INJURIES. 



crmuiTn, in.lencTofHdliering firmly to tJie bone, will fepa- 

 rr.re from it all round to fome diftance from tlie cdfjes. 



This alteration in the face and circumftances of the fore is 



'.'iced merely by the difeafed itate of tlic parts nndemcath 



icull, as is demonftrably proved, by obferving that the 



.fpeft of the woand, and the fpontanijous feparati«n of 



- ricranium, are always confined to that part which covers 



I'-'ercd oi-injiired portion of the di;ra mater, and do not at 



; .'^L-(\. the refl of tiie fcalp ; nay, obferves Mr. Pott, if it 



' y accident been wounded in any otiier part, or a por- 



has been removed from any part where no injury has 



: Jone to the dura mater, no fuch feparalioir will happen. 



• detachment above wi lalvvayscorrefpond to that below, 



10 found no where elfe. 



. ■. firll the expofed part of the (kull appears whiter and' 



dry than natural, and in proportion as the dura mater 



irates or beco.-n;3 floiigliy, the bone inclines more and 



. \; to a kind of purulent hue, or whitifh yellow. It 



u.-LL-rves notice, like.vife, th;it if tiie blow has occurred near 



a future, and thj fubjeft is younj, fuch future often fepa- 



rates fo as to let through it a loofe painful fungus. At 



this period iilTo the head and face are freq^uently Attacked 



with eryfipelas. 



The above defcribed effefts of certain contufions of the 

 kead are frequently found to accompany filTures and unde- 

 preiTed fraftures of the cranium, as well as extravafations of 

 ihiid, where the bone is entire ; and on the other hand, fays 

 Mr. Pott, all thefe do often happen without the concurrence^ 

 of this individual mifchief. Al!' this is matter of accider/t ; 

 but let the other circum'lar.ces be what they may, thefpon- 

 raneous ieparation of the altered pericranium., in eonS-quence 

 of a fevere blow, is almollr always followed by a fuppuration 

 between the cranium and du'-?. mater ; a circumilance, which' 

 Mr. Pott points out as highly worthy af attention in fi/Tures 

 and undeprefifed fractures of the llvull, becaufo it is from this 

 eaufe principally that the bad fymptoms, and the liazard'in 

 fuch cafes, arife. 



The fituation of e>:travafated blood within the cranium is- 

 eften uncertain ; but that of inflammation and fuppuration 

 of the dura mater, in confequence of external violence, is 

 almoft furely indicated, even whea the (\dn is quite free from 

 ■wound, or other mark of injury, by a puffy, circnmfcribed; 

 indolent tumour of the fcalp, and a fpontaneous feparation 

 of the pericranium from the iltuU under the fwelling. ■ 



It fhould be underitaod that none of the bad fynvptoms 

 are owing to tlie feceiTion of the perrci-anium, but to the 

 inflamiTiation of the dura mater. Hence, though the fcalp 

 may be fo wounded or torn by airy accident, as to leave a 

 part of the Ikull quite bare, the pericranium being feparated 

 by the violence, yet if the force has not been fuch as to 

 affeft the dura mater, the alarming train of evils above ex- 

 -plained do not follow. Here the bell praftice is to lay 

 down the fcalp in its natural fituation again, and give it the 

 opportunity of uniting. 



It remains for us to confider the treatment of the refpcC' 

 tive cafes, where there is either danger of an inflammation of 

 tJie dura mater coming on, or where the affeftion atlually 

 prevails, attended with the formidable fymptoms already de- 

 tailed. 



Every man of experience will coincide with Mr. Pott, that 

 of all the remedies in the power of art, for Inflammations of 

 membranous parts, there is none equal to p'llebotomy, and 

 thit if any thing can particularly contribute to the preven- 

 tion of the ills likely to follow fevere contufions of the head, 

 it is tiiis kind of evacuation ; but then it mail be made ufe 

 of in fuch a manner as to become tr'aly a preventive ; that 

 is, it muil be made ul'e o£.i:aui2diatcly and freely. 



There will often be feme difficulty iti perfuading a pcrfon, 

 who has had what may be called only a knock on tlie par-r, 

 to fubmit to fuch difcipline, tfpecialiy if he finds himfe 

 tolerably well : yet, in many inllanccs, the timely ufe.. or the 

 neglect of this fingle remedy, makes all the dificrcFce be- 

 tween fafety and fatality. It is true, thafby this n^ethoj 

 patients mull fometimes be b'ed, who would efcape inflam- 

 mation of tlie dura mater without fuch evacuation ; yet, let 

 it be remembered, that the lofs- of blood, howevtr '.nne-- 

 celTary in theie cafes, never endangers life, while it is fre- 

 quently the means of prefcrving it. In fliort, we muft agree 

 with Mr. Pott, tliat if every perfon who meets with a fe- 

 vere blow on the head were to be bled, as he undoubtedly ' 

 ougiit to be, many a very valuable life would be prcfcrvcd, 

 which, for want of thi-i kind of alTiflance, is loll. Acce- 

 leration, or hardnefs of pulfe, refileiiiitfs, anxiety, and any 

 degree of fever, after a fiiiart blow on the head, are always' 

 to be fufpecled and attended to. Immediate, plentiful, and 

 repeated evacuations have, in many iuttances, removed thefe - 

 complaints in perfons, to whom, Mr. Pott bclie\''es, very 

 terrible niilchief would have happened, had not fuch precau- 

 tion been ufcd. From thefe obfervations, however, let it not 

 be concluded, that early bleeding will always prove a certain ' 

 prefervative ; like all other human means it is fallible ; but, 

 if it fometimes fails, it alfo fucceeds to a greater extent than • 

 atiy other known plan. 



When the inflammation; of the dura mater has produced' 

 matter under the ci"aniura, the fluid ougjit to be difcharged 

 through a perforation of the bone. This operation ought' 

 always to be done immediately when the above defcribed- 

 lymp.toms ir.aaifetl the nature of the cafe. The fpontaneous" 

 Ieparation of the dura mater, if attended' with general 

 diforder oFthe patient, with chiliinefs, borfipilatro, lang^i'.or,' 

 and fever, was invariably conlldered by Mr. Pott a fure in-., 

 dication of mifchief underneath, and an urgent reafon for' 

 perforating the bone without delay. In fonie cafes one per- 

 ibration will fuffice ; in others, more openings mu!): be made. 

 This variation will depend upon the fpace of' detached 

 dura mater, and the quantity of matter collected. 



The repetition of blood-letting, of cooLng laxative me- 

 dicines, the ufe of antiphlogillic remedies, and a moil drift 

 oblervance of a low diet and regimen, are as indifpenlably. 

 requifite after trephining as before. The perforation obvi-' 

 ates the dangerous effefts of the confinement of matter;- 

 but it does nothing more : and the inflamed ftate of the' 

 parts under the ilcuUftill' calls for our moft earikft attention. 

 See Pott on Injuries of the Head. 



Fr,%ilures of the Shull. — 'Whenever the head is ilricken with- 

 a certain degree of viofonee, tlie eS'eft is not limited to a 

 vehement concuflion of this part of the body, or to the 

 bruifing and wounding of the fcalp ; the bont s forniiog the* 

 cranium are alfo liable to be broken. When the weapon, 

 or thing with which the blow is given, prefents an angular 

 or a projefting furface,- the frafture generally happens where 

 the violence is immediately applied ; but it may occur at a 

 different part of the head, when produced by a body of a 

 certain widtii. The poflibillty of fi-achires happening in a 

 fituation more or lefs diftant from tUat which received i.'.e 

 blow, is explicable on the principle of the unequal re- 

 fi.laiice oQered by the pai'ietes of the cranium at different 

 points of their extent. It is to fuch cafes that the name of 

 cour,:er-_fJfures is given. 



In order to explain the manner in which counter-fiflures 

 are produced, let us fuppofe a blow to fall upon the os ' 

 frontis, with a force equivalent to twenty, which bone, 

 being in the fituation of the forehead fomewliat thick, makes 

 a reuitar.cc equal to twenty-five. The falution of coDtinu- 



