UNDER THE SCULL. 



437 



although the frad:ure extended lower : I obferved another 

 fradlure in the upper and lower part of the fame parietal, 

 which had leparated a piece of the bone about three inches 

 long, and two wide ; this piece was neither indented nor 

 difplaced, was behind and a little above the part trepanned: 

 blood ilTued from the fuperior and pofterior fradtures. 



The next morning the patient was in the fame ftate, in- 

 fenfibly voided his urine and could not fwallow. The 

 dreffing was removed, much blood came from the opening 

 by the ti-epan, and from the fratfures. 



When 1 vifited him in the evening he was comatofe ; 

 but little blood came from the wound, nor did the prelTure 

 I made on the dura mater produce more. I introduced a 

 blunt flexible probe under the fcull in the diredlion of the 

 fradture, from whence the blood proceeded in the lafl drelT- 

 ing, and endeavoured to do the fame by the fradture which 

 defcended to the temporal region : at the diftance of about 

 a quarter of an inch, was flopped by a fudden refiifance, 

 and it was at that moment refledion fuggefted the method 

 I immediately put in practice. 



I prefumed the comatofe drowfmefs which continued, 

 was occafioned by colleded blood, and that it exifted under 

 one of the points of the fratfture in the temporal region, be- 

 caufe thofe efFufions which had been formed under the 

 other fratftures, were evacuated in the preceding dreffing. 



Had 1 followed the ufual method, it is polTible 1 might 

 have made many openings before I had fucceeded, or have 

 failed finding it ; confequently after the refledlion which 

 fuggefted, that the adhefion between the fcull and the dura 

 mater might be feparated without inconvenience, I deter- 

 mined to leparate the membrane by following the diredlion 

 of the fradlure ; and proceeded to this operation with a fd- 

 ver fpatula very flexible, the extremities of which were 

 rounded : I took the precaution to prefs it towards the bone, 

 and to bend my inftrument by degrees as I entered, to make 



it 



