Brain Abscess

Abstract

Newburgh and Marsh, have been used since 1918. The aim is to furnish a diet containing a sufficient number of calories to maintain the individual following his usual occupation at approximately 10 per cent less than the standard weight for age, sex and height. We consider the diet as maintenance only when the weight is maintained at the desired level with the patient performing his usual work and activity. In review¬ ing 1,520 cases treated over a period of seven years, I found that the average caloric value of the diet necessary for main¬ tenance was 2,500 calories. It may be possible to maintain an individual's weight on a diet lower in calories, but in order to do so the activity must be diminished ; and Dr. Bowen has pointed out in his cases that "when the occupations were com¬ pared, it was found that all except two of those who felt no fatigue had sedentary occupations." I take it that this group maintained their weight. The diet as a source of energy must therefore fulfil two requirements to maintain the desired weight and to maintain strength to perform the usual activity. On the other hand, if the patient is overweight, the caloric intake is limited and the patient must use his body fat as a source of energy until a desired weight level is reached. The carbohydrate content of our diets averages 65 Gm. The aver¬ age, amount of fat used is 220 Gm. and the protein averages 60 Gm. The available dextrose content of these diets averages 125 Gm. and the fatty acid dextrose ratio is 2.0. Dr. Bowen has pointed out that many of his patients who became fatigued easily experienced insulin reactions during exercise and that a disturbance of mental acuity occurred frequently during these reactions. May there not have been a certain number who had the sense of fatigability and a disturbance of mental activity due to a hypoglycemia, the result, of too much insulin, which was not severe enough to manifest definite clinical symptoms? In our series of 1,520 cases, insulin was used in only 361, or 23.7 per cent. Forty per cent of the patients had a tolerance not above 125 Gm. of dextrose and yet were able to take a maintenance diet without the aid of insulin. Had these 40 per cent been given a maintenance diet with a higher carbohydrate content, they would all have required insulin. dealt with the subject of the economic status of diabetic patients and refers especially to the benefit derived from insulin. I will report a case in which insulin almost proved fatal. The patient was a young man, a real estate agent, with a moderately severe diabetes. He had been under the treatment of some good clinicians who had prescribed a definite diet and insulin. He progressed well until he began to have convulsions early every evening. The attending physician called a neurologist in con¬ sultation. They decided that the young man was having epi¬ leptic seizures. He had to give up his occupation. It was dangerous for him to drive his car. They asked me to see him. I told him it was no use to see him until he had one of his seizures. One ...

The Otogenic Cerebellar Abscess, with Special Reference to the Posterior Fossa Cerebrospinal Fluid Syndrome

“…Both of these recovered. Out of twenty-eight cases of brain abscess three were cerebellar, and of these two recovered (Coleman, 1930). Kolomiitchenko (1936) records twelve cases of cerebellar abscess out of thirty-one otogenic brain abscesses in seven years to 1934 at Kiev.…”