1000000031

666

which rearon,

tho\l~h

lhe

ckprc:lli::d fr::.ll:ure

mi!y

be raired

the means

one oritice. yet,

is of a

con(jJel'~Llt:

lengd"

,,-,ill be almc..11: abf...

,Ju~ely

nrcdf.uy

make one

or t\\'o nlt>re opc:nin,gs, for (he convenience of dtfcharge ;

fince, f..,r

\VUlt

lhlS,

\'le

Cee

abfcellcs

incr~arc

daily in tllcir

~l1antity

maucr,

and

al lhe

cnd

of a fe\'!

weeks cany

f')ff

lhe palienf.

111 concnOions of the braio·w¡thout a fralture of lhe cra–

nium.

the trepan be applied, and vafl

difchugc;

enfuc,

it \1.'ill be

íllro

convenient to make more paforations intothe

abfcefs :lnd lhe nl'ighbourhood of lhe abreefs,

fhe

(iluation

of which will be e;,¡:'ly gndfed by

lhe

dircl..'tion of the Hream

of malter. And In.:re

be obferved, (hat ablcefTes

\vhich enfue from a concuJlion are gen·erally more extenCive

and dailgcroDs lha:') IhoCe which accompany a frallure wlth

dcpreffion: (or in • (roaure, the yielJing o( the bone de–

Hroys,

in a

grca.l dl!gree, the force: of the firik.ing body,

and

prcvenls itny violeot commotion of lhe braio; fo that

whlt

the brain CulTers rcCul ts (hitRy from

lhe

prdrure of

the inC\lmbent bone, and thl! laceration of lhe \tefféls, ne;lr

lhe fra crure: whereas, whcn lhe

cr~nium

teCifi, lhe- (hock,

::lit,

or great put of the

cuebrum

fullains lhe: concuffion,

and is o(<<n impoflum.tcd or inftamed .lnlO{t in its who{e

dirneDfion.

The m.nner of trepanning is lhis: H aviog fixed your pa·

tien!"s hcad i1e.cly, either on the bollter o( a bed, or by

pl.¡cing him in a low chair; with Ihe pin of your

f:tw.

miHk

the center of lhe: piece of bone to be taken out; lhen Wilh

~he

perforaling trepan, mak e:l.n orifice deep, enougb tO re:

cei\le lhe pin, which being fixI.d in

wiIl prevent the faw

from (]ippirig ; and thus you are to continue CawiDg, til! the

impreffion m::tde will prefen'e the {teadine(s witllout the pin,

when it is tO be taken away, for (ear of iu

wouDdin~

the

brain before the {aw has eDtered through the craniuro,

which it wotllJ do at lafl, becaufe of its projcélion. In

working throuRh

lh~

bone, the teeth of lhe faw will begin

to c1og, by thanime you arrive

the

diplo(;

wherc:fore a

bru!h mufl: be ready tO cleaD it every now analhen, and witb

a pointed prll!;e yorl mu(l clear away the duO: in the circle:

of the lrepanned bone, obfening.

it be deeper on one(¡de

than the olher, to lean aflerwards on lhal fide where lhe

impreffion is lean, that lhe \Vhole thickners may be (awed

Ihrouth at the {ame time:. To do all this with leCs ínter–

ruption, it will be proper to llave two faws of ex¡:¡ltly the:

(ame diameter, that an ¡ffiUant may be brunting one while

you operale Wilh lhe other. ' Ve are adviCed

faw bold–

Iy till we cone to the

¡jiplO(,

whieh, it i, (.id, will.lways

difiinguiCh "felf by the bloodineCs. But, howcver, this is nor

a certaio mark to SQ by : for though, where there is a

Jiplo(,

i, wiIJ

m.ni

(dl itfel( by its bloodine("

ye!

(ometimes tbe

fcull is (o very thin as not to adrnit of any; io which cafe,

aD operator fhould pufh

his ¡narument iD expeélatiso

meeting with thiv (ub(ldllce, he would unwarily wound

the botín. This is OOl TCry oflen Ihe caCe; hut, howeyer,

often enout h tO put a "'3D

his guard, and make him in_

qui re wh::therthe booe be loofe afler a linle fawing, wllich is

the only rule \'le go by when

w t!

have

pl(J"~d

lhrou 6 h the

diplpr,

and may as v/eH be attcnJed tO before! coming al ll, with_

OUl any confiJc r::óle lofs of

1¡lIle.

\Vhen it ís quite fawed

through, and líes lóo(e, it IO:ly be tdkeD away with the for–

ceps conlrived for lh;lt u(e; and if the

I~wer

cdges of the

orífice, ncxt to lhe

Jura ma/t r,

are Cplintered, they

Qlay

.be Icrapcu (::" otl. \'Ii,h a lenticul".

Tbefe .re the ehie( procelfe¡ of the oper.tion of the

trepon. Th:- only thinC rcmii;OIng to be dont:, ¡s, \\¡lb an e..

levator intloduced al lhe orllict', to r.ife 1he: d .. p, ClEoD. or

broltl!n (rhn lcrs,

thc:y caunol Olllerwlfc: be

J.oII,'

huId

:ilnd to oraw out

the

grulUous !.luo:J, or ao)'

lIt1.er

e:<rra:

neOUS

body.

Ihe

dura lIIa/(r

mn w:)undc:J

turro, an

inc¡fion mull

m::,;oe

thrvu~b

it,'

10 &1\'1! \\ ....

rhe blcod

or r;.au: r

\~'htch ~Itnon

cctto.li1ly he u¡'lJe:ncath il,

the

fyOl~)(Om6

.c.ve

becn b.d, aod nt)n:: h",s bec::n ulfchMJcd

froOl bttwe,n the

crnJúum

;¡od

dUt'o

UI:I/rr:

Though it

h.s b..:cn

lai.dy

obrcrvc..d. mOlt

2.0

abfcds

WliI

(omeurncs

form:d in the fuofhnce

th~

brain ;

Oln.,

thercfore, it the

puntrt1 re of the

dura 1J/íJ(er

docs nOI procure ln

(''f~Cl!a_

tion uf rhe mauer, and (he (ymptoms uf a CU:JpuJalion are

¡bll urgent, it wdl be ad.,(c.ble tO

m.ke

Jru,a

incifioo

wi .h

lancet ioto lhe Lrain ¡I(df

'Ve

luve ured the word Irep,n aU .loog, (or .he (ake of

bC'ing beuer

u~Jtr(lood

bUl lhe inflrument

her~

recorn–

OIerah:u is

trtphine; the advanl4ees

which, as alfo tbat

of a cylinolic.d

(JW,

or o..e or:arly cylindrical, are de(.;ri–

bed

tht: expl;lnation tlf lhe cÓppcr.platc

With rcgud tO the. drcflings

theCe wouods, it is very

certaio, that as ,he &(cateíl part of lhe evil proceeds feom

lhe quantity and prelrure of lhe matte:r, whatevee apFroache.s

towards lhe nature of á tent

and lncrea(es its quanrüyaod

prdrure by loekicg it up, mu{1 be perniciou,," Therefore the

ufe of.U {yndons

whate.er

Ihould be excluded. The h.Jly

'p–

plication too of (pi. its ofwine, which is fo commonly advlCed,

canoor be prnpee

as {hey are nor ooly on6t for infhtmma.ions

in general. but alCo criCp up the Te(fels ol lhe

áunl mil/U

aod

brain, and, flopping the fuppu ration. (ometimes produce a

~an·

:rene. Sioce lhen a clole application is inconvenieDt, and,

whatever good there lOay be: in toplcal MediCines,

cannOl for

the mol1 part be commuaic:ned to the abfet (s. by reafoD ofits

extent be!yund

lh~

ctl6c.e:, the bdl remedy will he drylintonJy,

which muO: be laid on loofcly

give veot lO the malter,

and be repeiued tWlce a day till ,he dif-:harg: is lefTcoed.

when once in twenty-four hours wll1 be fuffu:it:nt to Ihe

fi.

nifhin-g o( the cure, which will be fOmethlng retarded

the exfoliations that fome:times rollow this ope:ra('on. The

patient aflt:rwards

m~y

wear a place of tio opon th( fcae) tO

dcrend

from

Llows or aoy accidental ¡njury.

EXPL¿NATtON

Fig.

PIate CLVIlL

The perforaror, commonly called the perfor.atin: tr«·

pan. Wilh lhis iDfirumeot. an orífice is ufually maJe for

the reception of the pi,!,

the ceotre of tbe piece of

bone lhat is tO be: uken away, in the opcntion

trepaD–

qing; though i( the pin be .ery

(h.rp

, and projea bu, {¡ttle

beyond the (eeth of the faw, as in lhat muked with ,-he

letlee

the perCorator would be "eedlefs; bUI as tbe Plliar

of the pin preCendy grows blunt wilh ufe, and in that caCe

il is difficult tO fix the fa.w, .it is advi(eable lO bne this in–

lIrument in rcadif'lef,.

is alfo handy for boring into lhe

fu bHance of the bOlles, iD order tO promole a granulat,un of

Re01 on their {urfnces. When it is maJe uf::

0[,

it muU be

recClvt d anJ fall cned in lhe handle

'The crown, or (aw of the

trep:I.O

with tlae:. pio ap–

pcaring jun bcyond lhe cxtremitics of the teeth.

he (h,,¡pe

or Ihi) fao,v is cylinJrici!1.

T h: handle o( ,he foregoing inJlrument, caUed the

trephinc; wbich is moch preferable to lhe tr(pan,

(J.n ln–

JlrumeDt like a wimbl< u(ed by joio<rs,) bcclufe of ,he

grcilt