Brain abcess from the point of view of the neurological surgeon / by Hugh Cairns.

  • Hugh Cairns
Date:
1930
Catalogue details

Licence: In copyright

Credit: Brain abcess from the point of view of the neurological surgeon / by Hugh Cairns. Source: Wellcome Collection.

    3/12
    Neurological Surgeon. By Hugh Cairns, F.B.C.S. In taking stock of my own experience I find that I have personal records of forty-eight cases in which brain abscess was either suspected or overlooked. In twenty-three of these the presence of an intra-cerebral abscess was subsequently verified by operation or necropsy. Seven never came to operation ; in some others operation was performed too late. Thus, in one case, that of a frontal abscess secondary to frontal sinusitis, I arrived at the bedside of a patient only to find that she had stopped breathing about one minute before. A hasty examination while artificial respiration was being performed showed severe papilicedema, slight right facial weakness, and X-ray evidence of increased density of left frontal sinus. The left frontal lobe was hastily tapped and 2 oz. of pus were withdrawn. The patient improved temporarily, but died eight hours later from pyocephalus and leptomeningitis. I cite this example that you may have less cause to disbelieve me when I say that, in my own practice at least, the bad results are almost entirely due to delays or mistakes in diagnosis, and it is to the difficulty of diagnosis that I would particularly like to direct attention. I had originally hoped to say something about treatment, hut in the course of preparation of this paper I found that there was so much to say about diagnosis that it seemed best to limit myself on the present occasion to this aspect of the subject. There is one aspect of treatment, however, that I am prompted to bring up by listening to Professor Neumann’s interesting paper. Professor Neumann has made a careful comparison between the recent results in treatment of otogenic brain abscess and the results obtained by Macewen over thirty years ago, and he has sought an explanation for the fact that the results of otologists of the present day are very much wrorse than those of Macewen. This fact is one which has puzzled me also, and I have read through Macewen s book several times in the hope of finding some adequate explanation. Probably there are a number of causes for this divergence, but there is one possible cause that has not, so far as I am aware, received adequate consideration. It is, I believe, the usual practice among otologists of the present day to use the mallet and gouge or chisel in clearing out the mastoid process. As far as I have been able to ascertain from his hook, Macewen never used a mallet and gouge, but always opened the mastoid process with hand burrs. I would like to learn from Professor Neumann and the Members of this Section wthether the more modern method, involving as it does, intermittent percussion of the skull, may not produce in the underlying brain a disturbance that tends to promote the spread of the infective process. The success of any method of treatment depends in the first instance on the ability of the brain to localize the infection. No form of operation avails if an abscess spreads rapidly and ruptures into the ventricle within a few days of its inception. But this is, fortunately, a rare event. The brain is richly endowed with connective tissue cells, in addition to its own supporting glia, and these cells are rapidly mobilized when any focus of infection occurs. That they are often successful in limiting the spread of infection is shown by histological examination of the wall of an abscess, and by the not infrequent observation of cases in which an abscess is found to he completely surrounded by a dense fibrous capsule. The barrier
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