rite 3 
et : ‘ ae a at : a 
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. nese into view, the incision should be made sufficient to effect this 
ODOC. ghee 8H ely, ae TM dies Ass, 
Thesgeant situation of the depressed part of the bone next requires 
attention. In some cases we find it entirely separated from the rest 
ofthe skull; in others, it adheres at two points; whilst in some a 
fissure is discovered, with one side of the bone beat below the level 
of the other. ill cae em 
When a portion of the skull is broken into several pieces, it may 
be well generally to remove them, as they would never probably unite. 
In such cases the broken and detached portions of bone may for the 
mostpart be easily taken out with common forceps. But when only — 
one piece of a bone is depressed, and this adheres on one. 
sides to the contiguous bones, we may attempt to replace i tos 
mzy be done in oat cases witha a TS a introduced into — 
the sides of the fissure ; Or by means of a screw, perforating the 
skulland forming a handle wherewith to raise it, when the introduc« 
tion of it will not require too great a pressure upon the brain. . The: 
manner of elevating the bone, however, must be decided by the 
judgment of the surgeon, on an examination of the case, a 
But it sometimes happens, even when several portions of the bone _ 
are beat in, and very commonly when the depression is formed either 
of one piece entirely separated, or of a portion of the skull forced in 
upen the brain, without any of it being altogether detached, thatthe 
depressed pieces cannot be either removed, or raised toa level with 
the rest of the skull in any other manner than by making one or more 
per! ions in the contiguous sound bone, for the purpc se of intro>-— 
instument,. or lever, in order to elevate the de ressic 
purpose that the trepan is employed : hence, it is evi- — 
‘the operation can never be necessary when the depressed 
pieces can be removed in the manner I have mentioned; sisi oa 
The operation of trepanning may be performed more safely and ea 
advantageously in some parts than in others, on account of unevens 
ness, Or projections on the inside of the skull, or arteries of the imner — 
membrane. The parts we should avoid, if possible, are the under : 
_ part of the side bones; the under part of the occipital or hinder 
bone of the head; the lower part of the frontal bone ; and the who 
ready for the operation, a small hole should be made in 
bone with the perforator, sufficiently large for 
Be 
