306 
Gr. ARCHIE STOCK WELL. 
When fracture is not promptly followed by collapse and dis¬ 
solution, the first question that presents itself is, the feasibility of 
surgical interference, including operative measures for the relief 
of compression. 
From various experiments conducted on lower animals, especi¬ 
ally in connection with intra-dural inoculations and the artificial 
production of suppuration, abscesses aud compression, I am satis¬ 
fied that operative interference, in a majority of instances, is not 
oidy feasible and justifiable, but desirable and imperative, even to 
the free use of the knife upon the brain, and within its cortical 
substance! 
If the evidences of compression are continuous and urgent, as 
manifested by unconsciousness, coma, stertorous respiration, di¬ 
lated pupils and motor paralysis, they may justly be attributed to 
depressed bone or the introduction of some substance from with¬ 
out. If the evidences appear only after a lapse of some hours, 
we are well grounded in surmising them the result of hemor¬ 
rhage ; if delayed for some days, to pus. In either case com¬ 
pression will be uniform, owing to the adaptability of the cerebro- 
final fluid, and its obedience to the well-known law that fluids 
under all circumstances maintain their equilibrium. Again, where 
the blood-vessels are largely deprived of their contents, we have 
anemia , whence unconsciousness, coma and labored respiration ; 
and when the corpora quadrigemina and third pair also suffer, 
dilatation and paralysis are to be expected. Undoubtedly, in the 
great majority of instances compression is due to extravasated 
blood, or the formation of purulent fluid; and so far as can be 
gathered from statistics, it would seem that at least six-tenths are 
due to the latter cause. 
Following statistical evidence further, we find pus forms be¬ 
tween the dura and skull in five per cent, of the cases only, and 
that in twenty-five per cent, it arises from suppurative meningitis, 
and in seventy per cent, develops an abscess with the cerebral 
substance! 
“ Symptoms of purulent fluid within and about the meninges 
commonly occur between the sixth and twenty-first days; but 
those of cerebral abscess, only between the fourteenth and twenty- 
fifth day.”— Naucrede. (!) 
