A dictionary of practical surgery: comprehending all the most interesting improvements, from the earliest times down to the present period : an account of the instruments, remedies and applications employed in surgery : the etymology and signification of the principal terms : ... forming together a "catalogue raisonné" of surgical literature (Volume 2).

  • Cooper, Samuel, 1780-1848.
Date:
1823
Catalogue details

Licence: Public Domain Mark

Credit: A dictionary of practical surgery: comprehending all the most interesting improvements, from the earliest times down to the present period : an account of the instruments, remedies and applications employed in surgery : the etymology and signification of the principal terms : ... forming together a "catalogue raisonné" of surgical literature (Volume 2). Source: Wellcome Collection.

Provider: This material has been provided by the National Library of Medicine (U.S.), through the Medical Heritage Library. The original may be consulted at the National Library of Medicine (U.S.)

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    Immediately (he operation was finished, the temporal arteries were opened, and some purgative medicines exhibited. In a case of fungus of the dura mater, with diseased bone, mentioned by Schmuck- er, the trepan was applied eleven times in less than a month, and the operation used to cause so little indisposition, that the patient bardly ever required to go to bed afterward, and, on one occasion, actually went to mar- ket an hour after its performance. ( Wahrneh- mungen, B. I, p. 456.) Let not the young surgeon, however, draw from these dazzling cases of success an im- moderate solicitude to perform the opera- tion ; for it should never be undertaken but in the most pressing circumstances, and when the symptoms unequivocally show that a dangerous degree of pressure on the brain exists. I recollect an unfortunate ex- ample, in which the late Mr. Kamsden, of St. Bartholomew's Hospital, ventured to saw out a portion of the frontal bone for a mere long- continued pain in the part: -the palient was attacked with inflammation of the dura ma- ter, and perished in three or four days. We may therefore conclude, that the operation is not itself exempt from danger} and it is certain, that it ought never to be resolved on without deep consideration. Gravis tamen satii est operatio, ut nunquam, nisi in- dicationes sujjkienles udsint, institui debet. (Calfisen Syst. Chir. Hodiern. Tom. 1, p. 658.) The trepan, or trephine, is never neces- sary in injuries of the head, except for the purpose of relieving the brain from pressure. Such pressure may be caused by a depressed portion of the cranium, or it may be pro- duced by an extravasation of blood, or the lodgment of matter, betwixt the skull and the dura mater. The chief danger of con- cussion, when the accident is not directly or soon fatal from the disorganization and mischief done to the brain, depends upon the consequent inflammation of this organ, and therefore can be little likely to be be- nefited by the use of the trepan. If the operation becomes proper in such a case, it is when an abscess has formed under the cranium, and when the confined matter it- self creates bad symptoms by its pressure on the braiu. This state of things, how- ever, cannot come on till after the inflam- mation of the brain and its membranes has prevailed a certain time, and it is always accompanied with a detachment of the pe- ricranium and a puffy tumour of the scalp; or, if there be a wound of the latter part immediately over the abscess, the lips of the injury suddenly acquire an unfavour- able appearance, and lose their vermilion colour. The patient has also had much preceding febrile disorder, pain and tension over the whole head, redness and tumes- cence of the eyes, mid generally more or less delirium. When the matter is forming, there are usually some rigours, and, as soon :is it is formed, the patient falls into a co- matose state, and paralytic symptoms show elve<«. Here the urgency for th^ prompt application of the trephine is very great, and the patient's chance of living is almost essentially connected with the imme- diate performance of the operation. This important case has been particularly dwelt upon in the writings of Mr. Pott. In the article, Head, Injuries of, I have laid down the most remarkable symptoms of concussion, and compression of the brain, a subject which every surgeon should study with earnest attention, before he ever pre- sumes to employ the trepan. For, some- times these accidents are extremely difficult to be discriminated ; sometimes they exist together in the same individual ; a compli- cation which is peculiarly embarrassing; and in every instance where the symptoms are those of concussion, the operation, so far from being indicated, would be a step of all others the most likely to do harm, by in- creasing the irritation and inflammation of the brain and its membranes. A fall upon the back, or upon the head, occasions a di- rect concussion of the brain, and the shock not being materially weakened by the in- tervention of any yielding elastic structure, is the more dangerous. When a person has fallen from a certain height, and pitched on his head, his back, the buttock*, the knees, or even the soles of the feet; when he has been instantly deprived of his senses, and then by degrees recovered them and come to himself again ; the (act of his having suf- fered concussion of the brain is clear and indisputable. Concussion has likewise taken place, (hough in a slighter degree, when the patient bas been only stunned by the fall, and experienced a sensation of sparks. But a multitude of degrees separate this feeble concussion from that in which the substance of (he brain is instantaneously di-orgatnzed, so that the patient has not Ihe possibility of recovery. The symptoms of concussion of tbc brain are attended with coma, and il»<: compres- sion of this organ by au extravasation is also accompanied wit^ lethargic heaviness. How then is '^o surgeon (o ascertain, whether the comatose disorder arises from one o'- the other of these affections? Here in order to avoid repetitions, I beg leave to refer to (he observations already made in the article quoted above. But there is one criterion of such first-rate importance, that it may prevent innumerable fatal mis- takes', and, indeed, without the continual re- collection of it, no man ought to be rash enough to interfere with this dark and ab- struse part of surgery. On this account, I shall mention it here, notwithstanding it has been already noticed elsewhere. If the pa- tient is knocked down and stunned directly by the blow, and remains in a state insen- sibility, these primary symptoms » asiri- bable to the concussion. On the contrary, when the coma and loss of senseWo not lake place till an hour or two after the blow, they are to be imputed to an extrava- sation. The shock given to the brain by concus- sion must, like every other impulse to nrau-