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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    tfiiTISH JOUR. OF 8URS. Oo IT) W UJ cD < a. •< CO CO CD X X Forty-two years have elapsed since Sir William Macewen1 wrote as follows in the preface to his classical book upon Pyogenic and Infective Disease of the Brain and Spinal Cord: “ Ten years ago a physician reported in The Lancet a case of an abscess of the brain discovered at post-mortem in one of the London hospitals and quoted the remark of an eminent surgeon who saw it, that an abscess of the brain was one of those cases which occurred but once in the course of a lifetime. An individual experience of the last ten years given in this volume and supported by numerous cases recorded by other surgeons, affords quite a different estimate. . . . Though not sharing the hopelessness of the opinion expressed in 1883 by a distinguished neurologist as to the inutility of operations on the brain undertaken for abscess, the author was then inclined to take a more sombre view of the prospects of recovery from such operations than his subsequent experience has proven to be necessary. He now regards an uncomplicated cerebral abscess, early recognized, accurately localized and promptly operated on as one of the most satis¬ factory of all intracranial lesions, the patient being at once relieved from a perilous condition and usually restored to sound health.” With this statement before us, it is interesting to note the general methods which Macewen employed in the treatment of brain abscesses, and the success with which they were attended. His usual technique was first to gain as much information as possible as to the exact location of the abscess, particularly as to where it most nearly approached the surface of the brain and skull. Next he made a rather large bony opening over the site of the abscess, after which the cavity was opened widely and thoroughly washed with a mild antiseptic solution. Finally he placed within the cavity, in order to give it free drainage, a decalcified chicken bone. A dressing was then applied and left in place, usually for several weeks. When the dressing was removed the wound was often completely healed. Using this technique, Macewen reported the results in a series of 26 abscesses situated within the brain substance. Two of the fatal cases (both cerebellar) were not operated upon by Macewen himself, but were presumably under the care of an assistant trained in his methods. Among the total 26 cases, irrespective of whether they were or were not operated upon, there were 8 deaths, a mortality of 30*7 per cent. If we take only the 24 patients under Macewen’s personal care, there were 6 deaths, or a mortality of 25 per cent. Of these, however, only 20 were operated upon, with 2 deaths, giving an operative mortality of 10 per cent. Since Macewen’s day, no one, so far as I can ascertain, has been able to duplicate his highly successful treatment of brain abscesses in a large series of cases. There are, perhaps, many reasons to account for this, but-by studying in detail the case reports which he gives, three factors seem to play the most * Amplification of a paper given at the joint meeting of the British and American Societies of Neurological Surgery, London, July, 1935-