Lectures on the operations of surgery : and on diseases and accidents requiring operations / by Robert Liston ; with numerous additions by Thomas D. Mütter.

  • Robert Liston
Date:
1846
Catalogue details

Licence: Public Domain Mark

Credit: Lectures on the operations of surgery : and on diseases and accidents requiring operations / by Robert Liston ; with numerous additions by Thomas D. Mütter. 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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    flaps you have made over as well as you can, and perhaps you would retain them on by a slip or two of plaster. You would not cover the opening altogether, but leave a small space for the water to escape. You find after a time that granulations spring up from the dura mater, from the edges of the opening and the flaps. They thus come together, and the opening will be closed not by bone but by membrane. [It occasionally happens in young persons where the bones are vascular, that a deposit of lymph takes place upon the dura mater and in the orifice made by the trephine, in which deposit after a time, ossific points are discovered, and at length coalesce and thus close the opening entirely. From the fact that in the vast majority of cases no such union occurs, the older surgeons were in the habit of introducing into the opening plates of gold or silver, for the pur- pose of protecting the brain, but no such precaution is requisite, and the plate always does harm by acting as a foreign body and preventing union of the scalp. Its use has for many years been entirely abandoned.—T. D. M.] You now and then meet with cases where a patient receives an injury to the head ; he is stunned, perhaps, and after a little time recovers from this state of stunning and then falls into a state of coma. This sometimes occurs after injuries upon the temples. You can easily understand that when the effects of the concussion have gone off and the patient is suffering from an extravasation of blood on the brain, from an interruption to its circulation, and so on, you have nothing to lead you to the exact seat of the internal injury. You may easily enough conjecture that the cranium has been split in the temporal region—that the middle meningeal artery has been torn, and that the patient will in all probability die. You will find, on examination after death, a large clot between the bone and the dura mater—a clot consisting of some five or six ounces of blood, quite enough to account for the deep coma and the patient's death. Now, are you warranted in looking out for this extravasation of blood ? I think Mr. Cooper is of opinion that you are, but I regard it as very doubtful whether you ought to sub- ject the patient to an operation in such a case. Though it might do no harm, yet the probability is that the clot would not be dis- covered, and if it were there would be great difficulty in removing it. It wrould only be by a very extensive operation with the tre- phine, by applying it over and over again, and taking away a large portion of bone, that you could hope to succeed. A case of this nature was some lime since treated by one of our able physicians in the hospital. D. K., a tall, robust man, aetat. 47, brought to the University College Hospital, March 26, 1839, by the police, who found him, last night, lying in the street in a state of insensibility. The man
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