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
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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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    advise the operation whenever there exists an external wound or bruise over a vascular region of the cranium, and the symptoms of compression are suddenly developed and urgent, as in the boy operated on by Dr. Physick. When the operation is performed and we are successful in reaching the deposit of blood, if this be lodged between the membranes and the bone, it is for the most part thrown out by the pulsations of the brain. Hence it is unnecessary to attempt its removal with scoops, &c. &c. And as all such efforts produce more or less irritation they are carefully to be avoided. Where, however, the blood is coagulated and cannot escape in conse- quence of this circumstance, we may break down the mass with a probe used with the utmost caution. When the blood lodges between the dura mater and the brain, the membrane projects into the opening made by the trephine and forms a purplish tu- mour. In such a case there is obviously but one course to pursue, and that is to puncture the membrane and thus give egress to the blood. I am aware that some surgeons oppose this operation, but surely as we cannot relieve the compression without removing its cause, and as the blood cannot escape so long as the dura mater retains its integrity, a division of this membrane becomes absolutely essential. No surgeon, who values either his feelings or his reputa- tion, would resort to punctures and probings of the brainitself in cases where no blood is discovered at the trephine opening. That some have had recourse to such measures is but too true, yet I hardly think that any one will be induced by the results to pursue a simi- lar course of practice.—T. D. M.] But you will be called to trephine the cranium in consequence of fracture, whether simple or compound, with depression of a portion of the bone. I think it is laid down as a rule by the late Sir Astley Cooper and some other modern surgeons, that in cases of compound fracture you should apply the trephine, but that in cases of simple fracture, unless there are very severe symptoms, it should not be had recourse to. There is no doubt that in a great many cases of compound fracture the trephine does require to be applied, not in consequence of the integuments being wounded, but from the kind of injury that accompanies such wound. If the head be struck by a sharp-pointed body, and the integument has been divided, in all probability the internal table will be splintered and driven on the dura mater. Again, if the head is struck by a blunt body, the in- teguments may not be divided, the fracture will probably be exten- sive, and the depression will cover a considerable portion of the dura mater, and the pressure on the brain will be more uniform. The patient may get over the symptoms arising from the depressed portion of bone, the brain getting gradually accustomed to the pressure. In cases of compound fracture I think we are very
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