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Show 302 INJURIES or we scer. anticipate the evil. For when matter is actually confined in the centre of the bone, and the outer table is dead or carious, the inner table, and consequently the dura mater, cannot be safe. If the saw give out a l'etid smell, or if matter ooze out by the side of the instrument, it is safe to take that as a hint to persevere : and I am not in such a case satisfied with breaks ing up the outer table. If shivering and sickness have ushered in the train of symp toms, the View is no longer to be confined to the bone; the brain itself is directly in danger. Both the physician and surgeon should be aware of the slow progress and gradual effect of the caries of the skull after contusion. When the bone has been injured, but not deadeir ed, it falls slowly into disease ; it becomes carious and spongy, and admits the oozing out of matter. The dura mater does yum. AOFMM kthktll not separate from the bone, as in the more common case of death of the bone from injury ; but being the internal periosteum of the bone, it partakes of its disease, and grows into ..\‘_ \ ,.,-. a.-. ..-.~ its carious cells. This is a disease of the skull, like to the com» Ixmnlns or THE SGALI'. 30.3 to feel pain in the part where he supposedthat he had receiva ed a very trifling injury. The part is acutely pained on pres- sure, and there is a soreness over the whole head. Upon the place where the bone was injured, there is a puffy difl‘used swelling. By and bye the patient becomes languid, and inattentive to questions ; rigors succeed ; his strength fails, and the pulse becomes quick ; the sleep disturbed. Or, after lying insensible for some time after the injury, he recovers, and remains for a day or two quite sensible ; but there is a sickness and indescribable languor: then follow frequent fits of shivering, succeeded by heat, and great restlessness, con- fusion of the mind, and head-aeh; his countenance is bad, the skin is pale and the limbs weak and trembling. When the bone is laid bare by incisions, the pericranium is found to be separated from the bone. The bone dries quickly on exposure; for the surface is dead. Probably both tables of the bone have suffered; in which case the dura mater will have separated from the inside of the bone. If this state of the bone has succeeded to an open wound, mon disease of bones, where the external and internal perios~ the integuments are pale, gleety, and loose, and the edges of ieum, and substance of the bone, is diseased, with decay of them have separated from the boners. internal parts, and the formation of exostosis. But here the brain is still the source of apprehension and danger : and if the disease be neglected, sooner or later the and repeatedly; but when the disease of the bone has com~ surface of the brain will become diseased, and abscess form in its substance. When the disease is in an early stage, thfl‘ exfoliation of the bone, or the cutting of it out by operatio n: may save the patient ; but should the granulations of the dura mater have sprouted into the interstices of the bone, our endeavour to extract the diseased portion will endanger the tearng up of the (lura mater, and by violence produce a fatal accession of inflammation. There is an injury of the skull which produces the l'rm rr Morn or THE seam», and which is the most frequent occurn rence of any. It is pregnant with the most imminent dangerlt occurs when the scalp has sullfered by the blow, and th there is no cut. Some days after a scuttle, the patient begin" u it! In the first attack of this disease, we should bleed largely meneed-or rather, we should say, when the bone is dead-- what can we expect from purging and bleeding .9 A large trephine is then to be put on, and the diseased portion taken entirely away. This frees the matter on the dura mater from confinement, takes away the source of irritation, and allows of granulation. But I again repeat, that so great is the tendency of the brain to suppurate, that if the dura mater is much diseased, we may suspect, nay be almost certain, that the pie. mater has adhered to it, and that the surface of the. brain has sup~ purated. What should be done in this case, I eaimot decide. The general opinion is that the dura mater should be punctured. The case is a desperate one. " ‘ gee Putt. \i'hohas accurately described this consequence ot‘eontusion vmm M09917 |