Volume 1

Applied anatomy : surgical, medical and operative / by John M'Lachlan.

  • M'Lachlan, John
Date:
1889
Catalogue details

Licence: Public Domain Mark

Credit: Applied anatomy : surgical, medical and operative / by John M'Lachlan. Source: Wellcome Collection.

Provider: This material has been provided by The University of Leeds Library. The original may be consulted at The University of Leeds Library.

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    car disease; there will also prolaably be douhle optic neuritis, with an absence of bone conduction as tested by the tuning fork applied to the forehead or teeth (M'Eride). This last fact would seem to show that the nerve of hearing is destroyed by the suppurative ]irocess having spread to the labyrinth, and thence, through the internal auditory meatus, to the cerebelhim; one would also expect some signs of irritation or paralysis of the facial nerve. ^^lastoid tenderness points rather to cerebellar abscess. In the cerebrum one must chiefly trust, for purposes of diagnosis, to the slow pulse and low temperature, history of previous ear disease, together with signs of pressure on the cavernous sinus and parts near it, especially on the third nerve and venous canal, as well as the l>robable existence of unilateral optic neuritis—or it may be bilateral; also paralysis of tlie third nerve, oedema of the retina, circumorbital congestion and exophthalmos. One would also expect some interfer- ence with hearing, smell, or taste, according as the first, second, or third temporo-spheuoidal convolution is the seat of the abscess. In abscess of the brain the prognosis is so grave, wlien left alone, that the general rule is— When in doubt trephine. The only question is where. In a case of Professor Greenfield's, suc- cessfully operated upon by Dr CAinn, Professor Chiene advised the opening to be made in the skull near the tip of the temporo- sphenoidal lobe, in the region of the pterion, from the belief that the pus would tend to gravitate downwards and forwards, and also from the fact that there were signs of pressure on the cavernous sinus; the result fidly confirmed the correctness of his conclusions. In another case of abscess of the temporo-sphenoidal lobe, success- fully operated upon by INTr Barker, the trephine was entered an inch and a quarter behind, and the same distance above, Keiii'« base line. Dr M'Bbide thinks that the trepliine should be entered so as just to expose the roof of the tympanum, and for this purpose proposes that a curved incision should be made over the ear, the auricle dissected downwards, and the trephine entered just above and in front of the external osseous meatus. This incision is advised, both for the purposes of drainage, and also to attack the abscess as near as possible to its source. In order to reach the cerebellum, Mr Hulke perforated the occipital bone about tlxree quarters of an inch behind and inwards