DISEASES OF THE HOKSE. 311 



arc liable to be c-oinplic.atod with lacerations of the skin, in consequence 

 of which they are easily brought under observation. But when the 

 fact is otherwise and tlie skin is intact, the diaj^nosis becomes difficult. 



Symptoms. — The incomplete variety may be unaccompanied by any 

 special symptoms, but in the complete kind one of the bon}- plates may 

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

 cient force to produce serious nervous complications. When the injury 

 occurs at the Inise of the cranium, hemoriliage 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 

 ver}^ severe concussion may disappear, resulting in an early and com- 

 plete recovery, and the surgeon will therefore do well to avoid undue 

 haste in venturing upon a prognosis. In fractures of the orbital or 

 the zygomatic l^ones the danger is less pressing than with injui-ics 

 otherwise located about the head. 



Treatment. — The treatment of (ti-anial fractures is simple, though 

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

 hardly any interference is needed; even plain bandaging may usually 

 be dispensed with. In the complete variety the danger to be combated 

 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 ])rain substance must be carefully 

 cleansed away, and a simple bandage so applied as to facilitate the 

 application of subsequent dressings, 



KRACrCKKH (W THE BOXK.S OF THE FACE. 



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

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

 They ma}' easily be overlooked and ma}' ev^en 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- 

 flammation of the cavities of the sinuses are varying complications of 

 these accidents. The object of the treatment should be the restora- 

 tion of the depressed bones as nearly as possible to their normal 

 position, and their retention in place by protecting splints, which 

 should cover the entire facial region. Special precautions should be 

 observed to prevent the patient from disturbing the dressing by rub- 

 bing his head against surrounding objects, such as the stall, the 



