Brain abcess : clinical and operative data / Charles Bagley.

  • Bagley, Charles, 1882-
Date:
1923
Catalogue details

Licence: In copyright

Credit: Brain abcess : clinical and operative data / Charles Bagley. Source: Wellcome Collection.

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    Gravity is a most important aid in drainage of abscesses, and should always be considered in the placing of drains. The inability to drain frontal lobe abscesses from the bottom constitutes one of the chief obstacles in the management of this type. This dif¬ ficulty was forcibly brought to our attention in one of our fatal cases. Figure 4, reproduced from a roentgenogram of E. M., who had a large left temporal lobe abscess, shows a rubber tube drain placed through the floor of the middle fossa into the bottom of the abscess. This point was selected for drainage because the metallic foreign body producing the abscess had entered through the malar bone, and the proximal part of the original tract was used for drainage. Recovery fol¬ lowed this procedure. G. S. S. had a left temporal lobe abscess of three and one-half weeks’ duration. The left mastoid also was involved, and during the mastoid operation, which preceded the abscess drainage by four days, the otologist, Dr. M. L. Breitstein, noted that the dura was exposed above. With this knowledge, and the open mastoid wound, drainage of the left temporal lobe abscess through the original incision was simple. As this abscess was due to a Streptococcus hemolyticus, thorough drainage with very little operative trauma was essential. The photograph reproduced as Figure 5 was made three and one-half months after the opera¬ tion, and there was practically no drainage of pus, although the small protective drains were still in position. The after-care of the patient is very much more important than the operation, and all the dressings during the period of free drainage should be done by one person, that there may be no division of respon¬ sibility in having the drains remain in position. It may be necessary to continue drainage for three or four months after the operation, but the course is otherwise simple and there is little risk of having the infection light up after an apparent cure. This method of drainage is not useful in cortical abscesses occurring at the site of smashing skull injuries, when liberal drainage is usually demanded. It has been shown that the protective reaction in cases of this type establishes a firm fibrous tissue barrier;