Although brain abscess may remain latent for a long time, anfi al though it tnay rarely undergo absorption or rupture on the exterior of the brain, the prognosis is distinctly unfavorable. In any ease of brain abscess the possibility of rupture, either spontaneous or from traumatism, followed by sudden death must be borne in mind.
For all that in many eases the diagnosis of brain abscess may mean the patient's salvation because it offers the chance of a successful operation, whereas in cases of meningitis or brain tumor the chances for successful operation are much fewer. We must not omit to em phasize the importance of prophylaxis in brain abscess, which consists in the careful treatment of all suppurative wounds of the head and aural affections. The results of the many operations on brain abscess which have been performed in recent times are not altogether unfavor able. (Oppenheim computes 39 recoveries out of 53 cases of traumatic abscess, Korner 51 out of 92 cases of otitic abscesses.) Even infants am! very small children may recover (Holt had 5 successful cases with operation). Without going into the technic of the operation it may
be stated that the tendency nowadays is toward free opening of the skull and, if the abscess does not at once come into view, fearless exploration of the suspected portions of the brain with a needle. The favorable prospects of operation are unfortunately marred by the fact that abscesses are prone to be multiple so that, after a large abscess has been evacuated, death may ensue from a second purulent focus, the existence of which had not been suspected. Evacuation of the abscess without thorough treatment directed against the primary trouble is of course of no more value than any other symptomatic treat ment. If no operation is performed, the patient is very likely to die sooner or later from the effects of the abscess; hence, if the diagnosis is half way positive, operation should be attempted in spite of the uncertainty of its results.