1000000031

thc head with your fi.ngcrs,

till

the

ratient

cOR'lplains of

fome particu lar pan, whic:l in all hkclihood

lhe place af·

[cl'ted, and,

lhe

rcalp thcre be feparatcd from lhe

crmzium.

is .lmoO: infallibly [o. The [ymptoms of • froélure,

are, a bleeding al lhe ears and nore, a 10rs of fcofc:.

vomitO–

ines, drowGncfs, dtlir ium,

incontinence:

\arine

and

excrc·

ment;

bUI

what is nlofi

be depended upon, is a deprc:ffion

of lhe

banc.

or a roughnefs on its outfide ; for all lhe other

complaints

1l0t

ooly happea to concuffions, which do well

with ~

out the application ofa trepan.

bUI

likewife there are

fraaures

Dal

aHended with

any of

thc:m,

or al

leaO la

Oight degree;

fa rhen

tbeCe:

Tymptoms

alone,

without

exami08tiOD

lhe

pan aff'etl:ed. are bu[

an unccrtain

rule to go

by.

CODCUCJi~DS

without a fraélure, that produce the

fymp~

toms here laid down. and do well afterwards, the vefTc)s of

tbe brain aod membrades are ooly inllamed and dilated ; er

if <hey are r.plu red, lhey abforb lhe extr.vafated blood a–

la¡n; on which aceQunt, oature lhollld be affified by plen–

tiful bleedings, clyfiers, and other evacuations, and fo in

all fraaures where the patient is not trepaooed immediately:

however, ahhough peapie with vioteQt conellffions do fome–

times recover. it 1s fo very fddom, that there caD be no

pretenee, wheD they happen, for negleéling the trepan, but

!lot being able to learo in what pan lbe concuffion la.

Wri,ers difpute Yery mueh .bout lhe pollibility of the

4r,nlraftifure.

or a 6lTure occaGoned

the part of the head

oppofite to that oo ' which the blow is giveo, or where the

inner table is fraétu red "hile the outer one remalns entire ;

hut lhere are hirlories of cafes, which, if fairly Hated, make

it lloqaefiionable ; and this is

mo{~

cerraiD, that if the com–

plaiot be

a dinance from where the blo.w was, received.

there.e.n be no danger in [e.lping, and .pplying lhe trepaD

lo that pan where the paio is.

When lVe are afTured of a fraaure or depreffion, it is al–

",ay5 ad yif<:able to trepan:u foon as poffible, in order tO pre–

.enl the fpre.ding of ,he ab[eef., whieh feldpm fail. 'o

follow upon lhe rup,.re of ,he verrels of lhe buin .nd

membranes, and for (he mofl: pan

few d;¡ys .

The

ma~ner

of veating a fraélure of the

craniulIl,

will

be according to tha nature of the fraéture ¡tfclf, and lhe in·

juryof (he fcalp . I f the wound o rhe head be torn into ao·

gles,

p~rhap¡

cutting off ,he lacerated Ilaps will make room

for (he faw; if the bODe be broken iOlO

fe~eral

piece" the

pieces may be takcn áway with the forceps

or lf fome of

,he O,ull be alfo deprerred, lhe removal of ,he pieee. will,

wilheut perforating. mOlke way for the e1,yator to raife the

d epretrcd part ; but if the fratture be DOt complicated

with a wound of the fcalp t or t he wound be toO fmaIJ to ad·

mit of the operation, which feldom

fail~

tO be the cafe,

.hen ,he

fra~bre

muO: be laid bare, by taking away a large

pieee of lhe (e.1 p.

Befare the application of the trepan, ir is to be remem·

bered there are c(rtain .places on ,he fcull where jt cannot

be Qfed with fo much fa(c,y as on others; the whole Jeogth

of the fagiual CUlure, down tO the nofe) ís always mentloo·

as one whtre the perfora don is dangerous. becaufe of the

(pine of the

01f ronlil,

aod the courfe o( thet (uperior lon–

gitudínal.JÍl1ul under this pan, which., it is fuppofed would

be nr-cdr.aril-y wounded hy rhe faw, and in confequence de–

{hoy ,he p.alient by the hzmorrhage e but thOllgh a perfora–

tion may, contrary

the eenrral o pinio" , be made over

Ihejil1uJ

without offending it, and, evcn ¡fil was wounded,

ihe .ff.fion of blood

wo.ld

not in all probabililY. be mom.!;

yet at bcfi it ",ould be very troubh:romc; and lince we

.re

not nraitened in that part of lhe

craniulIJ

for room . it is atl.

vifeable

forbear oper,n ing in this place. The

bonyjil/ufof

1he

olfronlh

forbid {he ufe: of lhe trepan n(!ar the: or–

bits of the eyes; therefore, if it {hould be

deprdl~J

ncar

thore cavilies. lhe furgeon mufi be careful to perrOI ale

el–

ther above. or on one 'ide of lhe fraéture

;

fo r fawing be–

low it will ooly Jead ioto

thejillul,

a.nd

anfwer no purpofe

in)he

~erjgn

either of giving a 'difcharge to the m<llter fronl

the braio, or an oppo.nunit y tO d evale dle dcprcffion; oay,

perhaps leave an incurable

fi{~ula,

if the paticnt efcapes with

life.

The

01 occipiliJ

bcing very uneven, both in its internal

and external furface. ma.kes trepa.oning there almoH imprac·

ticable; befides, the great finures run about fo much of

it,

as hardly to affard fpace to perforare without danger of

w9unding them ; but then it is fO ,defeoded 'from injuries

its fi(uation and firength, that fra(tures do not happen tO it

fo ofte ft as to the other bones of the

craniulII;

and wheo

they do, fo'r the moR part they become fo {oon mortal,

Y afIeéling the

cueóellu1It

which it fuHaios, that lhe ope·

ratioD is feldo01 required in this cafe.

Indeed lhe

upp~r

angle of tRis booe líes above the

cereóellu1n.

and , wben fra c–

tured or

dep~elTc;d,

is not attended witb fa immediate dan–

ger ; but when this happcns, the courfe of [he longitudinal

HOlls down the middle of

it,

and the neighbou rhood of the

lateral jinufel

beDeath it,

Olakc

it advifeable to trepan at the

lower pan of the

OJ parida/e,

at lean upon or jufi below

the lambdoidal future, fo that the perforation of the

occ;–

pitÍ¡

can hardl y ever

proper .

Though wouDds in the cerebellum are always mortal, yet

great POrtiODS of the cerebrum have been carrit:d off, or

defl:royed, without aay notable incoDvenience.

The places theo unht to admit the faw. are the three de·

fcribed; that is, the Cagittal fUlure : that part of tbe

fronliJ

near the orbits of the eyes; and the

01 occipiliJ.

But wheo a fraélure happens in aoy other part above: the

eu, thcre is no objeélioD to the operadon. When there is

ooly a fmaJl 6fTure without any dc:preffion or motion in the

boDe, ,he trep.n may be applied

lhe firrure ilfelf, whieh

'\ViII more readil,. giV'e vent to the blood or man er under·

neath, than ir made at a dillance. If the fi lfl1re be

larg~,

and the bone weakened

deprelTed , the trepaD mull be

applied on one fide of

it,

but fo as tO nl.lke tt a pan of the'

circumference of the (awed piece ;

lhe fraéture run up·

wards, il will be eligible always to perforate near

its

bot –

tom, becaufe the depenclency of rhe ori6ce will give betl er

¡ffue ro rhe matter, though the ill-grounded apprehenfioo'

of rhe brain falling out there has

ml.de

m:\ny eminent fur–

~eons

contradiét (his rule in

th~ir

praétlce. I f, by making'

ene orifice, you cannot nife all lhe deprefTl'd pan, you mu!t

make a (econd and a (hird. and

COOtÍI1UC

doing (o, till you

have reduced the

\IIhol~

cranium even: there is frequentl y·

'occafion tO repeat it twice or thriee ; and

h;ls been done

twelve times, nay oftener, with fuccefs

which (hews lhe

liule danger there ¡s,. either in fawing the flmll, or expo·

fing the

dura moler

aftd brain, when the prefTurtt is taken

off. Inoet:d the mifchief of Jayiog lhe grajn barco is fo {'oulJ,

compared with a concllffion of tt, or an abfcefs from pent .up

matler that thofe fraétures ..

the fkull . where tht: bone is

broke n'into fplin ters the whole extent of it,

2Dd

can

be'

taken.

away. much more readily do well. rhan a fimple fitrure on–

Il ,

wherc lhe abfee[s eanDOI difeharge il[eH fr«ly; fer

wllichl