Clinical surgical diagnosis for students and practitioners / by F. de Quervain ; translated from the 4th ed. by J. Snowman.

  • Fritz de Quervain
Date:
1913
Catalogue details

Licence: Public Domain Mark

Credit: Clinical surgical diagnosis for students and practitioners / by F. de Quervain ; translated from the 4th ed. by J. Snowman. Source: Wellcome Collection.

Provider: This material has been provided by the Augustus C. Long Health Sciences Library at Columbia University and Columbia University Libraries/Information Services, through the Medical Heritage Library. The original may be consulted at the the Augustus C. Long Health Sciences Library at Columbia University and Columbia University.

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    which are spread over months or years, are often in the case of abscesses crowded into a few weeks. But there are many exceptions. Abscesses which are not very acute may remain unnoticed for months or even a whole year, if they have developed a firm limiting membrane. Even in these chronic cases the whole course of the disease differs from that in tumour. The development of an abscess is more irregular than that of a tumour, as indicated by periods when the whole con- dition becomes worse and is complicated by a rise of temperature. We have hardly yet referred to the latter, although, a priori, one would expect that the temperature would differentiate an abscess from a tumour. But this is not by any means the rule. In some abscesses there is no rise of temperature at all, or it comes at the very end, when it is too late for professional assistance. On the other hand, there may be an irregular temperature, even as high as ioo'5° F., in cases of cerebral tumour, and naturally also in cases of solitary tubercles. A rise in temperature can only be regarded as an aid in the diagnosis of an abscess in the exceptional cases wherein it possesses the definite character of a suppuration pyrexia—i.e., morning remissions with regular evening rises, or if the aggravation of the brain symptoms is accompanied by very high fever. In both these cases we should conclude that the fever points not only to an abscess, but also to its extension. The value of a congested disc for differential diagnosis consists in its pointing to a tumour rather than an abscess. Pain on percnssing a limited area on the skull may be a further sign of abscess, but it is also present in tumours and tubercle, so we cannot ascribe to it any differentiating value. The chief factor in our diagnostic reflections must concern the etiology. An abscess of the brain always has a definite cause, in so far as there must be a portal of infection, which can generally be demonstrated clinically. A tumour, on the other hand, has no cause which we can ascertain, at any rate, when it is primary. We must, therefore, primarily search for the source of an infection. If there be an open wound in the skull, this is easv enough, but even here the abscess may supervene long after the wound has healed. Exceptionally, micro-organisms can make their way by metastasis to a contused area of the brain. On one occasion I saw multiple abscesses following contusion in an old bronchitic patient. These contained pure cultures of Frankel's pneumococci. But an abscess of the brain is more frequently the sequel of non-traumatic suppuration in the cranial bones, the principal example of which is chronic suppurative inflammation of the middle ear, especially when this has attacked the air spaces in the peh^ous
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