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Show .~ M OPERATION or Teams. QPERATION 0F TREI'AN'. subtracting a quantity of blood, giving a calmer motion to the blood in the brain, and subduing the impulse of the brain against the depressed bone, or the edges of the trepanned hole. 80 it is in inflammation of the lung s : by bleeding the inflam- matory action is diminished, while the lessened velocity of the circulation and quantity of blood in the system, diminishes the call for respiration, and gives a quie ter and more equable motion of the lungs. In all cases in which there is an irreg u- lar surface presented to the brain, I dread a strong, hard pulse, as necessarily perpetuating the injury of the membrane of the brain, by pulsation against the bone. In every case, therefore, except that state, which imme diately follows concussion of the brain, the circulatio n must be kept. very low, and all tendency of the blood to the head prevented. The different kinds of injury of the bone require no fur- ,_ . mm", W 1 " 7' hhhtltltt'll‘cj" a. g t ther definition than the names them selves imply. 1. Frae- ture. 2. Fracture, with depression. 3. Fissu re. 4. Capillary fissure. 5. Contusion. I may only add, that fissure, - When a fracture passes the margin of the orbit, but espe cially if the margin is shattered, we should lay down the eye-brow, and feel the socket with the finger. . Although we do not operate for a fissure, yet it 18 very often necessary to ascertain the existence of a capillary fissure. A fissure may,._ we are told, be confounded with a suture, 0r 1.. the surface ofa bone. But in ei- the mark or an at "131,01; there ma be some inequality 0i. "101‘ Of these cases' wub 1 b y " .. ' eculi'ir surfac bemg the rent of the bone, Witho - g of it, - IS - more ut the gapin generally produced by falls, when the head hits broad 11 pot! e, there 15 mt the P < 8'ritt y rough ~> ness which the point of the instrument conveys to the feel, when .it is drawn For a very evident reason, when we have to follow a fissure, we cut upon that extremity whic h runs towards the temple. taken off, and the surface of the bone rasped over the suture, these natural irregularities disappear; but when there is a fracture or fissure, it becomes more distinct and defined, when the bone is a little cut down. the ground ; and that fracture with great depression is more frequently the effect of sharp blows. Of course there are many exceptions to this arrangement. If there is a fissure in the temple, with bleeding from the cars, we may suspect that the rent has gone down into the base of the skull. If the fracture is on the lowe r part of the frontal bone, the orbitary plate of the frontal bone may be beat up; and I have known two instances wher e this had happened and been neglected. This marginal plate, taken from one of my preparations, will explain my mean ing. A, the frontal bone. 8, the frontal sinus. (‘, the outer table , forming part of the sinus, beat in. The effect has been, that the orbital plate has been beat up on the anterior lobe of the brain. along a rent or fissure. Further, when the perlcramum is The blood sinks into a fissure, making a dark line ; but it does not sink into the suture. 'Without incision of the integuments, it is impossible to discover the place of fissures, especially the affection-of the Iiu~ teguments over the injured bone is very deceivmg, being common to every slight injury. There is no part of the cranium exposed to injury from without, on which we may not apply the trephine, with tllOSf‘ precautions which the knowledge of anatomy suggests. Parts which I should rather avoid are, l. The centre of the fore-head ; for the ridge or internal spine of the frontal bone sometimes runs high. and if the crown of the trephme 1‘ . 1‘ 3 , ' mm M05. '1' ' |