Linear craniotomy (miscalled craniectomy) for microcephalus / by W.W. Keen.

  • Keen, William W. (William Williams), 1837-1932.
Date:
1891
Catalogue details

Licence: Public Domain Mark

Credit: Linear craniotomy (miscalled craniectomy) for microcephalus / by W.W. Keen. Source: Wellcome Collection.

Provider: This material has been provided by The Royal College of Surgeons of England. The original may be consulted at The Royal College of Surgeons of England.

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    anxiety. Dr. Taylor did not leave the house till an hour after the operation, when the child's pulse and respiration were entirely satis- factory. An hour and a quarter after the close of the operation the child gave a few gasps and died instantly, presumably from heart- failure. It had not recovered consciousness after the operation. No post-mortem examination could be obtained in spite of the most earnest efforts. Case IV. (Gerster and Sachs).—A. F., female, aged four and a half years; labor normal; first child ; began to walk after the age of two years ; in third year began to speak a few words; but these she would use properly. When thirteen months old had measles. At fifteen months two distinct convulsive attacks without paralysis. Other convulsive attacks at the age of twenty- two months and at twenty-nine months; none since. After these attacks grew more idiotic; lost what little speech she had, became unruly, fretful and ill-tempered ; slept little. The fontanelles had disappeared. The meas- urements taken on shaved head were: Circumference, 31 cm.; fronto- occipital, from root of nose over top of head to occipital prominence, 30 cm.; biauricular, 32} cm. The child was operated under chloroform, the period of anaesthesia lasting not more than fifty minutes; linear craniotomy was done on the left side, from in front of the position of the coronal suture and beyond the lambdoidal suture. The opening in the skull was semicircular. The child's pulse was weak as soon as chloroform began to act; recovered nicely, however. Soon after operation was conscious, and pulse rallied. Without the further accident the child died suddenly three and a half hours after operation, from acute anaemia. Case V.—In the New York Med. Record, Feb. 21, 1891, Dr. John A. Wyeth reports a case of a male child, eleven months old, operated on by a median incision of the scalp from the nose to the occiput. Two lateral trenches, one-fourth of an inch wide and three-fourths of an inch apart, were made from just above the eyes to the occipital protuberance. At each end a transverse cut was made in the bone on each side and a similar trans- verse cut on each side at the middle. By the fingers these four bone flaps were then forcibly torn loose from the dura mater, widening the trenches from one-fourth of an inch to one inch each. No injury seems to have been done to the dura. Time required, an hour and a half. Wound well without incident in ten days. A month later the improvement was surprising and gratifying. The intelligence had greatly increased. Cases VI. and VII.—Two cases reported by Lannelongue in L'Union M'edicale, July 8, 1890, and of which a resume appears in my clinical lecture in The Medical News of Nov. 29, 1890. Case VIII. (Dr. J. C. McClintock's case.)—A girl, aged three years and eight mouths, though appearing to be not over one year of age. Premature birth at eight months; no instruments. Anterior fontanelle closed very early. Totally blind; not the faintest signs of intelligence. Two years ago the orbital plate of the frontal bone on the right side gave way, displacing the right eyeball from the orbit. The knee-joint became very painful a few months ago, and the arms and lower limbs contracted. Right tibia and fibula and left femur curved. Head narrow, forehead low. Linear crani- otomy (March 28, 1891) on each side of the longitudinal sinus, with lateral grooves at the two ends. The tips of the fingers were then passed into the grooves, and the bones spread on each side until the quarter-inch groove became an inch wide. The dura was not opened. Next morning the tem- perature was 103° with rapid pulse, but soon subsided to normal. Entire union at the end of a week. The time is too brief as yet to judge of the re- sult, but Dr. McClintock reports that the mother says that since the opera- tion the child is not so restless, does not cry nearly so much,and has required much less care and attention. The extremities are not so tender, and the child will try to play with any little article that is given to it. Before the operation she could only lie on one side; now she will lie on either side.