■INJURIES. 



■ Viliat arifes from the impoflibility of brin;;ing tlie lips of the 

 wound into finooth and immediate contact, the fear of wliich 

 fore mull be fmall in proportion. Sometimes fuch perfeft 

 re-union is not to be obtained ; in which cafe matter will be 

 formed and colled^ed in thofe places where the parts do not 

 coalefce ; but this will not hinder the prefervation of the 

 coverines of the head, the cure being only a little retarded 

 by a few fmall abfccfles, and the matter admitting of being 

 ■let out by one or two fmall openings. 



Occafionally, the whole fepar.ited piece will unite per- 

 feftly, efpeciaily in young and heahhy perlons. In certain 

 inttances the union will take place in fonie parts, and not in 

 others ; and, confequently, matter will be formed, and re- 

 quure to be difcharged, perhaps, at feveral different points. 

 In other particular cafes, circumlb.nces, and habits, there 

 will be no union at all, the torn cellular membrane, or the 

 flaked aponeurofis will inflame and become doughy, a con- 

 Cderable quantity of matter will be collected, and, perhaps, 

 .the cranium will be denuded. But even in this cafe, if the 

 furgeon takes proper meai'ures, and refrains from being too 

 much in a hurry to cut, things will be more profperous than 

 inay_ be expected. Let him take care to keep the inflam- 

 mation I'.uder by proper means ; let him have patie'.ice till 

 the maUer is fairly and fully formed, and the Houghs per- 

 feftly feparated ; and when this is accompliflied, "let him 

 make a proper number of dependent openings ; and let him, 

 by bandage and other proper management, keep the parts 

 in conilant contadt with each other, and he will often iind, 

 that, although he was foiled in his firil intention of pro- 

 curing immediate union, yet he will frequently fucceed in 

 this his fecond ; he will ftill fave the fcalp, fliorten the cure, 

 and prevent the great deformity ariling, particularly to wo- 

 men, not only from the fear, but from the total lofs of 

 hair. 



Many perfons have erroneoudy thought, that, when the 

 pericranium is flripped off the cranium by external violence, 

 or is afterwards call off, the fcalp cannot unite to the de- 

 nuded cranium, which mull of neccfllty exfoliate. However, 

 thefe notions are now well known to be unfounded. The 

 expofed part of the (kuU, uniefs much injured by contufion, 

 or improperly irritated by llimulating applications, will ge- 

 nerally live, throw out granulations, and become united to 

 the feparated fcalp, without any exfoliation 



Pun^ured •wounds of the fcalp are more apt than cuts to in- 

 flame and give trouble, and are indeed frequently the caufe 

 of fevere and alarming fymptoms. 



According to Mr. Pott, if the wound affects the cellular 

 membrane only, and has not reached the aponeurofis, or pe- 

 ricranium, the inflammation and tumour affeCl the whole 

 head and face, the (kin of which wears a yellowifli call, and 

 is fometimes thick fct with fmall bhfters, containing the fame 

 coloured ferum ; it receives the impreffion of the lingers, 

 and becomes pale for a moment, but returns immediately to 

 its inflamed colour ; it is not very painful to the touch, and 

 the eye-lids and ears are always comprehended in the tume- 

 faftion, the former of which are fometimes fo dillended as 

 to be clofed ; a feverifli heat and thirlt generally accompany 

 it ; the patient is relllefs, has a quick pulfe, and moil com- 

 monly a nnufca and inclination to vomit. 



Cafes are moll difpofed to affume this form in perfons of 

 bilious habit, the inflammation being in fadl erylipelatous. 

 The diforder is fomewhat alarming to look at, but it is not 

 ofcen attended with dantjer. Mr. Pott remarks, that the 



fuffer the IcnCve pain, and fatiguing reftleffncfs, which gp- 

 nerally attend mifchief underneath the flcull. 



Such eryfipelatous inflammation commonly foon yields to 

 phlebotomy, lenient purges, and febrifuge medicines, parti- 

 cularly thofe of the neutral kind. When the inflammation 

 is gone off, it leaves on the fl<in a yellowifli tint, and a dry 

 fcurf, which alio, in time, difappear. Immediately the dif- 

 order fubfides, the wound puts on a healthy ai'pedt, and heals 

 without trouble. 



Surgeons muft carefully diftinguifh from the foregoing 

 cafe another kind of erylipelatous fwtlling and inflammation 

 to wliich the fcalp is liable, as one of the effedts of inflam- 

 mation and fuppuration of the dura mater. In this laft im- 

 portant diforder the febrile fymptoms are much higher, the 

 pulfe harder and more frequent, the anxiety and reftleffnefs 

 extremely fatiguing, the pain in the Iiead intenfe ; and as, in 

 thefe circumllances, the fwelhng of the fcalp is moll fre- 

 quently the immediate precurfor of matter forming between 

 the Ikull and dura mater, it is generally attended with irre- 

 gular fliiverings, which are not followed by a critical fweat, 

 nor aftord any relief to the patient. When the inflammation 

 is confined to the parts on the outlide of the fltuU, the e-r^-fi- 

 pelas generally appears within the liril three or four days :■- 

 but when the dura mater is affeded, it feldom comes on till 

 feveral days after the accident, when the fymptomatic fever 

 is got to fome height. In the finiple eryllpelas, although 

 the wound be crude and uudigelled, yet it has no other 

 mark of mifchief; the pericranium adheres hrmiy to the 

 fliuU, and, upon the cefiation of the fever, all appearance* 

 become immediately favourable. In that which accompanies 

 injury done to the parts underneath, the wound not orly has 

 a Ipongy, glaffy, unhealthy afpeft, but the pericranium in its 

 neighbourhood feparates fpontaneoufly from tlie bone, and 

 quits all cohelion with it. In fliort, fays iVlr. Pott, one is 

 an accident proceeding from a bilious habit, and not indi- 

 eating any mifchief beyond itfelf; the other is a fymptom, 

 or a part of a difeafe, which is occafioned by injury done to 

 the membranes of the brain ; one portends little or no ill to 

 the patient, and almofl always ends well ; the other implies 

 great hazard, and mod commonly ends fatally. 



When the wound is fmall, and reaches to the aponeurofis 

 and pericranium, dilagreeable, and even alarming lymptoms 

 fometimes arife. In the cafe alluded to, the inflamed fcalp 

 does not rife into that degree of tumefaction as in the ery- 

 fipelas ; neither does it pit, or retain the impreffion of tiie 

 fiii'^ers of an examiner. It is of a deep red colour, unmixed 

 with the yellow tint of the erylipelas ; it appears tenfe, and 

 is extremely painful to the touch. The ears and eye-hds are 

 feldom comprehended in the tumour, though they may par- 

 take of the general inflamm.ation of the Ikin. It is gene- 

 rally attended with acute pain in the head, and fuch a degree 

 of fever as prevents fleep, and fometimes brings on dehrium. 

 A patient, thus affected, may be more freely bled than one 

 labouring under an erylipelas. Wami fomentations are pro- 

 per in both cafes; but emollient poultices, which are for- 

 bidden in eryfipelatous difeafes, may be employed in the 

 prcfent inrtance with much advantage. 



In exceedingly urgent cafes, Pott recommends making a 

 divifion of the wounded part down to the bone, to the extent 

 of half an inch, or an inch, as the bell means of Hopping the 

 fever, and preventing the aponeurofis and pericranium from 

 becoming floughy. 



Mere contufions of the fcalp, unattended by fra£lure, or in- 



wound does, indeed, neither look well, nor yield a kindly jury of the parts within the cranium, are not of ferio-.is im- 

 portance, confidered abftractedly. It frequently happens, 

 that when a fevere bruife has been inflicted on the fcalp, a 

 large tumour, containing estravaiated blood, quicklj ril'eg 



upon 



difcharge, while the fever continues ; but ftill it has none ot 

 that look which befpeaks internal mifchief; the fcalp con- 

 tinues to adhere firmly to the IkuU ; nor does the patient 

 6 



