Brain abcess / by Gilbert Horrax.

  • Gilbert Horrax
Date:
[1938?]
Catalogue details

Licence: In copyright

Credit: Brain abcess / by Gilbert Horrax. Source: Wellcome Collection.

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    important roles. In the first place, practically all of Macewen’s patients had chronic, encapsulated, single abscesses which had been present, as a rule, from two to three weeks up to a matter of six months or longer.* In the second place, he used every means available at that time to drain the abscess where it most nearly approached the surface. Lastly, he made a fairly large bony opening an held the abscess cavity widely open with his decalcified chicken bone. Gradually, during the past ten years especially, neurosurgeons and otologists have re-emphasized many of these principles as more concentrated thought has been directed toward the subject. Thus Eagleton2 has written extensively on t e pathways by which infection extends from the otitic process into the brain, and McKenzie3 has called attention to the importance of opening the abscess at its nearest approach to the surface. Grant4 demonstrated the great advantage in holding off operation, if possible, until capsulation had taken place, while CahilP and King6 particularly have stressed repeatedly the favourable results of wide open drainage. For this purpose Cahill and recently Kaplan7 have advocated the use of the Mosher wire drain, but it is probably the general principle rather than the particular form of drain which is most important. To my mind the method of treatment described by King is ideal in cases to which it is applicable^ It is similar in its essential aspects to the technique called “ marsupialization ” by Cushing and used by him for many years. This technique I described briefly in 1934,8 and it will be referred to subsequently. In a recent paper Adson and Craig have likewise advocated a somewhat similar method, using two catheters and gauze packing in order to hold the cavity widely open and thus to prevent ‘ pocketing \ In 1934 Cairns10 discussed various aspects of the treatment of brain abscesses, showing that no single method could be utilized in all cases. He wisely empha¬ sized the importance not only of applying correctly whatever method seemed indicated, but of giving the patient the advantage of extremely careful after-treat¬ ment. In contrast to these methods of opening the abscess widely, occasional successes have been obtained by single or repeated tappings of a brain abscess, as described by Dandy.11 This procedure undoubtedly has its place in the treat¬ ment of deep-seated abscesses or those which contain sterile pus. It is likewise helpful in unencapsulated abscesses as a means of lowering intracranial pressure in the hope that the abscess may become encapsulated, after which it can be dealt with in the more usual way. This, likewise, was a principle taught and used by Dr. Cushing, but in my opinion it should never replace marsupialization or similar open methods in superficial encapsulated abscesses. A third procedure sometimes used for the eradication of a brain abscess is total extirpation. Operations of this type have met with success at times, as in three instances here recorded, but there are obvious drawbacks and dangers to such an undertaking. Irrespective of the surgical methods employed, however, it must be admitted that the present mortality reports for brain abscesses are discouragingly high, ranging from 22 per cent up to 56 per cent. This very considerable discrepancy can doubtless be explained not only by the types of procedure used for drainage, but more readily perhaps by the fact that in some papers (those with the lower * This seems to contradict the statement made by Macewen and quoted at the beginning of this article concerning the early recognition of an abscess. However, for those days the early diagnosis of a brain abscess may have meant within several weeks or even months ol its