Remarks on Myalgia: With Cases
BMJ (Clinical Research Edition)
by trephininig it was found. In all these cases, however, there w-as the local inj'ury as a guide in the operation, and it is only in the very rare instances, where there is no distinct spot injure(l, no scalp-wound or fracture, that much hesitation need be felt on this point. The course of the symptoms, the time at which they occur, and the precedence of rigors and other indications of suippuration, sufficiently distinguish between efftisions of pus and those of blood or serurn, and a fortiori
... urn, and a fortiori do the symptoms difler widely from those of morbid growths. But if tlle surgeon will be seldom disappointed in his primary object-the discovery of matter-this series stupplies a very intelligible reason why his ultimate end is so rarely attained in the preservation of the patient's life. That out of seven successive cases, six should present unmistakeable evidence of pytinia in other parts of the body, and of phlebitis in the bones and sinuses of the skull, can hardly be considered an accidental circumstance, and will, I fear, go far to show that Mr. Duumville's opinion, as to the relative frequency of limited and difused suppuration, is not borne out by pathological investigation. I would willingly believe, however, that this may not be so in other parts of the country, where pyremia, that bane of all operative surgery in our London hospitals, is less rife; and I would appeal to the experience of our country hospitals to correct, if possible, this conclusion. But it may be said, were these eight cases properly selected for the operation? Were no limited abscesses found after death, in cases which had not been operated on, either above the dura mater, amongst the membranes of the brain, or even in the braini itself? To answer these questions, I refer again to ouir post mortemt books; and here I find seventeen other cases, besides the severi wlhich I have detailed above, in wlhich a post mortent examination showed the precise condlition of the parts. II. Eigbht of these belong to our second class, in which matter* wvas found between the bone and dura mater after death, the skull nlot having been trephined. CASE I. In one (vol. viii, p. 211), the injury wvas a scalp wound not exposing the bone. The bone was infiltrated with pus; besides the pus between the bone and dura rmater, the tissue of that miiembrane was inifiltrated with pus, and there was matter in still greater quantity in the arachnoid and subarachnoid spaces. The blood in the longitudinal sinus was also thought to conitain pus. This was in all probability a case of pynmia; but the other viscera were not examined. CASES II and iii. Two other cases followed scalp wounds, in which the bone had been exposed. In the first (vol. iv, p. 132), as the spine was fractured, no question of operating couldl have occurred. The mischief in the head followed an attack of diffuse inflammation. There was pus, both in the OCT. 16, 1858.] ORIGINAL COMMUNICATIONS.