Sometimes the abscess under the bone is of a chronic nature, as in
the following case:—The patient, a boy, æt. 11, received a blow on
the vertex, after which a puffy tumour formed in the injured scalp,
and was freely incised. He afterwards became subject to epileptic
fits, which were relieved by copious evacuation of matter from the
wound. Exfoliation of the cranium occurred; one small sequestrum
was separated, which involved the whole thickness of the bone, and
a collection of matter between the dura mater and skull-cap was
thereby exposed. The contained matter was evacuated, and the wound was
carefully dressed, with the view of procuring adhesion between the
membrane and bone, but without effect. The dura mater was ascertained
to be extensively detached around the opening; it was found necessary
to remove a large portion of bone by means of the trephine and cutting
pliers, and then the dura mater soon became united with the integuments
of the head. Many months afterwards, the patient complained of severe
pain in the back of the neck; an abscess formed in that situation, and,
pointing under the right scapula, was opened. Weakness of the right
arm and of the inferior extremity suddenly supervened, and the patient
gradually sunk. On examination after death, the cervical portion of the
spinal chord was found much softened, with infiltration of purulent
matter into its substance. The deficiency in the cranium was supplied
by a ligamentous expansion, to which the dura mater and scalp adhered
intimately.
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