forgive my friend,” Miles interjected. “It’s his first time
here in Ereen.”
The shopkeeper sighed and slowly let go of Kevin’s shirt. “You
keep him on short leash, or it may be his last.”
Miles nodded emphatically. “Yes, right. Noted, mate. Thank you,
we will be on our way now.” He grabbed Kevin by the arm and
hurried away, leaving the shopkeeper standing there, fuming.
Once they were far enough away, Kevin asked, “I don’t get it.
What did I say?”
“Anything at all is too much here, mate. But you practically
accused him of stealing the thing.”
“He had to have stolen it!” Kevin nearly shouted. “It’s not even
on the market yet.”
“Precisely. Which is why he was so angry to have been accused
of stealing it.”
They walked in silence for some time, Miles keeping his head
down and Kevin looking around like a small child in a toy store. It
wasn’t like Miles had never experienced something similar. He knew
what was going through Kevin’s mind. Ereen was unique, a time
capsule of sorts—part open marketplace and part new-age techie
dreamscape. But Miles had learned quickly of the dangers lurking
around every corner.
Like any other place, Ereen had its secrets, only in Ereen they
weren’t buried deep below everything. No, they were out in full
display in all of their ugly glory.
They passed by an array of food vendor stands, and Miles’s
stomach growled loudly, causing Kevin to laugh. “You and me both,
mate.”
Miles glanced around at the various food items for sale. “I guess
we could eat.” They hadn’t had a proper meal since before they left
the airport in Melbourne.
Kevin’s eyes darted from one food stand to the next. “It’s strange
seeing real people working all the stands instead of bots. I’m going
to let you point me in the right direction, though. I’m not sure what
most of this food is, and some of it is still moving.
“Right.” Miles stepped toward a cart which advertised AMERICAN
HAMBURGER. “Hi.” He pointed to the burgers, wrapped in aluminum
foil. “What is the protein? Beef?”
The vendor smiled a toothy grin. “Mostly.” He let out an ugly,
barking laugh.
Miles grimaced and nodded his head. “Two, please.”
Kevin elbowed Miles’s side. “Water too.”
Miles turned to the vendor. “And two colas.”
The vendor grunted and reached under the hot lamp, throwing
the two burgers into a small, paper sack. He reached into a bucket
of ice, grabbed two silver, unmarked soda cans, and handed one
each to Miles and Kevin. “Thirty kopeks.”
Miles nodded and rummaged through his pockets, finding his pay
card and held it up. “No kopeks, only crypto. That alright?”
The man nodded and punched a few numbers into a calculator,
then showed the amount to Miles.
Miles huffed, it was over priced, but he handed his card to the
man who looked at it and made a face. Miles figured he didn’t like
Brits, but there was no way of knowing what his particular issue
was, and he wasn’t about to ask. The man scanned the card with a
small machine, which beeped and flashed green.
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 Along with these signs the most important other indications are the
paralyses, which may consist of monoplegia, hemiplegia, or
paralysis of individual muscle groups, according as pressure is made
upon a limited area or upon an entire hemisphere. By the division of
the cranial cavity by the falx and the tentorium it is divided into
chambers, in any one of which pressure may be more manifest than
in the others. Nevertheless a serious compressing cause will affect
the tension of the cerebrospinal fluid and produce general
expression of pressure. The pupils often vary, and responsiveness to
light is occasionally noted. Nystagmus and ocular rotation may be
occasionally seen. Choking of the optic disk is also a frequent
phenomenon, to be recognized only by ophthalmoscopic
examination. This is due to pressure in the subdural and
subarachnoid prolongations along the optic nerve. In milder cases of
chronic compression disturbances of vision are of very great clinical
importance. These pertain especially to diagnosis of hydrocephalus
and of brain tumors. When they occur immediately after injury and
remain, they depend upon laceration or other severe injury of the
optic nerve. Those which quickly disappear depend mainly upon
pressure of blood, which is reabsorbed, while those which are later
in their appearance depend upon later intracranial complications. A
unilateral lesion of the optic nerve depends most often upon injuries
to it within the optic canal. When the lesion is bilateral the cause lies
deep. General paralysis may be of the type of hemiplegia, single or
double—i. e., by “double” I mean paralysis of the entire voluntary
musculature of the body, which necessarily implies serious and often
fatal hemorrhage.
Prognosis.—This depends in large degree upon the nature of the
compressing cause and of the possibility of its
removal. While the nature of the same may ordinarily be determined,
how much can be accomplished by way of removal may often not be
foretold before the operation at which this should be attempted. In
every acute case it is desirable to make this attempt early, for high
pressure, which may be borne for a short time, is fatal if continued.
Compression to any serious degree is usually fatal. So soon as
paralysis of circulatory and respiratory centres is apparent the
beginning of the end is at hand. Another reason for hastening
operation is that acute softening of brain tissue comes on promptly,
as well as general cerebral edema, which has destroyed many a
patient during the second to the fourth day after injury.
Treatment.—The treatment of compression is summed up in one
phrase—i. e., to remove the cause when possible. The
only cases in which this rule may be safely disregarded are those
where the attempt to remove the cause means more danger than to
leave it unremoved. This is not true, however, in the ordinary cases
of bone depression, meningeal hemorrhage, etc. Before operation,
however, or as a substitute for it in cases of minor severity, it may be
well to assist venous outflow by venesection, by which blood
pressure is reduced. In these cases this may be done from the
temporal veins or external jugulars, with the patient in the semi-
upright position. Drastic purgatives may also be employed in order to
utilize intestinal outpour as a stimulation to resorption of
cerebrospinal fluid. The physiological action of cold (ice-bags) may
also be secured for the purpose of contracting the cerebral arteries.
But all these measures are only to be resorted to when there is
uncertainty as to the wisdom of operating, since when operation is
indicated it should be done at once, and should take precedence of
everything else. This operation means ordinarily the procedure to
which the now general term trephining has been, by common
consent applied, and comprises any measure by which the skull is
opened at a suitable place and the dura or the underlying cortex
exposed to such extent as to permit removal of the compressing
cause. Whether the opening be made with trephine (annular saw) or
with the straight or revolving saw, with bone chisel, with bone
forceps, or with anything else, is a matter of choice on the part of the
operator. So, too, removal of the compressing cause should include
the elevation of depressed bone, the removal of dislodged particles
as well as of all foreign bodies, the cleaning out of blood clot, the
checking of hemorrhage, and the closure of the wound, with or
without drainage or counteropening at some other part of the skull,
as may seem desirable in special cases. This entire procedure
comes now under the name of trephining, and should in most
instances be painstakingly followed.
 The operative maneuvers will be discussed in another portion of
this chapter.

INJURIES OF INTRACRANIAL VESSELS AND SINUSES.

Intracranial hemorrhages may occur—
(a) From internal sources through the broken bone or between it
and the dura (extradural);
(b) Beneath the dura, between or into the membranes (subdural);
(c) Into the brain substance proper or the ventricles (subcortical or
intraventricular).
The vessels whose injuries are most often under consideration are
the meningeal arteries, the sinuses, the small vessels of the
membranes, and the internal carotid. The arteries, like the sinus
walls, may be ruptured either by substances forced in from without or
by sheer laceration. The longitudinal sinus is most liable to injury
from without. When this sinus is exposed, it may be dealt with either
by suture if the wound be small, or by ligation, or by tamponing with
prepared gauze. Hemorrhage from this source is ordinarily not
difficult to check. Fatal air embolism has resulted through an opened
sinus not properly plugged. The other sinuses are more rarely
injured, as by gunshot wound, fracture of the base, etc. The sinuses
have also been injured by compression of the skull during parturition.
Bleeding from a sinus is usually indistinguishable from that from a
meningeal artery, except that the former occurs more slowly.
Injuries to the Middle Meningeal Artery. —Injuries to the middle
meningeal artery
naturally occur in the immediate neighborhood of this vessel, which
is not infrequently ruptured by contre-coup. The artery runs
sometimes in a groove of the bone, sometimes in the dura, and
sometimes entirely in the bone. The more it lies within the bone the
more likely it is to be ruptured when this part of the skull is fissured.
Basal fractures often follow the groove for this artery. The anterior
branch is more often injured than the posterior. Extravasations from
this source are more common than from all others combined, the
amount of blood varying within wide limits. 240 Gm. of blood clot
have been known to collect and the dura to be separated down to
the base of the skull. I have repeatedly taken away a small teacupful
of blood clot in such cases (Fig. 377 and Plate XLIII).
 Fig. 377

Compression following hemorrhage from the middle meningeal artery. (Helferich.)

 Symptoms.—The symptoms of this hemorrhage are those of
compression, while extravasation may be rapid and
quickly fatal, delayed for some time, or may take place in two stages,
the first but slight and producing no coma. New clots are always dark
and disk-shaped, thick in the middle, with a definite margin. As the
clots become older they become more adherent and difficult to
remove. The symptoms of meningeal hemorrhage consist of an
interval of consciousness or lucidity after injury, followed by epileptic
or spastic symptoms, alterations in the pupils and pulse,
unconsciousness passing into coma, and stertorous respiration.
There may or may not be external evidence of head injury. The
character of the paralysis (hemiplegia) may indicate that the clot is
really upon the side opposite to that of the skull which shows
evidence of injury. In this case arterial laceration is the result of
contre-coup. According to the rapidity of the symptoms is the extent
of the primary lesion. Meningeal hemorrhages involve immediately
the motor area, which makes diagnosis all the easier.
Injuries to the Carotid.—Injuries to the carotid within the cranium
are exceedingly rare. Still, it has been
injured in basal fractures and penetrating wounds.
Arteriovenous Aneurysm.—Development of arteriovenous
aneurysms after basal injuries is
occasionally noted. They will occasionally give rise to pulsating
exophthalmos. Pulsating tumors within the orbit which push the eye
forward not infrequently occur after serious head injury. Of 77 cases
collected by Rivington, 41 had a traumatic origin.
Subdural Hemorrhages.—Subdural hemorrhages are not
infrequent in the skulls of the newborn,
and constitute the so-called apoplexia neonatorum. They may
occasion convulsions and paralyses of irregular type, while if the
extravasations become infected multiple abscess may result.
In adults subdural hemorrhages are most commonly connected
with brain lesions which have been already spoken of as contusions.
They may be the starting points for pachymeningitis. Their most
common results are disturbances of consciousness and mentality.
Paralytic dementia follows in some of these cases. Extensive
subdural hemorrhage may give a clinical picture corresponding to
extradural. Disseminated minute ecchymoses constitute minute focal
lesions, which are, however, usually so distributed as to confuse and
prevent accurate diagnosis. Apoplexy or intraventricular
hemorrhages, especially from the lenticulostriate artery (Charcot’s
“artery of hemorrhage”), have until very recently never been
regarded as warranting surgical interference. Of late, however,
especially in the ingravescent or progressive forms, ligature of the
common carotid has been of some service, though in order to render
this effective ligation should be done early.
Traumatic Intraventricular Hemorrhage.—Traumatic
intraventricular
hemorrhage occurs in much the same way as meningeal, by contre-
coup. Individuality of symptoms is lost in the general comatose
condition of the patient, but when operation is performed, as it is
usually best to perform it, if no extradural clot be found and if brain
tension be evidently increased, the dura should be opened; after
which, if no subdural clot be seen, the ventricles should be tapped
with an exploring instrument. In this case, if blood be removed by
aspiration, a knife should be passed directly into the ventricle, after
which blood, if present, will promptly escape. Dennis was the first to
diagnosticate the presence of intraventricular clot and to deliberately
incise into it, and I have myself repeatedly imitated this procedure,
both with and without success.
In every case in which superficial or cortical hemorrhage can be
recognized—or even suspected—or intraventricular hemorrhage as
well, one should insist upon exploration. This means trephining, with
perhaps aspiration of the ventricular contents. Tapping of the
ventricle is described under Treatment for Hydrocephalus, while
trephining is described at the end of this chapter.

LACERATIONS AND INJURIES TO THE BRAIN SUBSTANCE.

These have been mentioned under contusion of the brain. They
may be divided into those which occur with or without fracture of the
cranial bones. The term contusion was first suggested by Dupuytren.
The condition comprises all degrees of injury, from the most minute
local disturbances to lesions involving the entire hemisphere. The
milder forms show a sprinkling of punctate hemorrhages, numerous
in the centre of the injured area, the surrounding tissue taking on a
more or less diffuse tint, which fades out toward the periphery,
discoloration being due to the imbibition of the coloring matter of the
blood. In more extensive injuries clots as large as peas, or larger, are
embedded at various points, each surrounded by its area of
discoloration. When foreign bodies have been driven into the brain
the tissue is also discolored, while various foreign materials may be
met. In instances of great violence there may occur absolute rupture
of brain tissue extending from cortex to ventricle.
Prognosis.—Prognosis depends in large degree upon escape
from or occurrence of infection. In infected cases the
principal dangers are from blood pressure and from later edema or
acute softening as well as from meningitis. Brain lacerations may
heal by cicatricial repair, but usually with some perversion of
function.
The possibility of cystic degeneration of large or small clots is one
of great importance. (See Cysts of New Formation in Chapter XXVI,
page 264.) A blood clot within the cranium which fails to resorb is
essentially a hematoma, in whose interior softening and conversion
into a cyst may easily occur. These cysts make room for themselves
at the expense of surrounding brain tissue, and when located in the
motor area give rise to localizing symptoms as well as to epileptic
convulsions. They may be often diagnosticated with certainty after
an accurate history of the case and a study of the phenomena which
it presents. As they grow older their walls become firmer, and it is
often possible to dissect them out.
That foreign bodies may be encapsulated and remain without
producing disturbance is now well known. This is particularly true of
bullets. As a rule, however, though encapsulated, they produce
symptoms like headache, vertigo, etc. (See Plate XLIII.)
Symptoms.—The general features of brain lacerations are those
of contusion. So long as the disturbances are minute,
even if multiple, or the foreign body small, compression symptoms
are not produced, or at least in very incomplete degree. Minute
diagnosis is not easily obtained. The most essential thing is to
decide upon the question of operative interference. In the absence of
distinctly localizing symptoms or other external markings it is not
usually performed. Upon the other hand a lesion which can be
localized is probably due to extravasation sufficiently large to be
easily reached by opening the skull; and, unless there be other and
sufficient reason to the contrary, this should be done (Fig. 378).
In many instances, however, contractures or paralyses of muscle
groups occur later, and are followed by spastic conditions which may
be permanent. More can be done in these cases by massage, by
internal medication, perhaps with external counterirritation, than by
distinctly surgical procedures. Tendoplastic or neuroplastic measures
for their relief may also be considered. Both albuminuria and
glycosuria are known to be the result of injuries herein described, as
well as bulbar paralysis and disturbances of special senses. More
immediate dangers after these head injuries are those of
bronchopneumonia or hemorrhagic or edematous infiltration of the
lower lobes of the lungs—conditions often spoken of as hypostatic
pneumonia, much resembling those produced experimentally in
bilateral division of the pneumogastrics. Some of them are produced
by paralysis of the glottis, the result of which is incomplete closure,
with aspiration of fluids and solids from the mouth, whose
decomposition sets up an infection within the lungs, and is often
referred to as aspiration pneumonia. Some form of pulmonary
disturbance follows in perhaps one-third of the cases of the injuries
above alluded to, and should be anticipated and prevented.
 Fig. 378

Bullet embedded in anterior fossa. (U. S. Army Med. Museum.)

GUNSHOT WOUNDS OF THE HEAD.

These have already been extensively considered in a previous
chapter, so that but little more need be said of them here. Such
wounds in the scalp are likely to be followed by sloughing. So far as
gunshot fractures of the skull are concerned, there is frequently a
marked discrepancy between the wounds of the inner and outer
tables, that last perforated by the bullet being almost splintered.
Penetrating wounds of the cranium by Mauser and similar bullets are
not necessarily fatal. Many men were shot through the head during
the Cuban and South African wars and yet did not die as a result of
the wound. (See Chapter XXII.)
Treatment.—So far as treatment is concerned, gunshot injuries of
the skull necessitate trephining or exploration, for
checking of hemorrhage, disinfection of the bullet track when
possible, often for a counterdrainage opening with through drainage
either by tube or gauze. The bullet, if it can be found, should be
removed. In searching for it the old porcelain-tipped probe of Nélaton
has almost completely given way to Fluhrer’s aluminum probe, which
is larger and longer and when rightly directed will by slight weight
usually glide gently along a bullet track, thus leading often to the
missile, and at the same time indicating by its direction where the
counteropening should be made. Two other methods of detecting
bullets are now in vogue. Girdner, some years ago, invented a
telephone probe, by which, so soon as the instrument touches the
missile, a telephone circuit is completed and the operator with a
telephone receiver applied over his own ear hears the tell-tale “click”
indicating the fact. This has been further improved by the substitution
of a bell or “buzzer,” which tells its own tale when the probe touches
the bullet.
A still more ingenious application of electricity for the purpose is
that afforded by Röntgen’s discovery, and during the American and
English campaigns of the past few years skiagrams of skulls
showing bullets in various locations have become quite common.
(See Plate XIII., p. 229.)

PROLAPSUS AND HERNIA CEREBRI.

Escape of brain matter beyond its normal level is not uncommon in
connection with compound fractures or their sequels. It may be
primary, escaping with the blood at the time of the accident, or
secondary, occurring during the ensuing days. Any lesion of this kind
in which the brain appears or can be handled is entitled to the term
prolapsus, in contradistinction to hernia, which implies that, though
escaping from the proper cavity, it is nevertheless covered by other
textures—e. g., the dura or scalp.
The protrusion may vary in size from a small tumor to one the size
of a fist. It is always the result of uncontrolled intracranial tension,
and may be produced by hemorrhage, by serous imbibition, or as the
result of brain abscess. When immediate it is of the first variety;
when later, of the second or third. When abscess is present it usually
delays protrusion, which is produced by degrees. Prolapse occurs
through large openings, such as those made by gunshot wounds,
the trephine, etc. Prolapse proper implies laceration of the dura. It
pertains obviously to the convexity of the skull, occurring, however,
in exceedingly rare cases into the orbit (Fig. 379).

Fig. 379

Prolapsus cerebri. (Bryant.)

Prognosis.—The prognosis is generally unfavorable. There is

always risk of edema or infection, either of which may
prove fatal.
Infiltration, gangrene, suppuration, or repair by granulation may so
disfigure and disguise the real brain substance as to lead to error of
diagnosis. It by no means follows that every tumor presenting
through an opening in the skull is of this character. When gangrene
and spontaneous separation occur, spontaneous recovery may
follow, the stump being covered by granulations and finally roofed
over by connective tissue.
Treatment.—Treatment in the primary cases should include the
most rigid asepsis with removal of all foreign particles.
Localized pressure does some good, especially in those cases
where it can be tolerated. Signs of abscess should always be
watched for, and deep exploration is often justified or indicated.
While excision or cauterization are often heralded as successful,
they are by no means without their dangers. Nevertheless in
selected and suitable cases excision may be freely practised. Cases
that admit of it should wear a protective shield properly molded to the
part. Skin transplantation, or even osteoplastic repair of the defect,
may give good results in favorable cases.

SEPTIC INFECTIONS WITHIN THE CRANIUM.

Under the general term septic infection are included:
A. Abscess;
B. Thrombosis;
C. Sinus phlebitis;
D. Meningitis;
E. Encephalitis.
These are different manifestations of infection, the clinical picture
differing according to the tissues and localities involved. For the
production of these infectious conditions no special bacteria other
than those already catalogued in Chapter III are comprehended.
Their method of activity is there discussed at sufficient length, and
we need here only consider the various paths of infection. These
may lie along the bloodvessels, the lymphvessels, nerve sheaths,
and prolongations of the membranous sacs which extend from the
cranial cavity proper.
The most common of all the paths of infection is afforded by the
middle ear, especially when involved in a chronic suppurative lesion,
which is by no means necessarily connected with a patulous
tympanic membrane, and which may consequently be undiscovered,
though in more or less constant activity.
 A. Abscess of the Brain.—This may be traumatic or non-
traumatic. The former variety is most
often due to the direct result of injury, infection displaying its
consequences promptly or sometimes not until long periods have
elapsed. The ordinary form occurs within the first two weeks, usually
as an acute cortical abscess beneath a more or less compromised
membrane, surrounded by a zone of red softening, and this by
another of brain edema. The chronic traumatic abscesses are less
often cortical, but are deeper. They are marked by prolonged
suppuration of the external wound, but may occur through some
mechanism not understood. Only the chronic abscesses show
encapsulation, the capsule partaking of the character of the
pyophylactic membrane, elsewhere described. (See Chapter VIII.) It
may cover a long period—to my personal knowledge at least nine
years, while others have mentioned twenty and more. The non-
traumatic abscesses are in the main due to middle-ear disease.
When the roof of the tympanum breaks down it is the middle fossa of
the skull which is infected; when the posterior wall, naturally the
posterior fossa. The most common result of perforation of the
tympanic roof is involvement of the mastoid antrum or the sigmoid
groove and sinus. In the former case we have temporosphenoidal
abscess; in the latter, cerebellar, if any. Previous to actual perforation
there is thinning of bone with thrombosis along the minute veins
connected with the sinuses. When the dura is exposed by the
carious process, granulation tissue often protects it against further
inroads, while masses of the same projecting into the tympanum
have been mistaken for prolapse. If the sigmoid groove be the site of
the first disturbance, extradural abscess may form between the sinus
and the remaining bone, the granulating process then involving the
whole bony groove. Its later consequence is sinus phlebitis, sinus
thrombosis, or intradural infection. If there be adhesion between the
dura and the cortex we have actual brain ulceration without
formation of a true abscess; but if once the perivascular sheaths
have carried infection to the substance of the brain there is a rapid
purulent disintegration of the same, and formation of a true subpial
or deep abscess, which latter is in effect a purulent encephalitis.
Macewen has shown how important it is not merely to evacuate such
abscesses, but to eradicate the path of infection from the point of
origin, which is rarely easy.
Extradural pus may escape into the mastoid cells by erosion of
their inner walls. Such pus may escape suddenly, and serious
symptoms thus be mitigated. Even abscess of the bone may thus
empty itself by the process of adhesion and pointing toward the
surface. Pus from the mastoid cells may perforate the
temporomaxillary joint or escape along the digastric groove and form
deep cervical abscesses.
When the arachnoidal tissue is involved, both subdural and
subarachnoidal spaces participate in the infection, and the brain
floats upon a pus-bed rather than a water-bed. Leptomeningitis
under these circumstances becomes quickly diffused and fatal.
Serous fluid may accumulate so quickly as to produce death by mere
obstruction to the cerebral bloodvessels, while distention of the
ventricles and an acute infectious internal hydrocephalus is possible.
Leptomeningitis may be propagated wherever anatomical paths may
carry it, even to the cauda equina and along the spinal nerve
sheaths.
The pus within cerebral abscesses is often discolored, sometimes
offensive. A greenish color is usually imparted by the Bacillus
pyocyaneus, while the offensive odor comes mostly from the Bacillus
coli. Around such an abscess is a zone of inflamed cerebral tissue. If
within this zone a pyophylactic membrane is produced by
condensation the abscess may become encapsulated and life be
prolonged. When a capsule fails to form, the process being too acute
or rapid, death is the speedy termination of such a case. These
abscesses are generally single, but may be multiple. There is also a
metastatic expression of abscess formation, seen in typical cases of
pyemia, where numerous miliary abscesses are found within the
brain. Pressure symptoms are less likely from abscess than from a
tumor of the same bulk, while there is much greater liability to edema
and sudden infection. Gradually extending paralysis implies
pathological activity around the abscess. Large collections of pus are
often met in the least vital parts of the brain, as in the frontal or
temporosphenoidal lobes.
Symptoms.
—Aside from causal indications (e. g., injury to the head, middle-ear
disease, recent operations upon the air-containing cavities, etc.) the
first symptoms may be slight. They consist usually of headache,
often ascribed to cold or trifling injury, becoming exaggerated, rarely
definitely located, radiating widely. In time it is spoken of as
“excruciating,” and may be continuous or intermittent. Vomiting is not
infrequent, rarely accompanied by nausea. Chills come on early in
the history of the case, varying in intensity, duration, and frequency.
The more frequent, the more likely is it that the abscess results from
some general infection. Temperature is seldom much elevated; it is
often subnormal. When exalted it is in proportion to the degree of
meningeal involvement. If pressure symptoms become marked we
get the usual slow pulse due to increased tension. After evacuation
of pus pressure symptoms may subside, but temperature rise. Such
discharge from the middle ear as may have been previously noted
usually diminishes. A history of cessation of discharge and of
increased pain and fever occurring at irregular intervals is very
characteristic.
These patients seldom come under the surgeon’s notice until the
condition is serious. If they are still conscious, pain is the dominating
complaint. This may be aggravated by percussion over the affected
region. Rigidity of the sternomastoid on the affected side is a sign of
lesion of the sigmoid sinus. Pain elicited by deep pressure in the
posterior cervical triangle is also significant. There is mental
hebetude, with progressive failure of mental and physical power, as
the stupor increases, or coma becomes marked.
Abscess may be often distinguished from infectious thrombosis, as
in the latter respirations are quickened and vomiting occurs when the
patient is in the upright position.
Vomiting accompanied by cephalalgia is always indicative of
intracranial mischief. If it be a special feature throughout the case it
may indicate cerebellar lesion. Convulsions are also frequent, but
rarely distinctive. They are the result in most cases of secondary
irritation of motor areas. Paralysis is the consequence of destructive
rather than of irritative lesions.
The ear should be examined, and the use of a probe may give
much information.
 Brain abscess connected with middle-ear disease will usually be
found in the temporosphenoidal lobe, but occasionally occurs
beneath the tentorium, in the cerebellum. Many of these cases are
connected with self-evident indications of purulent otitis media and
mastoid disease, and operation for the latter has often to be
combined with the recognition of and suitable treatment for brain
abscess. The surgical treatment of mastoid disease will be
discussed in separate paragraphs and under a separate heading.
Whenever there is any reason to suspect the existence of pus within
the cranium the operator should expose the dura by opening above
the mastoid; or his operation may already have taken him as far as
the sigmoid sinus, in which case, with the dental engine or with other
bone-cutting instruments, he may much enlarge the field of operation
and thus make access both to the sinus and to the brain itself. An
extradural collection of pus may be found within the sinus or above
it. Drops of pus may escape as the operator cleans away or even
presses apart the granulations. He has often to decide upon further
exploration, either to open the sinus expecting to find it filled with
disintegrated blood clot and products of decomposition, or to open
the dura proper, expose the cortex, and perhaps explore here with
the aspirating needle for pus located more deeply. In those cases
where evidences of brain abscess are more pronounced, and those
of mastoiditis less so, the lateral region of the skull may be exposed
and the cranium opened with a trephine before working downward
and exposing the mastoid region. In not a few instances both
operations are combined and the area of bone to be cut away is
relatively large. Thus complete tympanic eventration, with removal of
much of the mastoid, may be combined with trephining and opening
of a brain abscess, or opening of the sinus, in which latter there may
be found such a condition as to make it advisable to ligate the
common jugular low in the neck, and irrigate from the sinus to the
location of the ligature, where the vein is laid open, or even to pass a
small swab upon the end of a flexible probe. Nothing can more
predispose to typical pyemia than a breaking-down clot within a
sinus or vein involved in thrombophlebitis.
Temporosphenoidal abscess will often be indicated by the escape
of pus through the dura, above the roof of the tympanum. Although
such an abscess might be evacuated by enlarging the tympanic
approach to it, it would ordinarily be much better to open the skull
above the ear, and thus make free access and provision for
drainage. In any part of such an operation when the dura has once
been exposed its appearance should be carefully noted. The coarse
of the pial vessels can usually be traced through it. Therefore when it
is sufficiently opaque to prevent any appreciation of conditions
beneath, or sufficiently distended, it may be opened.
When cerebellar abscess is suspected the trephine should be
applied about midway between the tip of the mastoid and the
external occipital protuberance (inion), i. e., one inch beneath Reed’s
base-line and one and a half inches back of the mastoid. The
instrument should here be used with care, as the occipital bone is of
irregular and variable thinness. In a brain abscess which can be
freely opened gauze packing will be found serviceable, even though
its use necessitates the employment of secondary sutures or
perhaps leaving the wound open in order to permit of its removal.
Localizing symptoms are only occasional in connection with
cerebral abscess, because the majority of these lesions are located
without the motor area. Pupillary alterations are indefinite. As an
abscess enlarges the size of the pupil may increase. Infective
thrombosis rarely affects the pupils, save that when located in the
cavernous sinus it may produce ptosis. In temporosphenoidal
abscess pain is usually localized in or near the ear upon the same
side. As the motor area becomes involved there is a gradual
development of localizing phenomena, referred to the opposite side.
Facial paralysis is common in advanced destructive lesions in the
mastoid and tympanum. When produced by cortical lesion it is rarely
so pronounced as when by direct paralysis of the nerve. In frontal
abscess there are few localizing phenomena. Abscess in the parietal
region is most commonly of traumatic origin, and is to be suspected
in accordance with external surface markings. Occipital abscess is
exceedingly rare, and cerebellar abscess furnishes few localizing
symptoms. Its most prominent clinical features are retraction of the
head and neck; slow, feeble pulse and respiration; subnormal
temperature; violent yawning; rigidity of the masseters; slow speech;
optic neuritis; vertigo and vomiting. If accompanied by thrombosis
there is pain upon pressure in the upper part of the neck. In all of
these cases when abscess is near the surface there is more or less
leptomeningitis, which becomes diffuse at once when the abscess
bursts. If meningitis be present we have high temperature without
marked remissions, rapid pulse, and general irritability, rapidity of
pulse indicating predominance of leptomeningitis over encephalitis,
since the more marked the latter the slower the pulse. As
distinguished from sinus thrombosis we have in the latter high
temperature with marked remission, rapid and weak pulse, frequent
chills, profuse sweats, and often symptoms of pulmonary infarct or
diarrhea, with cervical and submastoid tenderness and involvement
along the jugular vein upon the affected side. If all three conditions
be associated the symptoms of thrombosis usually prevail, although
there may be retraction of the head due to basilar meningitis. As
between tumor and abscess we have in the former absence of
explanation of infection, slow progress of symptoms, more definite
localizing phenomena, progressive involvement of nerves,
pronounced optic neuritis, absence of chill, and alternating periods of
mitigation of symptoms. Temperature and pulse afford little help,
save that subnormal temperature points rather to abscess.
Prognosis.—From every direction come statements that the
tendency of cerebral abscess is invariably toward fatality. No matter
what the cause, unless relief be promptly afforded, death is the sure
result. Of the acute cases those not promptly operated usually die
within a few weeks. The more chronic or prolonged cases rarely
come under surgical treatment; most of those which do are the result
of disease in or about the middle ear. Were it possible to early
diagnosticate formation of these abscesses prognosis would be
much more favorable. When seen before necessarily fatal
complications have arisen, in instances where the position can be
reasonably well determined, surgical attack is likely to give good
results. After proper evacuation even complete mental and bodily
recovery is possible. Anchoring of the brain by adhesions may leave
a train of disquieting symptoms, which, however, are not so bad as
fatality. Abscesses may remain for a long time encysted, and yet be
a fruitful source of danger. Multiple abscesses may complicate both
the diagnosis and the treatment and produce a condition beyond
help.
The operative treatment of these cases will be discussed by itself.
B. Sinus Thrombosis.—The sinuses are predisposed to
thrombosis by virtue of their size,
inflexibility, shape, and the fact that they are not emptied during
respiration, all of which tend to retard blood flow. If to these be added
defect in the blood supply, then everything predisposes toward
marasmic thrombosis. This occurs much less frequently than the
infective form, is mostly confined to the longitudinal sinus, is noted
mainly at the two extremes of life, and is often seen in cases of
death following exhausting diarrhea in children. In the marasmic form
the clots are dense, firm, stratified, and non-adherent; they rarely
occupy the whole caliber. In old cases the clots may be tunnelled
sufficiently to permit reëstablishment of circulation. Their principal
evil consequences are edema of the frontal lobes and
serosanguineous effusion into the ventricles or orbits—in the latter
case producing exophthalmos. Sometimes epistaxis is produced.
Strabismus, tremor, muscle rigidity, or contractures are more often
seen conjoined, especially in children, with convulsions, sometimes
unilateral, and choked disk.
Diagnosis.—The diagnosis in adults is difficult, but in children, when
convulsions occur after exhausting illness, with the signs just noted,
marasmic thrombosis may ordinarily be diagnosticated.
Infective thrombosis, the other variety, is due exclusively to the
invasion of pyogenic organisms. It is observed mostly in the basal
sinuses; its origin is local, and it is always secondary to some
external infection. Its most frequent cause is middle-ear disease;
consequently the sigmoid sinus is the one most often involved. It
may follow carbuncle, erysipelas, or cellulitis of the external parts, or
nasal ulceration, as well as dental caries, suppuration of the tonsils,
etc. Infection may be propagated by tissue continuity, or through the
circulation.
Symptoms.—Infective thrombosis presents few distinctive
symptoms. Local ischemia, perversion of function, extracranial
edema are too vague. Headache is nearly always constant and
vomiting is frequent; temperature runs high, with marked remissions;