Three cases of cerebral abscess consequent upon suppurative disease of the middle ear, with remarks / by Thomas Barr.

Barr, Thomas, 1846-1916

Date:: [1880]

Credit: Three cases of cerebral abscess consequent upon suppurative disease of the middle ear, with remarks / by Thomas Barr. Source: Wellcome Collection.

Provider: This material has been provided by The University of Glasgow Library. The original may be consulted at The University of Glasgow Library.

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ical feature of the temporal bone—viz., the numerous hollov?- spaces (one of which—the antrum mastoideuui—is almost as large as the tympanic cavity itself) which are found chiefly in the mastoid and petrous portions, but are found also in other parts of the bone. These cavities all communicate freely with the tympanum, and are apt to participate in suppurative processes which may originate there. The cells situated in the mastoid bone are separated from the dura mater only by a thin cortex of bone, just in the situation of the lateral sinus, while the tympanum itself at its roof has but a very thin plate of bone, which is often in fact defective, separating its mucous membrane from the dura mater. In addition to the dangers which may at any time arise from the proximity of these osseous spaces to the vital parts within the cranium, the anatomical arrangement just referred to pre- sents very favourable conditions for the retention, accumu- lation, and decomposition of the purulent secretion. The decomposing pus, loaded with bacteria, stored up in these cell- ular spaces may often remain, sometimes dried up into cheesy looking masses, many years without disturbance; but it may also lead suddenly to rapid ulcerative conditions in the neighbourhood, or, by absorption, to fatal embolic and septic diseases. Besides, the gases of decomposition which arise from these putrefying masses do not merely pass outwards, wliere they fall very unpleasantly upon our sense of smell, but they may pass upwards upon the brain itself, and exert an irritating and putrefactive influence there. When we consider that the roof of the tympanum and mastoid cells is often very thin, sometimes at parts only membranous, and always peifor- ated by foramina, it is easy to understand that these emanating ffases may gain admission to the cranial cavity. We thus see that the source, in most cases, of discharges from the ear is an inflamed mucous membrane, which is so intimatelv connected with the periosteum as to threaten to invest the disease with all the gravity of a periostitis. All surgeons recognise periostitis, with the attendant danger ot caries and necrosis, as a serious afi-ection in any bone of the body; but in a cranial bone, and especially in the temporal bone, it has a much more weighty significance. In shore, Gentlemen, I do not know any part of the body where, from a theoretical standpoint, we should so earnestly strive to avert inflammatory processes and accumulation ot purulent secretion. The following three cases, which have come under my observation during the past two years, show that practical experience bears out this a fAoH statement. I should men-

Three cases of cerebral abscess consequent upon suppurative disease of the middle ear, with remarks / by Thomas Barr.

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