ABSCESS AND TUMOUR OF THE BRAIN.
When the first edition of this book was pub lished, abscess and tumour of the brain were barely mentioned, because the detection of them during life was a matter of very great difficulty, and their treatment was an impossibility. But, in the interval since then, so great have been the strides made in medicine and surgery that in a large number of cases not only the presence of an abscess or tumour can be settled with certainty, during the patient's life, but very often its exact location can be stated, and, if undertaken in time, an operation can be done in the majority of cases, and with a large measure of success.
It is of the utmost importance, therefore, that the most skilled opinion available should be obtained in any case of head symptoms, and that no time should be put off. Many lives are lost that could be saved, were the surgeon permitted to operate while the patient still retained some measure of strength and vigour. The word "tumour" includes "abscess". All abscess, that is to say, is only a variety of tumour; but it is of so special a kind of tumour as to merit a paragraph to itself.
Abscess is a tumour consisting of a sac con taining purulent fluid, that is, pus or matter. There are other kinds of tumour consisting of a sac containing fluid, blood, for instance, or clear watery fluid, and these are called cysts ; and there is a great variety of tumours which consist of solid materiab tubercular,for instance, or cancerous, fatty or bony. But the feature of an abscess is that its contents are " matter " or pus. Now, in accordance with modern views of suppuration, the process by which matter is produced, wherever it occurs, it is due to the operation of living organisms, such as have been described iu Section XXIV. Au abscess in the brain, therefore, is always the result of the activity of the pus-producing organism. In a few cases the organism may reach the brain in the blood stream. This has been known to occur in typhoid fever. But in the great ma jority of cases the organism gains admission by a Wound, as in fracture,•or, and this is the most common way, from the ear, or nose, or Orbit. The suppurative process is then set up
and the abscess slowly or rapidly forms. There are, therefore, certain situations in the brain where abscess is commoner than in others, situ ations related to the place from which the organism enters. In the case of the ear, only a thin plate of bone separates the middle ear from that part of the brain lying over it, the region to Which T points in the upper part of Plate XI, and this is one of the commonest seats of abscess, the infection reaching the brain from the middle ear. Another common seat is a little farther back in the region to which, on the same plate, L r points.
Symptoms in such cases need not be minutely discussed. They are headache, some change in the mental state of the patient, irritability, dulness, stupidity, au irregular temperature, a very slow pulse. Tapping the head with the point of the finger may elicit tenderness over the place where the abscess is. But besides these there are usually certain special symptoms which may not b• obvious to anyone who does not carefully look for them. Thus there may be weakness or paralysis of some muscles of the face ; the eye on the affected side may be wholly or partially blind, the pupils of the eyes may be unequal in size, that on the affected side being usually widely dilated. There may, later, be a staggering gait, and finally stupor comes on. Tho fact of cardinal importance in a case of such symptoms is that the patient has had for years a suppurating ear.
Treatment.—Surgical proedure to open the brain and get at the matter is demanded in these cases, and the sooner the grave nature of the case is realized, and the operation done, the better. Nothing else is of the slightest use. If a surgeon is not available to do this, all that can be done is to make sure of the condition of the head as to wounds or injuries, the state of the ears, nose, &c., and, where any suspicion regarding the ear exists, to bathe or syringe with antiseptic solutions.