Three cases of cranial surgery ... / by William H. Morrison.

  • Morrison, W. H. (William H.)
Date:
1892
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Licence: Public Domain Mark

Credit: Three cases of cranial surgery ... / by William H. Morrison. Source: Wellcome Collection.

Provider: This material has been provided by The Royal College of Surgeons of England. The original may be consulted at The Royal College of Surgeons of England.

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    port. The arm movements are increasing in force. The drainage-tube open- ing has closed, but there is a distinct depression of the scalp at the seat of the abscess. The mental condition is normal, but she is easily excited. From this time she steadily improved and gained in strength, and has now practically returned to her normal condition. A study of this case offers several interesting and instructive les- sons. In the first place, it forcibly illustrates the danger of delay. The trephine should have been applied at once, for although there was no fracture of the external plate, but simply an incision extend- ing through it to the diploe, yet the character of the wound rendered it almost certain that the internal plate had been fractured. I recog- nized the advisability of immediate trephining, and have to offer in palliation for the sin of omission ouly the facts before stated. The absence of symptoms, although not unusual, is of interest. Dr-. Chas. B. Nancrede,1 in a paper on “ Surgical Interference in Cerebral Abscess,” in speaking of this condition, says: “ Mental hebetude, slow pulse, headache, perhaps rigor, subnormal tempera- ture, constipation, and at the end sudden development of the com- pression symptoms, as evidenced by profound coma, hemiplegia, respiratory failure’and death, seemed to have in all cases marked the occurrence of brain abscess.” In this case, prior to the appearances of the signs of compression of motor areas, there was an absence of all the symptoms noted above with the exception of the pain and the non-elevation of temperature. I regret that the exact temperature was not recorded ; it is simply noted that the temperature was not above normal. Dr. Nancrede, in the article referred to, lays stress upon subnormal or normal temperature as a diagnostic feature of abscess involving the cerebral tissue, saying that “ where high tem- perature is noted, either the pus collection is a localized suppurative arachnitis or there is meningitis in addition to the abscess.” The position to which the pain was referred corresponded very closely with the situation of the abscess, although Dr. Spitzka2 states that “ the pain is sometimes localized, but the subjective localization does not correspond to the actual site of the morbid focus.” The abscess in this case was situated just anterior to the middle of the ascending frontal convolution, and, as would naturally be supposed, the chief brunt of the pressure fell upon the centers for the upper extremity, while those for the leg and those for the face were not so seriously implicated. The muscles of the face, tongue, 1 Transactions American Surgical Association, 18S4, vol. ii. p. 94. 2 Pepper’s System of Medicine, vol. v, p. 795.