Volume 1

Green's Encyclopedia and dictionary of medicine and surgery / edited by J. W. Ballantyne.

Date:
1906-1909
Catalogue details

Licence: Attribution-NonCommercial 4.0 International (CC BY-NC 4.0)

Credit: Green's Encyclopedia and dictionary of medicine and surgery / edited by J. W. Ballantyne. 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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    organisms, and is met with in connection with local inflammation, the result of injury, septic osteitis of the cranial or facial bones, facial erysipelas or cellulitis, and, particularly, sup- purative otitis media. The micro-organisms usually reach the sinus by the infection spreading along thrombosed emissary veins from the septic focus outside the cranium to the intracranial sinuses. The most common sinus affected is the lateral sinus. This is usually the result of otitis media. The longitudinal sinus may be thrombosed from compound fractures of the skull or septic scalp wounds. The cavernous sinus is affected in cases where the nasal fossfu, mouth, or orV)it are the seat of inflanmiatory septic mischief. Owing to the invasion of micro-organisms a clot forms in the lumen of the sinus. This in turn is invaded by organisms, tends to break down and to be carried into the general blood- stream, giving rise to symptoms of pyiBmia, while infarcts in the lung, followed by pneu- monia or gangrene of the lung or metastatic abscesses in other parts of the body, may result. In the case of tlu'ombosis of the lateral sinus, basal meningitis and cerebellar abscess are frequent consequences. Sympt07ns.—In all cases of septic thrombosis of the inti'acranial sinuses the prominent symptoms are those of a pytemic character. Thus we meet with high fever with marked remissions, the temjjeratiu'e ranging from 103° to 106° F.,and dropping suddenly to 96° or 97° F. The pulse is rajjid and M'eak. Rigors are fre- (luent and severe, and are a very characteristic symptom. In addition to these symptoms we may have vomiting, sweating, headache, severe pain over the affected sinus, and, in addition, there may be evidences of lung mischief, metastatic abscess in joints or elsewhere, and other signs of septic infection. In the case of the cavernous sinus there is protrusion of the eyeballs and oedema of the lids, due to pressure on, or thrombosis of, the veins of the orbit, while pressTU-e on the nerves may give rise to ptosis or squinting. In the case of the lateral sinus there will usually be clear evidence of a previous otitis media followed by symptoms of mastoid disease, viz. a'dema and pain over the prominence. The internal jugular vein in the neck may, in the later stages, be palpably resistant and tender to pressiu-e, while the deeper glands situated in relation to the upper end of the sterno-mastoid muscle may be inflamed, and may suppurate. Treatment. — Early and energetic treatment is necessary, as otherwise the results of lateral sinus phlebitis are very sei'ious. The condition of the middle ear should be attended to. In case of mastoid disease thorough clearing out and drainage of the mastoid antrum and cells should in all cases be done, and the bone carefully chiselled away backwards till the sigmoid sinus is reached at a point | of an inch directly ])ehind the external auditory meatus. Pus will usually be found siuTounding the lateral sinus. This should Ijc w;ished away and the sinus examined. If it appear to be resist- ant, if the mastoid vein be blocked, and if on pricking the lateral sinus with a fine needle no blood come out, thrombosis is present, and the following opei'ation shoidd be done :— The internal jugular vein should be exposed in the upper part of the neck by an incision along the inner Ijorder of the sterno-mastoid muscle. The vein should be ligatured so as to prevent general infection by the septic contents of the lateral sinus being carried down the jugular vein towards the heart. The lateral sinus should then be opened, the contents washed or gently scraped out, and the wounds plugged with gauze. In the case of infective thrombosis of the longitudinal or cavernous sinuses the treatment is chiefly preventive, and consists in dealing with the cause of infection by the carefid cleansing of scalp wounds, the removal of pieces of dead bone in cases of compound fracture and necrosis, and by attending to ordinary surgical indications. Epilepsy As surgical interference has proved futile in cases of ordinary or idiopathic epilepsy, while its results in other forms of the disease are very encouraging, it is necessary to discuss shortly the varieties met with. Idiopathic epile])&y is distinguished by the attack coming on suddenly, with little or no warning, except, in many cases, the occurrence of a cry; the patient falls to the ground, loses consciousness, and is seized by general con- vulsions which last a few minutes. Foaming at the mouth and Ititing of the tongue are familiar symptoms. Deep unconsciousness follows the convulsive attack, and subsecpiently the patient passes into a deep sleep which often lasts several hours. In these, the common cases of epilepsy, surgical operation is useless, although temporary cessation of the fits has occasionally been noticed to follow trephining. Jacksonian UriLEPSY.—In this variety there is a conscious sensation of the commencement of the attack in some region of the body, e.g. the arm, leg, or face, and the convulsions, beginning in such a part, spread from it in a definite order up or down the body. The patient does not, as a rule, lose consciousness, though he may do so if the convulsions eventually become general. This foi'm of epilepsy, as shown by Hughlings .lackson, is due to organic disease attecting