230 



OPEEATIONS ON BONES. 



quence of which they are easHy brought under observation. But 

 when the fact is otherwise and the skin is intact, the diagnosis 

 becomes dif&cult. 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 com- 

 plications. "When the injury occurs at 

 the base of the cranium, hemorrhage may 

 be looked for, with paralytic symptoms, 

 and when these are present the usual ter- 

 mination is death. It may stiU happen, 

 however, that the symptoms of an appa^ 

 rently very severe concussion may dis- 

 appear, with the result of an early and 

 complete recovery, and the surgeon wiU 

 do well to avoid undue precipitation 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. The treatment of cranial fractures 

 is simple, though involving the best skiU 

 of the experienced surgeon. "When in- 

 complete, hardly any interference is need- 

 ed; even plain bandaging may usually 

 be dispensed with. In the complete va- 

 riety the danger to be combated is com- 

 pression of the brain, and attention to 

 this indication must not be delayed. The 

 Via. 254.-ApparatuB for Frao ^eans to be employed are the trephining 



tare of tli9 Nasal Bone. -^ , j- .-l. s . 



of the skuU over the seat of the fracture, 

 and the elevation of the depressed bone or the removal of the por- 

 tion which is causing the trouble. Fragments of bone in commin- 

 uted cases, exfoUations, collections of fluid, or even protruding 

 portions of the brain substance must be cleansed away, and a 

 simple bandage so applied as to facilitate the application of sub- 

 sequent 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 over- 



