Brain abcess / by Gilbert Horrax.

  • Horrax, Gilbert, 1887-1957.
Date:
[1938?]
Catalogue details

Licence: In copyright

Credit: Brain abcess / by Gilbert Horrax. Source: Wellcome Collection.

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    well as the efficacy of the method of marsupialization. Certain comments, however, should be made concerning simple tapping and radical extirpation of a brain abscess. Table II.—Chronic Encapsulated Brain Abscesses : Methods of Treatment and End-results in 18 Cases Case No. Sex Age Method of Treatment Location End-results, with Time Since Operation Disability, if any i. D. D. Male 7 Marsupialization Right motor area Improved, 2 yr. Some weakness of left arm and left leg 2. M. D. Female 12 Marsupialization T emporo-parietal Improved, 4^ yr. Some weakness of left side. Convul¬ sions, 1 yr. 3. L. H. Female 15 Marsupialization Left frontal Improved, 9 yr. Convulsions 4. R. H. Male 10 Marsupialization Left frontal Well, 3i yr. None 5. H. A. B. Male 35 Marsupialization Right frontal Died 6. A. F. F. Male 14 Marsupialization Left frontal Well, 4 yr. None 7. A. M. M. Female 12 Marsupialization Left temporal Well, 10 mth. None 8. M. P. Female 10 Marsupialization Left frontal Well, 1 yr. None 9. A. S. Female 5 Marsupialization Right frontal Well, 1 yr. Very slight weakness of left arm 10. G. E. K. Male 6 Repeated tapping Left frontal Well, 2 yr. Some reduction in vision from second¬ ary optic atrophy 11. J. A. Male 40 Repeated tapping Right parietal Well, 1 yr. None 12. B. O. Male 10 Repeated tapping Left frontal Well, 1 yr. 10 mth. None 13. P. R. Female 14 Single tap Left cerebellar Well, 3 yr. None 14. M. M. W. Male 28 Extirpation Left frontal Well, 2 yr. 3 mth. None 15. J. T. C. Male 26 Extirpation Right temporal Well, 5 mth. Died from other cause 16. F. J. Male 4 Extirpation Right parietal Well, 5 yr. None 17. T. J. O’D. Male 50 Rubber tissue drainage Right temporal Died 18. E. R. P. Male 17 Negative cerebral tap Left frontal Died From a glance at the table it will be noted that all four patients who were treated only by single or repeated tappings recovered and were well from one to three years subsequently. This does not tell the whole story, however, since three of the patien who eventually came to marsupialization received one or more taps, and did so 1 ily by this method that there is no doubt they would have died unless the more radical procedure had been carried out. In this case the mortality from tapping only would have been 43 per cent instead of zero. On the other hand, I am inclined to agree in certain particulars with Dandy, who has so forcefully advocated this method, when he says that in general one should do as little as seems necessary in the presence of a single encapsulated abscess. It is possible that tapping should always be tried first, but I feel that it is potentially dangerous for two reasons. In the first place, other foci of infection may be started along the track of the needle as it is withdrawn; and in the second place, even after an abscess has been tapped it may refill so rapidly as to cause sudden increased intra¬ cranial pressure and even death before proper measures can be instituted. Further¬ more, King13 (1936) included a significant statement in an excellent article dealing with the subject in hand. He says : “ Recently I saw sections of three brains o cc ZD CO 60 cQ k> hi (3 Ct ZD O 3E - ^ CD OO CT> £2 i- is * ^