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Show ismnr or rm: BONE, 8w. nxrmvassrron or BLOOD. INIURY OF THE BONE FROM A GUN-SHOT WOUND. IF the ball strikes the head obliquely, the injury will in all, probability resolve into the case of contusio cranii. Though the bone be not fractured, it is bruised and killed . We know the consequence; and, certain from the begin ning, that the , ‘ "mm W" : ball has injured the,cranium, &c. if it has touch ed it, we are prompt in freeing the dura mater of the bone, on the very first accession of symptoms. "'hen the skull is broken by balls, or the fragments of bombs, we are told (for this I have not seen) that the dura. mater is often covered with blood, which firmly adheres ; and sometimes spots of extravasated blood are seen upon its surface, resembling the beginning of gangrene. If the dura mater has been torn up by the fracture, or is pricked by the ... lithhtfiuffd at ,, w. i. .7 a..- .5 30$ infant exfoliations of the size and thickness of wafers, proceed" ing as I conceived, from injury by the forceps. In old people, this change is very slowly produced; and very often the firm« ness and density of the earthy part of the bone keeps the ex« foliating portion long attached a source of irritation to the bone beneath, until the dura mater ulcer-ates. Of this I have seen many examples, when a little longer time would have safely separated the surface of the bone, and have saved the person's life. In other instances, I have found that when there has been an ineffectual effort of the lower part of the bone to detach itself from the dead surface, and the formation of a shallow furrow, the mark of beginning ex« foliation, the whole bone has yielded to the ineffectual effort, and become dead; then the dura mater having separated from the bone, and white matter having been formed on the surface of the dura mater, an ulcer in the brain has cut the innit} 01' has suffered by the attrition of the ball, it is to be arge y laid open, says Dufl. This is certainly necessary on- person offIt becomes then a question of some importance to determine ty in the case of contusion of the membrane. whether interference may assist this process. l . , 01" EXFOLIATION 01-" THE CRANIUM. . We ought, I . . . conceive, to keep the vascular action low; for exfoliation is naturally a slow process, and the danger is, that the irritation fun last observation which I conceive it necessary to makc of the dead portion of bone may be too much for the part beneath. To allow the little sprouts of granulation to rise by on the injury of the bone, relates to exfol iation. This process is very frequently the consequence of contusion of the integu~ the sides of the bone, or through the exfoliating bone, must ments, or abrasion of the perieranium. The outer table is dead, and deprived of vascularity; it becomes a source 0[ surely be of advantage; and therefore I conceive that small holes may be made with the perforator. These granulations, I conceive, give relief to the action of the lower portion of the irritation to the meditullium, and inner table which still pre- bone. serve their vitality. must take care how we apply instruments which may bruise change. This is the commencement of th e; The inner table inflames ; and by the absorpti0n of But when the bone is loose, and yields to pressure, we and irritate the now soft parts beneath. the earth of bone within the influence of its vessels, granula» trons shoot into the space left by the absorbed bone, and seem to push off the scale of exfoliation. But in fact the granulaw trons, by growing into the irregular surface of the exfoliatme‘ table, often retain it for some time. v 1" yOung people, this process is more easily and quickly performed than 1n old. I have seen from the skull of a Voung OF EXTRAVASATION OF BLOOD BETW'IXT THE BONE AND DURA MATER. THERE is certainly something obscure and difficult to be understood in the phenomenon of blood being found lying be twixt the bone and dura mater. vor. 1. Q2 ' ' ‘ , x3 5, . WOW M09917 |