edges together by means of silver-wire, leaving room over exposed brain for drainage. While in the act of remove ing the bone the pulse stopped for a little, but gradually returned after administering a little alcohol the
Anterior
Left
parietal c
v
^
Pari?tal*
3&INCHES T
posterior
or
~J-_ Sagittal
suture.
lower.
rough sketch
respresents the bone removed 2-\ x lg inches. A small part of the right parietal is suture seen to the right. The spot bone with the sagittal The above
marked A. had been clean cut through by the edge of the axe, the bone being perfectly smooth there and rough every where else. Ordered cold water to be kept continually dropping on the lint over the wound, soup to be given every two hours, and a couple of drachms of rum three or four times a day, also chloral at night if necessary. Evening temperature 99'2?. 6th-.?Morning temperature 102?, evening 99-4?. Did not remove dressing, but continued pouring cold water over it. 1th.?Removed dressing on which there was a good deal of pus. A little serum was oozing from the wound. Dressed with carbolic oil, but in the evening changed it for the cold water as there was pain and smarting. Sth.?Morning temperature 99? ; evening 100"4o. 1 Oth.?Morning temperature 1)9-2?; evening temperature 100?. Pulse cannot be felt at wrist to-day, but is fairly good at arm. Patient is cheerful ; has no pain; slept well ; tongue clean ; bowels moved. Wound looking well, oozing of serum stopped. Dressed with carbolic oil. 12th.?Morning temperature 98-2? ; evening temperature 98,2?. Stitches have cut through and the wound is gaping: put Pulsation of brain in four silver wire sutures : pulse good. can be still seen through aperture. has been normal since 21 st.?Doing well. Temperature 13th; pulse good. There is still aslight opening through which the brain can be seen pulsating. Removed sutures and allowed patient to sit up for a little. 10th January.?Wound perfectly healed and woman quite, well. A considerable amount of pressure can be borne without uneasiness over the part, nor does the sun affect the patient in any way. _
CASE OF FRACTURE OF SKULL. By Robert Cban, M. D., M. C.,
North Luckivipore, Assam. On the morning of the 4th December last I was sent for to see a coolie woman whose head had been cut by an axe. About 8-30 A. M. I saw her, found her weak, trembling and very nervous. There was a wound on the top, left, back part of the head extending from the middle line 1| inches downwards and forwards. In breadth it was f of an inch. The edges were much swollen, and the girl had lost a great deal of blood, all her clothes being saturated with it. She was quite sensible and talking a good deal. The pulse was weak and fast, and the pupils contracted. Having no instruments with me I sent her into hospital, and there discovered by the aid of a probe an extensive fracture of the skull, a sharp portion of which projected and seemed to have been pressed or levered up from the surrounding bone. There being no active symptoms I resolved to wait, ordering cold water to be constantly applied to the head, the patient to be kept in a darkened room and perfectly quiet; and in the evening calomel grs. viii. with to be given. opium grs 5tli.?The patient slept most of the night, but the pulse was weaker and she was much exhausted. Temperature 101 '3?. The swelling had entirely disappeared, and I could see the projecting corner of bone, and between it and the anterior edge of the wound the pulsation of the brain was distinctly visible. The fractured portion of skull was quite movable. Tongue furred ; bowels not moved. Fearing the presence of spicula in the brain might cause irritation and inflammation, and the bone being so loose, I resolved to remove it, at the same time believing its removal to be the only chance the girl bad of recovery. Having put her well under chloroform, I converted the wound into a T-shaped one and dissected back the scalp, twisting a few twigs. By means of an elevator I gently removed the loose piece of bone. Although there were no spicula in the brain, I found the pia mater lacerated and a very small portion of the brain matter torn, the brain looked dark in the centre of the exposed part and the rest very much congested. After washing the wound thoroughly with weak carbolized water and removing fill the clots of blood, 1 brought the
North LucJtimpore, Tipper Assam. 25th January, 1881.
^
J
Anterior
Left
parietal c
v
^
Pari?tal*
3&INCHES T
posterior
or
~J-_ Sagittal
suture.
lower.
rough sketch
respresents the bone removed 2-\ x lg inches. A small part of the right parietal is suture seen to the right. The spot bone with the sagittal The above
marked A. had been clean cut through by the edge of the axe, the bone being perfectly smooth there and rough every where else. Ordered cold water to be kept continually dropping on the lint over the wound, soup to be given every two hours, and a couple of drachms of rum three or four times a day, also chloral at night if necessary. Evening temperature 99'2?. 6th-.?Morning temperature 102?, evening 99-4?. Did not remove dressing, but continued pouring cold water over it. 1th.?Removed dressing on which there was a good deal of pus. A little serum was oozing from the wound. Dressed with carbolic oil, but in the evening changed it for the cold water as there was pain and smarting. Sth.?Morning temperature 99? ; evening 100"4o. 1 Oth.?Morning temperature 1)9-2?; evening temperature 100?. Pulse cannot be felt at wrist to-day, but is fairly good at arm. Patient is cheerful ; has no pain; slept well ; tongue clean ; bowels moved. Wound looking well, oozing of serum stopped. Dressed with carbolic oil. 12th.?Morning temperature 98-2? ; evening temperature 98,2?. Stitches have cut through and the wound is gaping: put Pulsation of brain in four silver wire sutures : pulse good. can be still seen through aperture. has been normal since 21 st.?Doing well. Temperature 13th; pulse good. There is still aslight opening through which the brain can be seen pulsating. Removed sutures and allowed patient to sit up for a little. 10th January.?Wound perfectly healed and woman quite, well. A considerable amount of pressure can be borne without uneasiness over the part, nor does the sun affect the patient in any way. _
CASE OF FRACTURE OF SKULL. By Robert Cban, M. D., M. C.,
North Luckivipore, Assam. On the morning of the 4th December last I was sent for to see a coolie woman whose head had been cut by an axe. About 8-30 A. M. I saw her, found her weak, trembling and very nervous. There was a wound on the top, left, back part of the head extending from the middle line 1| inches downwards and forwards. In breadth it was f of an inch. The edges were much swollen, and the girl had lost a great deal of blood, all her clothes being saturated with it. She was quite sensible and talking a good deal. The pulse was weak and fast, and the pupils contracted. Having no instruments with me I sent her into hospital, and there discovered by the aid of a probe an extensive fracture of the skull, a sharp portion of which projected and seemed to have been pressed or levered up from the surrounding bone. There being no active symptoms I resolved to wait, ordering cold water to be constantly applied to the head, the patient to be kept in a darkened room and perfectly quiet; and in the evening calomel grs. viii. with to be given. opium grs 5tli.?The patient slept most of the night, but the pulse was weaker and she was much exhausted. Temperature 101 '3?. The swelling had entirely disappeared, and I could see the projecting corner of bone, and between it and the anterior edge of the wound the pulsation of the brain was distinctly visible. The fractured portion of skull was quite movable. Tongue furred ; bowels not moved. Fearing the presence of spicula in the brain might cause irritation and inflammation, and the bone being so loose, I resolved to remove it, at the same time believing its removal to be the only chance the girl bad of recovery. Having put her well under chloroform, I converted the wound into a T-shaped one and dissected back the scalp, twisting a few twigs. By means of an elevator I gently removed the loose piece of bone. Although there were no spicula in the brain, I found the pia mater lacerated and a very small portion of the brain matter torn, the brain looked dark in the centre of the exposed part and the rest very much congested. After washing the wound thoroughly with weak carbolized water and removing fill the clots of blood, 1 brought the
North LucJtimpore, Tipper Assam. 25th January, 1881.
^
J
