62 SURGERY. 



them by excluding all kinds of excitement, especially light and noise, 

 and by the application of ice and evaporating lotions to the head, 

 which should be elevated upon pillows. If great reaction occur, 

 manifesting itself by delirium, convulsive movements, a full and 

 active pulse, pain, &c., local and general bleeding, together with 

 enemata and purgatives, are to be resorted to ; opium will also have 

 a beneficial influence if administered judiciously, especially in con- 

 nexion with calomel and tartar emetic. For some time after the 

 violence of the inflammation has subsided, the brain remains weak 

 and requires watchful care ; excitement, both physical and mental, is 

 to be avoided, the diet regulated, and the head kept cool. The me- 

 mory is often impaired, the conversation childish and incoherent, the 

 eye wild and vacant in its expression, the demeanour either most 

 timid and gentle, or entirely the reverse; occasionally one or more 

 of the special senses, such as hearing or smell, is lost; such conse- 

 quences may be temporary or permanent. The treatment most 

 suitable is a mild mercurial course, long-continued counter-irritation, 

 regulated diet, avoidance of all excitement, and exposures to changes 

 of weather, together with the use of the cold shower-bath. 



FRACTURES OF THE CRANIUM. 



These occur more frequently in adults than in children, on ac- 

 count of the unyielding and brittle nature of their bones, whereas 

 the bones of a child's head are pliable, and yield to the force without 

 fracture. Fractures of the cranium are classified, by the extent of 

 injury, into simple fissure, stellated, depressed, and camerated frac- 

 tures, fractures of the external or internal table, &c. The dangers 

 attendant are various: there may be concussion, compression, 

 hemorrhage, and inflammation of the brain and its membranes. 



A simple fissure is of but little importance, even should it be ex- 

 tensive, and traverse a suture, which it often does. The fracture 

 itself requires no treatment, unless accompanied by symptoms of 

 concussion, compression, or inflammation. 



Fracture at the base of the cranium is a very serious injury, and 

 usually attended with laceration of the membranes, and internal 

 hemorrhage. It is usually suspected, from the early appearance of 

 symptoms of compression, the manner in which the injury was 

 received, escape of blood from the ears, and sometimes from the 

 nose and mouth. This latter symptom, although generally consi- 

 dered a most dangerous one, may be the result of mere laceration 

 of the lining membrane of the ear or the nose. The treatment 

 required will be that for inflammation or compression. 



A depressed Fracture. — This is to be carefully diagnosticated from 

 a fracture of the external table alone, and from a depression in the 

 middle of a tumour occasioned by the effusion of lymph. It is 



