Licence: In copyright
Credit: Abcess of the brain / by Heinrich Neumann. Source: Wellcome Collection.
![\ \ Section of ©toloo\>. 'fFebruary 7, 1930.] Abscess of the Brain. '> .. By Professor Heinrich Neumann (Vienna). About five decades have passed since Macewen’s fundamental work on the pyogenic diseases of the brain and spinal cord. The question which now arises is: What results have the last fifty years of research on brain abscesses brought to us ? Firstly, we will consider some statistics and compare Macewen’s results with those of later times. I will begin with statistics of temporal lobe abscess :— Author Summary Healing Mortality Ropke 142 59 (41 per cent.) ... 83 (59 per cent.) Hammerschlag ... 53 27 (53 „ ) - 26 (47 5 > ) Schmiegelow 13 5 (38 „ ) - 8 (62 > 5 ) Korner ... 7 2 (29 .) .- 5 (71 5 ? ) Hegener 24 5 (21 „ ) - 19 (79 ?? ) Henke ... 16 5 (35 ,, ) - 11 (65 ? J ) Heine 31 10 (32 n ) -. 21 (68 > 5 ) Michaelsen 8 5 (62 „ ) - 3 (28 ) 5 ) Maier 23 9 (39 ,, ) -. 14 (61 5 > ) Niihsmann 18 6 (33 „ ) - 12 (67 5 5 ) Behlau ... 5 1 (20 „ ) -. 4 (80 J > ) Neumann 47 16 (34 » ) ». 31 (66 J? ) The first two, being collective figures, and not taken from one special clinic, lose in real value. The results of other figures, even the smaller ones, do not differ greatly from my own personal statistics of forty-seven cases treated at my clinic during the last ten years. And the average of them all agrees approximately (34-39%) with my figures. Comparing these statistics with Macewen’s, we are surprised to find that even the best, with 62% of successes, is not nearly so good as Macewen’s results, which I will indicate later, when discussing cerebellar abscess. This difference in the successful results is the more astonishing because general medicine, and with it otology, has made great progress both in diagnosis and operative treatment. Brain surgery and diagnosis of endocranial complications especially, have improved considerably. It is an interesting question why, in spite of these facts, we are so far behind Macewen’s results with his 80% of successes. Probably it is due to difference in the material. Macewen operated on selected cases, excluding all those combined with meningitis or sinus thrombosis, and he operated personally. But even when I select cases from my material, excluding all cases in which there are bacteria in the spinal fluid, and all cases of sinus thrombosis, I get only 47% of healing, which is far below Macewen’s percentage. There is, perhaps, another factor that helps to explain the difference between the present day successes (47%) and Macewen’s (80%). Even after the diagnosis of brain abscess was made, Macewen, at a preliminary operation, exposed the dura and painted on it a 20% solution of carbolic acid to get protective adhesions before actually opening the brain ; thus, we are justified in thinking that he waited May— Otol. 1 PHOC. ROYAL SOCIETY MEDICINE, MAY 1S30 PAGE 10U S'](https://iiif.wellcomecollection.org/image/b30628313_0001.jp2/full/800%2C/0/default.jpg)
