On Suppuration within the Cranium after Injuries
Authors: T. Holmes
Journal: BMJ (1858)

but on June 12th, having been attacked with measles, he was removed upstairs to the fever ward.June 29th.He was readmitted.The swelling was now of about the same size as at the last report (June 12th).July 1st.The tumour was again punctured; but, owing to the toughness of the cyst and the bluntness of the trocar, little more than the end of the cannula was introduced into the interior of the tumour, and very little iodine could be injected.The fluid which came away was slightly tinged with blood, but much thinner than last time it was tapped.July 2nd.There was no bleeding.The cyst was collapsed, and contained more solid matter.July 17th.There was no further increase in size.The child was ordered to go home, and to be brought back again if the cyst enlarged.August (latter end).He was seen as an out-patient.No increase in size had occurred.The tumour was quite solid, consisting only of an enlarged gland, of about the size of a walnut.REMARKS.The above are instances of a disease which fre- quently proves very intractable, especially in adults, and which, from the situation, size, and coanexions of the tumour, may in such cases become one of the most formidable ailments which a surgeon can be called upon to treat.A very good illustration of this fact was furnished by the case of a young woman who was a patient at St. George's Hospital several years ago, with a large serous cyst (hydrocele) of the neck, and in whom the tumour resisted for n. than a year all the attempts made to produce its obliteration.Thus it was originally tapped and in- jected, as in the two cases here reported; then, as, after re- peated injections, it continued to fill again, a seton was intro- puced; and, on this measure failing, it was laid open from top to bottom, and the lining membrane destroyed, as far as possible, with nitric acid.The cyst was still, however, unde- stroyed, and was apparently reproduced by growth from below.Accordingly, it was again cut down upon, and an attempt was made to dissect it out entire.This, however, was found to be impossible, from the membrane dipping below the sheath of the carotid vessels.Accordingly, the wound was kept permanently open, and the cyst gradually contracted, and at length, it is believed, became perfectly obliterated.In such a case as this, it is evident that the cyst must have had some origin more deeply seated than the common areolar tissue, but whether it was connected with the thyroid body, or not, seemed uncertain.The origins which.are generally ascribed to such tumours, when they are not merely subcutaneous, are, that they are formed by dilatation of the cavities of the thyroid gland, or from cysts in connexion with the blood-vessels, either in vascular tumours or otherwise.(See Paget, Lectures on Surgical Pathology, vol.ii, p. 38.)In the two cases before us, it seemed most likely that the cysts had no such origin, and that the admixture of blood which the fluid contained was pro- duced merely by exudation from the lining membrane of an otherwise simple seroiis cyst.It will be noticed, however, that in Mr. Johnson's case, after an apparent obliteration of the cyst, it rapidly filled again during one night, probably from the effusion of blood into its cavity, so that here some communication with the cavity of a blood vessel is certainly possible.In Mr. Pres- cott Hewett's case, the rapid and entire obliteration of the cyst