The first lines of the theory and practice of surgery: including the principal operations (Volume 2).

  • Cooper, Samuel, 1780-1848.
Date:
1844
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Licence: Public Domain Mark

Credit: The first lines of the theory and practice of surgery: including the principal operations (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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    flaramation spreading rapidly, and soon involving not only the scalp, but the forehead, eyelids, and greater part of the face. Too often also, notwithstanding the most judicious treatment, delirium, or co- ma, comes on, and the case has a fatal termination. I know of several instances, in which the removal of very small encysted tu- mors from the head led to the production of phlegmonous erysipe- las, in so violent a form that the loss of life was the result. Contusions of the head frequently give rise to an effusion of blood under the aponeurosis of the occipito-frontalis. The swelling is generally soft in the centre, and hard at its circumference; hence the feel of it may lead an inexperienced surgeon to suspect, that the accident is a fracture of the skull, with depression of the bone. In other instances, the extravasated blood may lie immediately under the scalp, and cover all the upper part of the head, raising up the soft parts in a manner that creates an alarming degree of disfigure- ment. In general, however, these accumulations of blood under the scalp, from blows on the head, subside very favorably under the use of a few brisk purgatives, and the application of lotions, con- taining a proportion of the muriate of ammonia, diluted acetic acid, and camphorated spirit. If, however, inflammation and abscess were not to admit of being prevented, fomentations, poultices, free openings, and washing out all the matter and putrid blood with a syringe and tepid water, would be the proper treatment. When the scalp is wounded, or severely contused, the hair should always be cut off immediately; and, in many cases, it is a matter of prudence to shave the whole scalp, not merely that the wound may be rightly and conveniently dressed, but that every part of the out- side of the head may be seen and duly examined, and every mark of external violence detected. Haemorrhage is, of course, to be stopped, and the wound freed from extraneous substances, and clots of blood; rules applicable to wounds in general. Frequently the scalp is not merely wounded, but lacerated, bruised, and more or less extensively separated from the subjacent parts. In many instances, not only is the scalp thus torn and detached, but a portion of the skull completely denuded, the aponeurosis of the oc- cipito-frontalis muscle and the pericranium being torn up together with the scalp. Here the raised portion, or flap, of the scalp, how- ever torn and irregular it may be, should never be cut away, but be immediately replaced, and laid down upon the exposed portion of the cranium. The scalp is exceedingly vascular, and nature is more successful in repairing its injuries, than circumstances would some- times lead us to anticipate. At all events, the chance of its pre- servation and reunion should be taken; for, if we succeed, we ma- terially lessen the risk of necrosis of one or both tables of the skull. Wethus expedite the patient's cure, and obviate the deformity which would ensue, either from cutting the flap away, or leaving it more or less displaced from the parts with which it was naturally