Remarkable case of abscess of the dura mater and brain, following a blow on the head : a clinical lecture / by I. Burney Yeo.

  • Isaac Burney Yeo
Date:
1879
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Licence: Public Domain Mark

Credit: Remarkable case of abscess of the dura mater and brain, following a blow on the head : a clinical lecture / by I. Burney Yeo. Source: Wellcome Collection.

Provider: This material has been provided by The Royal College of Surgeons of England. The original may be consulted at The Royal College of Surgeons of England.

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    But the diagnosis of cerebral abscess is proverbially difficult, and chiefly on account of the latency of its symptoms, of which I must now say a few words. Sir William Gull says that “abscess” following in- jury to the head “ may remain latent for months or even longer”; and, again, “an abscess may lie latent in the brain for many months, and then acute symptoms may suddenly set in and the patient die in a few days”. The writer in Ziemssen whom I have already quoted is equally emphatic on this head. “An acute encephalitis following a non- perforating injury of the head can run its course without one having a suspicion of its existence”; and, again : “Cerebral abscesses have been found especially in the temporal lobes, the existence of which had not been betrayed during life by a single symptom”. So it is certain—and I wish particularly to call your attention to this —that, with the history of the recorded observations of cerebral abscess before us, it is impossible to form any positive opinion as to the period at which the abscesses were formed, which we discovered at the au- topsy of the case we are discussing. They may have existed when he first came into the hospital. They were undoubtedly not very recent, for they were both encysted. If, however, as Dr. Ferrier believes, the 1 smaller abscess in the ascending frontal convolution occupied the seat of the facial centre, and so gave rise to the partial facial paralysis which was observed, the formation of this abscess and the occurrence of the facial paralysis ought to have coincided in point of time; and the facial paralysis was first noticed on December 21st, i. e., forty-six days after his admission and twenty days before his death. Next let us consider the question of temperature, which ran such a remarkable course in the case before us, simulating an anomalous kind of intermittent fever. The fact that the course of cerebral abscess may simulate that of some forms of fever had not escaped the notice of Sir William Gull, for he says: “Patients suffering from cerebral abscess may have symptoms so closely resembling continued fever, that it is extremely difficult, if not impossible, with any degree of certainty to say whether it is a case of fever or of organic disease of the brain.” Huguenin, in the twelfth volume of Ziemssen, says: “Two cases occurred to us which, in consequence of our total ignorace of etiological factors and the entire coincidence of the symptoms with intermittent fever, were regarded as such.” One of these cases he reports in full, and it bears some resemblance to this case. The case began with a high temperature (105 deg.) and sweating; then freedom from fever for four days. No head-symptoms. Then again a rise of temperature extending over three days, and reaching 103.2 deg.; and “energetic treatment with quinine”. Then seven days of freedom from fever, but occasional vomiting, “attributed to quinine”; and frequent complaint of headache. But there was no further rise of temperature, and the resemblance to an intermittent or remittent form of fever was by no means so complete as in this case. Moreover, the case ran its course (as reported) in twenty days. Now, in the case before us, for twenty
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