DOI: 10.7925/drs1.ucdlib_280674
title: Effusion of lymph between the petrous portion of the temporal bone and the dura mater

description: Watercolour medical illustration depicting effusion. It has the alternative reference number 1101, P15A and 13 on the front. There is no Richmond Hospital Museum reference. The artist's name is in the bottom right corner 'J. Connolly Del.t' and in the left corner 'J.s Kirwan Aet 8yrs'. Includes stamp of Turnbull London papermakers in bottom right corner. The typescript and handwritten notes on the back begin 'Caries of Temporal Bone. 2. Effusion of Lymph between the petrous Portion of the temporal Bone and the Dura Mater; Purulent Effusion on Cerebellum'.
description: Scope and content: The full typescript and handwritten notes on the back read 'Caries of Temporal Bone. 2. Effusion of Lymph between the petrous Portion of the temporal Bone and the Dura Mater; Purulent Effusion on Cerebellum- Dr Hutton said he had to communicate a case of disease of the internal ear. He regretted that the specimen (which he had intended to present at a former meeting) had been somewhat spoiled by long keeping; but he had a drawing to exhibit, taken at the examination of the recent parts: this accurately represented the state of the membrane of the brain. The subject of the case was a boy, nine years of age, who for a long period had a discharge from the left ear. Ten days before his admission into the Richmond Hospital the discharge from the ear was almost completely suppressed; he vomited and had fever; got gradually worse, and was brought to the hospital. At his admission he had the head retracted; any effort to restore it to the natural position caused great pain; the muscles of the back of the neck were spasmodically affected; the general aspect was ghastly, the eyes straining, the teeth uncovered by the lips, and the whole body emancipated. He understood questions, and returned answers, but in a few hours afterwards fell into a state of coma, and died. In examining the body after death, the meatus externus of the affected ear was found filled with caseous matter; there was an opening in the membrana tympani, and at the insertion of the membrana there was a fungous growth; the mucous membrane lining the cavity of the tympanum was thickened and granular; it adhered firmly to the bones; the ossicula remained; the temporal bone itself was not carious nor softened, nor was its mastoid process at all diseased; the dura mater was separated from the petrous portion, and there was lymph effused between them; the dura mater was sloughly, and there was an aperture in it; the upper surface of the cerebellum was smeared with purulent matter; the inferior surface of the tentorium was similarly smeared; the brain was not softened; no communication could be traced between the cavity of the cranium and the internal ear. This case Dr Hutton considered as an instance of the consequences of suppressed otorrhoea. He alluded to Surgeon Wilde's paper on otorrhoea, in the Dublin Journal, with part of which he coincided, but he dissented from Mr Wilde's opinion, that such discharges may be suppressed with safety. Dr Hutton considers that they should not always be suppressed without previous preparation, and perhaps the substitution of some other discharge, even in cases where there is no evidence of disease of the bone. – 27th January, 1844'.
description: Numbering/sequence: Original reference number: 1101.