Traumatic injuries of the brain and its membranes : with a special study of pistol-shot wounds of the head in their medico-legal and surgical relations.

Phelps, Charles, 1834-1913.

Date:: 1897

Credit: Traumatic injuries of the brain and its membranes : with a special study of pistol-shot wounds of the head in their medico-legal and surgical relations. Source: Wellcome Collection.

Provider: This material has been provided by the Augustus C. Long Health Sciences Library at Columbia University and Columbia University Libraries/Information Services, through the Medical Heritage Library. The original may be consulted at the the Augustus C. Long Health Sciences Library at Columbia University and Columbia University.

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$ter; in one it was coincident with an extrusion of brain matter on the second day and continued twenty-four hours; in the other two it occurred on the second and fourth days and was of brief duration. All the sources to which these watery fluxes have been ascribed seem to have been exemplified in these few cases. In three it was demonstrably the final phase of hemor- rhage, and in one the outcome of aural inflammation; in two it was no less positively the cerebro-spinal fluid, and in two an inflammatory arachnoid effusion; in one at least certainly, and in others presumably, it was the result of the coagulation of blood following an intracranial hemor- rhage. In this way it often happens that exclusive theories are disproved by the results of sufiiciently extended observation. The diagnostic value of watery discharge is very lim- ited ; if it is primary and profuse, it is pathognomonic; if, as these observations seem to show, it usually follows a hemorrhage, when it occurs at all, it adds nothing to the already assured certainty of fracture. Another and still more infrequent symptom of basic fracture is an oedema of the mastoid region. In the single instance noted, No. LXIL, it accompanied fracture of the posterior fossa which traversed the groove for the lateral sinus, with obstruction of that vessel by a thrombus. The occurrence of such a symptom must necessitate the joint condition of a venous obstruction to cause the oedema and of a fracture to permit its appearance in a cranial region. It could hardly be apparent at any point where the super- ficial tissues are thicker than those which so thinly cover this bony prominence. In one of the instances cited of secondary serous discharge from the ear, it is possible that$