Canale D J
Department of Neurosurgery, University of Tennessee, Memphis, USA.
J Neurosurg. 1996 Jan;84(1):133-42. doi: 10.3171/jns.1996.84.1.0133.
The year 1993 marked the centennial of the publication of Sir William Macewen's monograph, Pyogenic Infective Diseases of the Brain and Spinal Cord, and its accompanying volume, Atlas of Head Sections. As Harvey Cushing noted, the text on pyogenic diseases of the brain was a landmark in surgery of the nervous system. At the time of its publication, Macewen's work was the most comprehensive study of pyogenic brain diseases. In this paper the author reviews the state of knowledge of brain abscess existing in the 19th and 20th centuries, with particular emphasis on the late 19th century, and elucidates factors contributing to Macewen's remarkable success. His thorough knowledge of the natural history of pyogenic diseases of the temporal bone and nasal sinuses, in addition to his clear description of cranial anatomy, as illustrated in his Atlas of Head Sections, were especially important in developing his successful treatment of brain abscess. The x-ray had not yet been discovered; Macewen's diagnosis was based on clinical findings superbly illustrated by his three clinical stages of brain abscess development. His clinical observations are as relevant today as when he described them 100 years ago. Macewen recorded 25 cases of brain abscess. Nineteen of these patients came to his attention in time to undergo surgery, resulting in 18 recoveries. All five of his patients with extradural abscess recovered. These results were achieved in the era known as "the most glorious period in British surgery." Neurosurgery was in its infancy; nevertheless, even as the 20th century closes, Macewen's results still have not been surpassed.
1993年是威廉·麦克斯韦恩爵士的专著《脑与脊髓的化脓性感染疾病》及其配套卷册《头部切片图谱》出版一百周年。正如哈维·库欣所指出的，关于脑部化脓性疾病的这篇文章是神经系统外科领域的一个里程碑。在其出版之时，麦克斯韦恩的著作是对化脓性脑部疾病最为全面的研究。在本文中，作者回顾了19世纪和20世纪有关脑脓肿的知识状况，尤其着重于19世纪后期，并阐明了促成麦克斯韦恩取得显著成功的因素。他对颞骨和鼻窦化脓性疾病自然史的透彻了解，以及他在《头部切片图谱》中对颅骨解剖结构的清晰描述，在其成功治疗脑脓肿的过程中尤为重要。当时X射线尚未被发现；麦克斯韦恩的诊断基于临床发现，他所描述的脑脓肿发展的三个临床阶段对此进行了极好的说明。他的临床观察在今天与他100年前描述它们时一样具有相关性。麦克斯韦恩记录了25例脑脓肿病例。其中19例患者及时引起了他的注意并接受了手术，18例康复。他所有5例硬膜外脓肿患者均康复。这些结果是在被称为“英国外科最辉煌时期”的时代取得的。神经外科当时尚处于起步阶段；然而，即使到了20世纪末，麦克斯韦恩的治疗效果仍然未被超越。
