State
admission. ?When seen by me he from sj^mptoms of brain compression ; conjunctivas, insensible to touch ; pupils, equal and somewhat dilated; stertor; intervals ot restlessness with irregular spasmodic movements of the limbs; no apparent paralysis of either side. On the right side of the head over the frontoparietal area there was an extensive shallow swelling of the scalp, noticeable only after careful examination of the shaved scalp. The right upper eyelid was swollen and discoloured. No fracture could be felt. Operation.?A semi-circular flap of the swollen portion of the scalp was reflected (no chloroform being necessary), and a depressed comminuted fracture of the right parietal jusbehind its anterior inferior angle was found. Three fragments were elevated and removed. A fissured fracture was also felt running downwards and forwards in the direction of the temporal fossa. The flap was replaced, and hopes entertained of some improvement, but compression symptoms continued and the patient died at 11 a.m. the next morning. Post-mortem.?On the right side of the skull matters were found as described at the operation, but. on the opposite side?in a position exactly opposite the fracture?a large saucer-shaped clot, depth and 3" by 2" in area, was found between the dura mater and the skull. No fracture or splintering of the skull on that side was present to account for the wounding of the meningeal vessel which must have been the source of the haemorrhage. The only way in which a meningeal vessel could have been injured was by concussion or contre-coup?the result of the blow on the opposite side of the head. The man was under 30, not of an age to be subject to disease of the arteries. There was no laceration of the brain-cortex. Remarks.?The points of interest seem to be? (1) The rupture of a meningeal vessel by a blow on the opposite side of the head without a fracture of the skull to account for it. (2) The co-existence of two possible causes TWO CASES OF CEREBRAL COMPRESSION: of compression?the chances are that TREPHINING. By Sukgn.-Capt. P. C. Gabbett, if a depressed fracture is found and Acting Givil Surgn Cocoiuida. elevated, there will be no other cause of compression ?at any rate one Case I.?" Oopaya," brought to the hospital would not look for another cause on at 8 p.m., on 20th December 1896, with the the opposite side of the skull withfollowing history ;? out special indication. History.?He had been struck on the side of It may be also remarked that the history of the head with a stick during a gambling quarrel the case indicated at about 5 p.m., on 19th December; had fallen compression by effused blood rather than depressed bone. down and alter a short period of unconsciousness Case II. History.?Was also one of assault, had picked himself up and walked home, where the patient having been hit on the head with a he gave an account of the quarrel and the blow lathi in a quarrel at 10 a.m. He was brought to he had received. About three hours later he became the hospital at 9 a.m. the next morning?having remained unconscious and gradually totally so, until brought to the hospital at 8 P.M., been totally unconscious from the time of the on the following evening. receipt of the injury?a period of 23 hours. was
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admission. ?When seen by me he from sj^mptoms of brain compression ; conjunctivas, insensible to touch ; pupils, equal and somewhat dilated; stertor; intervals ot restlessness with irregular spasmodic movements of the limbs; no apparent paralysis of either side. On the right side of the head over the frontoparietal area there was an extensive shallow swelling of the scalp, noticeable only after careful examination of the shaved scalp. The right upper eyelid was swollen and discoloured. No fracture could be felt. Operation.?A semi-circular flap of the swollen portion of the scalp was reflected (no chloroform being necessary), and a depressed comminuted fracture of the right parietal jusbehind its anterior inferior angle was found. Three fragments were elevated and removed. A fissured fracture was also felt running downwards and forwards in the direction of the temporal fossa. The flap was replaced, and hopes entertained of some improvement, but compression symptoms continued and the patient died at 11 a.m. the next morning. Post-mortem.?On the right side of the skull matters were found as described at the operation, but. on the opposite side?in a position exactly opposite the fracture?a large saucer-shaped clot, depth and 3" by 2" in area, was found between the dura mater and the skull. No fracture or splintering of the skull on that side was present to account for the wounding of the meningeal vessel which must have been the source of the haemorrhage. The only way in which a meningeal vessel could have been injured was by concussion or contre-coup?the result of the blow on the opposite side of the head. The man was under 30, not of an age to be subject to disease of the arteries. There was no laceration of the brain-cortex. Remarks.?The points of interest seem to be? (1) The rupture of a meningeal vessel by a blow on the opposite side of the head without a fracture of the skull to account for it. (2) The co-existence of two possible causes TWO CASES OF CEREBRAL COMPRESSION: of compression?the chances are that TREPHINING. By Sukgn.-Capt. P. C. Gabbett, if a depressed fracture is found and Acting Givil Surgn Cocoiuida. elevated, there will be no other cause of compression ?at any rate one Case I.?" Oopaya," brought to the hospital would not look for another cause on at 8 p.m., on 20th December 1896, with the the opposite side of the skull withfollowing history ;? out special indication. History.?He had been struck on the side of It may be also remarked that the history of the head with a stick during a gambling quarrel the case indicated at about 5 p.m., on 19th December; had fallen compression by effused blood rather than depressed bone. down and alter a short period of unconsciousness Case II. History.?Was also one of assault, had picked himself up and walked home, where the patient having been hit on the head with a he gave an account of the quarrel and the blow lathi in a quarrel at 10 a.m. He was brought to he had received. About three hours later he became the hospital at 9 a.m. the next morning?having remained unconscious and gradually totally so, until brought to the hospital at 8 P.M., been totally unconscious from the time of the on the following evening. receipt of the injury?a period of 23 hours. was
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