Notes on a Case of Cerebral Suppuration Due to Otitis Media Diagnosed and Successfully Treated by Trephining and Drainage
Authors: A. E. Barker
Journal: BMJ (1888)

IF any example were required to illustrate the perils of inflamma- tion of the middle ear, and the need of the most careful study of them by physicians and surgeons, the following case would fur- nish it.It supplies, on the other hand, fresh evidence of the advance of operative surgery to the rescue of cases hitherto con- sidered altogether hopeless, and suggests the possibility of still further progress.Apart from its intrinsic interest, this case is of importance from the contrast it offers as to pathology and sym- ptoms with a case of abscess in the temporo-sphenoidal lobe published by myself in conjunction with Dr. Gowers in the Jorn- NAL of December 11th, 1886, in which trephining and drainage were also followed by complete recovery.If the present case was, as I belieave, primarily one of fairly localised meningitis, the difference of its symptoms from those of the first case are easily explained.A. G., aged 33, an engineer, was admitted into University Col- lege Hospital on January 21st, 1888, under the care of Mr. Ileath, who, knowing my interest in such cases, kindly transferred him to my care.The patient's family history was excellent.When 7 years old he had scarlatinal otitis media, which soon hiealed, but the right ear has discharged more than once since, and before the last attack.Up to the age of 21 lie enjoyed good health.At that time he suffered from some epileptiform seizures, and was treated for them for a few days in Uiiv ersity College Ilospital.At 24 he states that he was under treatmCent ior gastric ulcer in an infirm- ary.At 29 lie had a bad fall, and injured his spine, after which his right arm and leg were more or less paralysed for eighteen months, witlh partial anvesthesia.For this he was treated by Dr. Beevor at the Queen Square Hospital, and recovered completely.InMay, 1886, lie contracted gonorrhea, and was an in-patient at University College h1o8pital for prostatic abscess.At this time he began to complain of weakness, and a sensation of coldness in the .rightleg, which he dragged in walking.The left leg was strong; ankle-clonus was well mark-ed on the right and absent on the left.Knee-jerk was exaggerated on the right and well marked on the left.There was some localised annsthesia on the dorsum of the right foot; tdche cerebrale was well marked.On August 25th, 1886, the patient came under the care of Dr. Gowers, whose notes record exaggerated knee-jerk on both sides, with ankle-clonus on the right but not on the left; also tremors in the right upper limb on movement, but only slight in the left.Slight nystagmus on movement was doubtful The pupils were dilated, and reacted sluggishly to lighlt, but well to accommoda- tion.There was tenderness from the fifth to the eightlh dorsal spines, but no prominence.Dr. Gowers's diagnosis was lateral sclerosis, and under his treatment for this the various nervous synm- ptoms mentioned disappeared one by one; but, on December 4th, 1886, neuralgic attacks in the right side of the face were noted.After March, 1887, hie ceased attendance, and appeared, from his own account, to have been quite well until the present illness.The latter began on December 5tli, 1887, witb a purulent discharge from the nrght ear, for whichl hl became an out-patient under 3Mr.Bilton 'ollard.The rirrht mem brana tympani slhowed a large perforation an eighth Of an inch across in the anterior segment, and from this the dischargE escaped freely.The treatment consisted in thoroughly mopping out the latter, and dressing the inflamed surfaces lig,htly with iodoform powder.