FRACTURES OF BONES IN THE HEAD. 311 



usually runaways which have come in collision with a wall or a tree 

 or other obstruction ; or it may occur in those which in pulling upon 

 the halter have broken it with a jerk and been thrown backward, 

 as might occur in rearing too violently. Under these conditions we 

 have witnessed fractures of the parietal, of the frontal, and of the 

 sphenoid bones. These fractures may be of both the complete and 

 the incomplete kind, which indeed is usually the case with those of 

 the flat bones, and they are liable to be complicated with lacerations 

 of the skin, in consequence of which they are easily brought under 

 observation. But when the fact is otherwise and the skin is intact, 

 the diagnosis becomes difficult. 



Symptoms. — The incomplete variety may be unaccompanied by any 

 special symptoms, but in the complete kind one of the bony plates 

 may be so far detached as to press upon the cerebral substance with 

 sufficient force to produce serious nervous complications. WTien the 

 injury occurs at the base of the cranium, hemorrhage may be looked 

 for, with paralytic symptoms, and when these are present the usual 

 termination is death. It may happen, however, that the symptoms 

 of an apparently very severe concussion may disappear, resulting in 

 an early and complete recovery, and the surgeon will therefore do 

 well to avoid undue haste in venturing upon a prognosis. In frac- 

 tures of the orbital or the zygomatic bones the danger is less pressing 

 than with injuries otherwise located about the head. 



Treatment. — The treatment of cranial fractures is simple, though 

 involving the best skill of an experienced surgeon. WTien incomplete, 

 hardly any interference is needed ; even plain bandaging may usually 

 be dispensed with. In the complete variety the danger to be com- 

 bated is compression of the brain, and attention to this indication 

 must not be delayed. The means to be employed are the trephining 

 of the skull over the seat of the fracture and the elevation of the 

 depressed bone or the removal of the portion which is causing the 

 trouble. Fragments of bone in comminuted cases, bony exfoliations, 

 collections of fluid, or even protruding portions of the brain substance 

 must be carefully cleansed away, and a simple bandage so applied as 

 to facilitate the application of subsequent dressings. 



FRACTURES OF THE BONES OF THE FACE. 



In respect to their origin — usually traumatic — these injuries rank 

 with the preceding, and are commonly of the incomplete variety. 

 They may easily be overlooked and may even sometimes escape recog- 

 nition until the reparative process has been well established and the 

 discovery of the wound becomes due to the prominence caused by the 

 presence of the provisional callus which marks its cure. When the 

 fracture is complete it will be marked by local deformity, mobility of 

 the fragments, and crepitation. Nasal hemorrhage, roaring, frequent 

 sneezing, loosening or loss of teeth, difficulty of mastication, and in- 



