INJURIES. 



^ipon tbe head, or blows on this part with ftones, flicks, &c. 

 Bat, notwithltanding the immenfe disfigurement aUonding 

 this fort of accident, if the Ilcull and its contents be free 

 'from injury, the cafe is no: of a dangerous nature. The 

 efTufcd blood generally admits of being removed by abforp- 

 ■tion, provided the furgeon is careful to keep the patient's 

 bowels wi-11 open with faline purges, and apply to the tu- 

 mour itfelf linen wet with the fatuniine lotion, or with a 

 lotion compofed of fpirit of u-iiic, vinegar, and the muriate 

 ■ot ammonia. Many furgical authurs countenance the plan 

 of difcharging the coUedion of blood by a fmall punfture. 

 As far as our obfervations extend, thio praftice fliould be 

 avoided in the generality of inllances. When an opening 

 is made, fui)puration within the fwclling becomes inevitable. 

 On the contrary, abfcefl'es may frequently be prevented 

 altogether, by allowing the abforbents to do the office of 

 .taking away the efFufed blood, aiTilled by the means already 

 recommendejd. It is not to be denied, howevei-, that matter 

 will fometimes form, and then tiie method of making an 

 opening for the difcliarge of the contents of the fvvelling is 

 undoubtedly proper. 



With regard to thofe tumours of the fcalp, which are the 

 ■confequence of blows, falls, &c. and which arc filled with 

 effufed blood, J. L. Petit made a remark, which has been 

 repeated by all fubfequent writers, namely, the facility with 

 which the centre of the fvvelhng may be deprefl'ed, while the 

 circumference fcems hard and prominent, circumflances which 

 may eafily impofe upon the inexperienced furgeon, and lead 

 ■him to miftake the cafe for a frafture of the cranium with de- 

 prefTion of the bone. If, upon fuch a fuppofition, lie imme- 

 diately makes an incifion into the tumid fcalp, he may give 

 the patient a great deal of unnecefTary pain, and endanger 

 his own reputation. 



It is obferved by Mr. Pott, that in this cafe the touch is 

 fo liable to deception, that recourfe fhould always be had to 

 other circumflances and fymptoms, before an opinion is 

 .given. If a perfon, with fuch tumour occafioned. by a 

 "blow, and attended with fuch appearances and fcel, feems to 

 "labour under dangerous prelTure upon the brain, a divifion 

 of the fcalp, in order to enquire into the ilate of the (Icull, 

 is right and nfceffary ; but if the patient is well, or not 

 ■ferioutly affefted with any fymptoms of compreflion, the 

 mere feel of fome thing like a frafture, nay, we may add, 

 .even the acluaSexiftence of a frafture itfelf, will not autho- 

 rife or vindicate cutting the fcalp. 



For an account of the fymptoms of prelFure on the brain, 

 fee CoMPiUissioN and Extravasation. 



InflantKuition of the Dura Mater, and Suppuration under the 

 Skull. — The fymptoms attending an inflamed or doughy ilate 

 of the membranes of the brain, in confequence of external vio- 

 lence, are all of the febrile kind, and never at firil imply any un- 

 natural prefl'ure upon the brain. When, in thefe cafes, the 

 fymptoms of prefTure come on, it is not until the latter esd 

 of the difcafe, that is, until a con fiderable -quantity of matter 

 is formed, which matter raufl prefs like any other fluid. 



The late eminent Mr. Pott has written a mofl aMe de- 

 fcription of the inflammation and fuppuration of the dura 

 mater from external violence. The following obfervations 

 are chiefly from his jien. 



When there is neither fiflure nor frafture of the flcuU, nor 

 oxtravalation, nor commotion underneatli it, and the fcalp is 

 neither confiderably bruifed nor wounded, the mil'chief is 

 feldom difcovered or attended to for fome few days. The 

 firfl attack is generally by pain in tlie part which received 

 the blow. This pain is foon extended all over the head, and 

 is attended with a languor or dejeftion of flrength and 

 ^irits, which are foon followed hy a naufea and inclination 



to vomit, a vertigo or giddinefs, a quick and hard puMe, and 

 an incapacity of fleeping. A day or two after this attack, 

 if no means preventive of inflanmiation are ufed, the part 

 ftricken generally fwells, and bet;omes puft'y and tender, but 

 not painful. Neither does the tumour rife to any confiderable 

 height, nor fpread to any great extent. If this tumid part 

 of the fcalp be now divided, the pericranium will be found 

 of a darkifii hue, and either quite detached, or very eafily 

 feparable from the fl<ull, between which and it will be found 

 a imall quantity of a dark-coloured ichor. If the diforder 

 is fo advanced, that the pericranium is quite feparated from 

 the fliuU, the latter will be found fomewhat altered in colour 

 from a healthy bone. 



From this tune the fv-mptoms generelly advance more 

 haflily and more apparently; the fever increafes, the flcin 

 becomes hotter, the pulfe quicker and harder, the fleep more 

 difturbed, the anxiety and reflleffnefs more fatiguing ; and 

 to thefe, fays Mr. Pott, are generally added irregular rigours, 

 which are not followed by any critiual fweat, and which, 

 inflead of relieving the patient, add confiderably to his fuf- 

 ferings. If the fcalp has not been divided, until the fymp- 

 toms are thus far advanced, the altwation of the colour oF 

 tlie bone will be found to be more remarkable ; it will be 

 found to be whiter and more dry than a healthy one ; or, 

 as Fallopius has obferved, it will appear rather like dead 

 bone. 



There will be more fanies or fluid under the pericranium, 

 and this membrane will have a more livid afpefl. 



In this ftate of matters, if the dura mater be denuded, it 

 will be found to be detached from the infide of the cranium, 

 to have loll its bright filver hue, and to be fmeared over 

 with a kind of mucus or pus. Every hour after this period 

 Jill the fymptoms are exafperated ; the he;id-ache and thirll 

 become more intenfe, the flrength decrcales, the rigours are 

 more frequent, and, at laft, convulfive motions, attended in 

 fome with delirium, in others with paralyfis, or comatofe 

 ftupidity, finifli the tragedy. 



If the fcalp is now divided, a very offenfive difcoloured 

 fluid will be found lying on the bare and altered cranium. 

 If, at this period, a perforation is made in the bone, matter 

 will be found between it and the dura mater, generally in 

 <;onfiderable quantity, but different in diflerent cafes and 

 circumflances. Sometimes it will be in great abundance, 

 and diffufed over a very large part of the membrane ; and 

 fometimes the quantity will be lefs, and confequently the 

 fpace which it occupies fraaller. Sometimes it hes only on 

 the exterior furface of the dura mater ; and fometimes it is 

 between it and the pia mater, or alio on the furface, or in 

 the fubrtance of the brain 



Tlie foregoing mifchief is entirely the confequence of the 

 contufion which the head has fuff.-red. But it defervei 

 attention, fhat as the inflammation and feparation of the 

 dura mater are not immediate confequences of the violence, 

 fo neither are the fymptoms immediate, feldom coming oa 

 until fome days have pafled. 



We have next to conlider the cafe where the fcalp has 

 been wounded, either by the accidental violence, or by 

 the furgeon making an inciiion immediately afterwards 

 for the examination of the bone. Here the wound will, 

 for fome little time, have nothing particular about it ; 

 but after a few days, any favourable appearances which 

 it may have put on will vanifli ; the fore will loi'e its florid 

 complexiim and granulated furface ; will become pale, 

 glaliy, and flabby; inflead of good matter, it will dif- 

 charge only a thin difcoloured fanies ; the hnt with which 

 it is drelfed, inflead of coming off eafily, as in a kindly 

 fuppurating fore, will Hick to all parts of it ; and the pen- 



cranittjn 



