It should not be forgotten, however, that brain-abscess occurs occasionally without any apparent focal symptoms at all, and sometimes, indeed, with very few general symptoms, the diagnosis being a post-mortem revelation.
Analysis of 169 cases, including 6 per sonal. Of this number, 98 were cases of abscess proper, and of these 40 were located in the temporal lobe and 31 in the cerebellum. Localizing symptoms were found, in a large proportion of cases, conspicuous by their a,bsence. As to subnormal temperature, in only- 2 eases of these 98 was the temperature below normal. The most constant altera tion of temperature was a moderate ele vation. Aphasia was present in only 6 of 40 eases, involving, the temporal lobe. many of them on the left side. Frank Allport (Jour. Amer. Med. Assoc., Oct. 22 to Dec. 24, '92).
Personal ease in which the patient had had no discharge from the ear, the only sign of disease of the mastoid process being dullness on percussion. The cerebral abscess had cansed neither somnolence nor fever, but there was a lowered inter nal temperature and a diminution of hearing on the opposite side from the abscess. On the eighth day incessant hiecough supervened. It was seen on trephining that even very slight packing of the cerebral wound produced the sante effect as the compression caused by the pus. The patient completely recovered. II. Etilenstein (Monat. f. Ohrenhcilkunde, No. 3, '95).
While in many cases an acute abscess of the brain may be diagnosed with some certainty, a chronic cerebral abscess may exist and yet give no positive indication of its presence. Too often the condition is only discovered by post-mortem exami nation. The diagnostic indications of a chronic abscess of the brain are few and untrustworthy. Of first importance among such indications is the presence of a sufficient cause, such as middle-ear disease, local injury, or caries of the cranial bones. Not that the exciting cause need be so grave as these; the abscess may follow any of the specific fevers, and, as these occur so very frequently without leaving any such sequelt-e, the connection may not be ree og,nized. The signs of a chronic cerebral abscess are few in number,—pyrexia, headache, and optic neuritis,—but none of these can be depended on; pyrexia is often completely absent, and, as Mimi points out, in many cases a subnormal temperature is present ; the headache, if localized and persistent, and occurring after one of the usual exciting causes, is suggestive, but nothing more; and optic neuritis may equally be a sign of a tumor or meningitis. Other symptoms
such as paralyses, though often of use in determining the situation of a lesion, are of no value in deciding as to its nattire. If we have in any case a suf ficient cause, and the signs already men tioned are well marked, we may be fairly confident that an abscess is present, but vt-e cannot be at all certain. Augusto Muni, (Lancet, Jan. 3, 12, 26; Fel). 2, '95).
Study of 32 cases, 13 of which were in children under one year of age, of these being under six months and 5 under three months; 3 occurred during the second year, and 5 each in the third, fourth, and sixth years, no case being included in which the patient was live years old or over.
Conclusions; In a large proportion of the cases only g,eneral symptoms are present, and these in very great variety. Focal symptoms may be misleading un less they are constant; and even then they may depend upon associated lesions, such as meningitis. Motor symptoms only can be trusted, since the sensory symptoms are diflieult or impossible to determine in infants or youn,t,t, ehildren.
T,. E. Dolt (Archives of Pediatrics, Afar., '98).
Report of 2 cases of abscess of the brain due to the pnemnococcus, and 7 cases from literature. The first per sonal case occurred some weeks after recovery from an attack of bronclio pnemnonia. Vertigo, transitory loss of consciousness, cramps and pain in the right arm, followed by contractures and involuntary movements were first noted. Within a few days there was complete right hemiplegia and rapid death from coma. At the autopsy slight hepatiza tiou of the lungs was found, but no bronchiectasis, suppuration, or gan grene. An abscess was found in the left parietal lobe, destroying part of the corona radiata, and extending immedi• ately under the meninges, which were inflamed and suppurating. The pus from the abscess contained a large num ber of Fraenkers diplococci, together with chains of streptococci. The second patient complained of joint pains, suf fered from delirium, and died within a few days of the onset of illness. Hepa tization was found also at the bases of both lungs. A small abscess was found in the corona, radiata of the left hemi sphere under the lower part of the as cending parietal convolution, the pus of which, as well as the meningeal exudate, contained Framikel's diplocoecus, to gether with staphylococci and strepto cocci. In only one of the 9 cases recorded was the pneumoeoccus the only organism found. Boinet (Rev. de Feb. 10, 1901).