Brain abcess / by Gilbert Horrax.

  • Gilbert Horrax
Date:
[1938?]
Catalogue details

Licence: In copyright

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

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    mortality rates) only chronic encapsulated abscesses were dealt with, while in others all varieties, such as metastatic, multiple, and acute abscesses, were include . is because of this frequent lack of classification that comparisons are not always possible, but even with chronic encapsulated abscesses mortality statistics during the past ten years have been reported as high as 30 to 40 per cent from some of the leading neurosurgical clinics in America and in Europe. The purpose of this paper is to review a series of 30 cases seen during e years 1926 to 1935/ with special reference to their grouping and remarks concerning the methods of treatment. All of these patients had true intracerebral or mtra- cerebellar abscesses. Any instances of extradural or subdural collections of pus sometimes included in the general term of ‘ brain abscess 5 have been eliminate . In order that a clear idea may be had of the type of brain abscess under discussion and thus, if profitable, to compare the methods of treatment here advocated wit_ those, for instance, which were alluded to in Macewen’s series, we must separate the 30 cases of our own into two entirely distinct groups. Qroup /.—acute AND MULTIPLE (OFTEN METASTATIC) ABSCESSES USUALLY HAVING SERIOUS PULMONARY OR SYSTEMIC COMPLICATIONS The first group may be dismissed briefly, because, in reviewing the case histories, it is extremely doubtful whether any of them should have been regarded as surgical problems and subjected to an intracranial operation, even of a palliative variety. Such procedures as were carried out were for the most part simple tappings, done with the vain hope that if intracranial pressure was relieved the patient might be able to overcome the accompanying serious systemic condition. In no instance was this hope fulfilled. Of the patients 12 came within this category, and of this number 10 were operated upon. Six patients had metastatic abscesses with complications such as bronchiectasis, lung abscess, empyema, etc. The other 6 had local complications in the form of meningitis or spreading encephalitis or the abscess had already ruptured into the ventricle. . No case in Group I survived either with or without operation, and it is my impression that little can ever be expected in the treatment of such seriously compli¬ cated conditions, except perhaps in an extremely occasional instance. CASE REPORTS One or two brief case histories will suffice to illustrate the conditions obtaining in this group. . , _ , , Case 1—B. M. G. (P.B.B.H. Surgical No. 36455), a 12-year-old girl, was referred by Dr. S. S. Martin, of Windsor, Vt., on May 12, 1930. , j History.—She had had an empyema of the right chest drained seven weeks previously. Four weeks later she began having headaches and vomiting, and rapidly developed a left *This series comprises cases seen and treated during the period mentioned. A large number of them were operated upon by the author in the Clinic of Harvey Cushing at the Peter Bent Brigham Hospital, and to him the author wishes to make grateful acknowledgment. The other patients were operated upon by the author at the New England Deaconess and the New England Baptist Hospitals, the Children’s Hospital, Boston, and the Rhode Island General
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