Linear craniotomy (miscalled craniectomy) for microcephalus / by W.W. Keen.
- William Williams Keen
- Date:
- 1891
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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![almost lost the restless wringing of the hands which was so marked a peculiarity before the operation. February 17, 1891. A precisely similar operation to the first was done upon this patient at the Jefferson Hospital. The improved forceps en- abled me to do it in thirty-five minutes instead of an hour and a quarter. She was entirely well in five days. No drainage was used. March 24. The child is slowly improving. I do not see that her pro- gress has been any greater since the second operation than before. Case II.— K. K., girl. Patient of Dr. F. X. Dercurn. Condition, May 23, 1890.—Age, one year (when first brought to Dr. S. Weir Mitchell at the Orthopaedic Hospital and Infirmary for Nervous Diseases). Very small. Makes no attempt to walk or sit; moves arms well; feet and hands cold; muscles flabby. Circumference of head 141 inches ; diameter, biparietal, 4 inches ; occipitofrontal, 4.5 inches. Knee- jerk slight, sensation good, no clonus, no rigidity. Fontanelle closed. Nose bridge very wide. No mental development; hearing and vision good ; does not speak at all; disposition good. Passes water and stools without notice. Spine straight. Five teeth. A general restlessness comes on at times ; usually excessively cheerful. Both parents alive and well. Father and mother are first cousins. No venereal history ; no consumption in the family history except a sister of the father who contracted consumption. The mother has been married five years and has two children, of which the patient is the younger. Her brother is four years of age, and is strong. He was breast-fed ; is hydrocephalic ; circumference of head 53.3 cm. The patient was born at term. Labor lasted tweuty-four hours and was very hard. No instruments were used. Patient was very small in size. No palsy, but very weak. No fontanelle existed at birth and her head has not grown since, though her body has. She was breast-fed for three months, and since then bottle-fed. She had a cold in her head for six months. Condition, December 1 (nineteen months of age).— Cannot sit alone; con- stantly in motion. Twelve teeth. Circumference of head 36 cm. (14i in.). Biparietal, 10.3 cm. (4-^ in.) ; biauricular, 10.2 cm.; bitemporal, 8.3 cm. (3:> in.) ; occipitofrontal, 11.9 cm. (45 in.). Circumference of chest, 38.2 cm. (151 in.). Height, 69.8 cm. (27.5 in.). Weight, 12.5 pounds. [Iap- pend the following normal measurements at birth from Schroeder's Lehrbuch der Geburtshulfe: Length, 50 cm. Head—Bitemporal, 8 cm.; biparietal, 9.25; occipitofrontal, 11.75 cm.; circumference, 34.5 cm.] Top of head quite prominent. Can hold things in her hand ; cannot feed herself. Moderate contraction of flexors of both feet; legs not paralyzed, knee-jerk absent, no ankle clonus. Idiotic expression in repose. Frontal lobe retreating. Two convulsions this summer, two last winter, each time with teeth. Has the expression of a precocious idiot. Attention can be won, but only momentarily. Mind and eye flit from one thing to another quickly. Operation at the Infirmary, December 3, 1890.—-An incision was made one inch to the left of the middle line, parallel to the sagittal suture and six inches in length. A curved incision was then made from the anterior end of this line downward so as to lift a frontal flap, the scar of which would be hidden by the hair. A half-inch button of bone was removed by the trephine, and from this anteriorly and posteriorly a furrow a quarter of an inch wide was cut out of the bone, extending to](https://iiif.wellcomecollection.org/image/b2230485x_0006.jp2/full/800%2C/0/default.jpg)
