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Show 300 INJURILS or Inn scam, INJURIES or THE SCALP. If a man has his scalp cut from the skull, but still With necessary, when the parts can be laid down upon a bone*. If the integuments of the head are torn and bruised, and tion among the hair, whether suppuration be not taking place instead of adhesion. If matter be allowed to form, it may fall down with rapid progress by the side of the ear. The integuments must now be punctured at a depending part, and the state of the bone ascertained by the probe. If the bone be not bareand rough, the matter must be squeezed out, and compresses brought gradually to encroach upon the margin of the abscess, so as to procure adhesion. But if the surface of the bone has been injured, and is now exfoliating, the scalp must be freely cut up. the dirt be kneaded into them, as by the passing of a cart If the outer table be cut off from the skull, and be adher wheel upon the side of the head-~then, as the parts must suppurate before they unite with the bone, a large poultice should be applied, and suppuration assisted. When the ing to the scalp, I think it should be cut away, and the flap iaid down on the diploe. _ a broad adhesion to the rest of the integuments, and if it be alive and bleeding, it is to be replaced, and preserved in. its place by adhesive straps, and by a soft compress and roller. If we foresee much occasion of trpuble with the hairy scalp, as preventing the adhesion of straps, some one point of the scalp may be fixed with a ligature; but this ligature should be taken early away. In general, we say, stitches are un- «or/Wu ,,,,,,, parts are clean and granulating, lay them down as recent parts. huh!" But this advice is by no means absolute, If the dirt can be washed away, and the skin be not much bruised , the "a" x w-.. '2'. ..,~ 301 parts may be made to adhere, at least partially, so as to di~ minish the extent of the wound. But what I particular ly wish to guard against, is snppuration lying concealed un~ der the scalp; for when the integuinents are injured,as I have described, there is danger of their adhering only at the edges, while matter may be lodged under the loose scalp. At all times when the scalp is laid down for adh€~ sion, the surgeon must continually watch its progres s, and be careful to ascertain by the touch, and the degree often derness, by the quaggy soft feel, and the blush of inflamma* There is undoubtedly some peculiarity in the scalp, which makesthc injuries of it troublesome or dangerous, more than what is derived from the direct communication of disease to the brain. ‘Vhen the corner of a stone has struck the head, and bruised or cut the integuments, and bruised the bone, it is a very bad wound ; one in which the danger is to be dreaded, whilst yet we cannot act decidedly to prevent its. If we find that the pericranium separates from the injured bone, and that the bone remains smooth, and of a dead white, or of the yellowness of ivory, we have to dread that the life of the bone, in its entire depth, is destroyed: or the centre or diploe of the bone may have inflamed, and the outer table (in as much as regards the life of the bone) be separated from the part be reath ; Though it still retains its adhesion by the earthy part of the bone, just as a slough continues unseparated for a long time after its death. A question in this case occurs, whether, when you have de~ termined on the application of the trephine, the outer table only is to be taken away, and the matter within the bone allowed to escape, or the perforation is to be completed so a: to expose the dura mater .9 I attribute this If the taking away of the outer table alone, can ever be to the sensibility of the hairy scalp; to its being spread over the bone, and. being more liable to be bruised tliiin any other part; and to the nu: deemed sufficient, it must be only where we have been able to merous cennection of its nerves with those which go down to the vis« cera. Indeed, with every important nerve has the lesser sympathet ic or portia dura, and the branches of the fifth nerve connection, " This is that kind of in] ury which is very apt to be attended w iih fracture of the internal table, although the outer surface be only bruised. From such an iniurjc. sf? er "".'1!'~‘€. :m internal sharp cxostosis has 'w'v-rrri. wom M099» |