( 433 ) 



No. LXVII. 



An EJfay on a nciv Method of trcat'mg the Effufion u^hich 

 colk£h under the Scull after FraBures of the Head, By 

 J. Deveze, Ojiccr of Health, of the frjl clafs, in the 

 French Armies. 



Read, May/^F the different cafes which require the opera- 

 6, 1796. \J tion of the trepan, I ihall only confider the 

 efflifion between the dura mater and the fcull, occafionetl 

 by blows and fraftures. 



Mr. Petit, a celebrated furgeon of Paris, has contribut- 

 ed greatly to the improvement of this art, by pointing out 

 the particular fymptoms which diftinguifli efFufions under 

 the fcull from concuffion of the brain. Thefe different 

 accidents equally refult from falls or blows received on the 

 head ; and previous to this diftindion it was eafy to con- 

 found them, a miffake highly prejudicial to the patient who 

 is affedted with concuffion only, as it requires a different 

 treatment from effufion and is not relieved by the trepan. 



When there is a colledion of blood from a blow or 

 fradure of the fcull, all authors advife the trepan, in order 

 to difcharge the colleded fluid ; but the difficulty of afcer- 

 taining the part where it has accumulated, often makes 

 frequent repetitions of the operation neceflary before it is 

 difcovered. Mr. Marefchal, firft furgeon to Louis XiV. 

 gives us an example of this, he trepanned a young lady 

 twelve times before he found the effufion occafioned by a 

 fra£lure of the parietal and temporal bones on the fame fide. 

 This cafe, and many others of a fimilar kind too numerous 

 to relate, evidently fliew how important it is to render an 

 operation more eafy, which is often repeated without real 

 neceflity, is painful to the operator, and lometimes fatal 

 to the patient. 



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