A case of gunshot wound of the brain in which the Roentgen rays showed the presence of eight fragments of the bullet : localization by Sweet's method made operation inadvisable : with a description of an improved apparatus for localization of foreign bodies / by W.W. Keen and Wm. M. Sweet.

  • Keen, William W. (William Williams), 1837-1932.
Date:
1903
Catalogue details

Licence: In copyright

Credit: A case of gunshot wound of the brain in which the Roentgen rays showed the presence of eight fragments of the bullet : localization by Sweet's method made operation inadvisable : with a description of an improved apparatus for localization of foreign bodies / by W.W. Keen and Wm. M. Sweet. 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.

    5/12 (page 3)
    Treves and Sir Victor Horsley in reference to his treatment. A brief synopsis of their opinions is as follows: lhat the position of the retained bullet should be accurately determined ; that the ball is now not likely to shift its position ; that it is a possible source of future irritation which might result in traumatic epilepsy, and that the advis- ability of the removal of the ball would depend upon its location. Dr! Sweet then made some skiagraphs of the head, of which one is presented in Fig. 2. By his method of localization he determined the following facts: In the brain there are one principal fragment and seven other minute fragments of the bullet, the largest of the latter being about the size of a medium-sized pin’s head. Two of these fragments are at the point of entrance. Five of them are scattered through the brain 2.5 cm. to 3 cm. above a line running from the wound of entrance to the present position of the ball. The position of each one of these fragments was precisely indicated on the scalp by Dr. Sweet. After careful consideration of the present location of the bullet and of the boy’s excellent recovery, I decided that it would be inadvisable to remove the ball. Of course, the removal of the smaller fragments was not even considered. The following were the reasons for my decision : The ball lay vertically 5 cm. below a point 2.2 cm. to the right of the middle line and 1.5 cm. back of the fissure of Rolando on a line parallel with the middle line (Fig. 3). Dr. Sweet marked not only the point on the top of the head corresponding vertically to the ball, but also a point above the ear which corresponded to it hori- zontally. This point was, of course, 5 cm. below the level of the top of the head, but on the curved surface of the scalp was 8.3 cm. from the middle line. It was 4.5 cm. back of the fissure of Rolando. In the horizontal plane from the surface of the head toward the middle line the ball lay at a distance of 6.3 cm. (Fig. 4). As it was very important that these two points corresponding horizontally and vertically to the position of the ball should be accurately and permanently marked, with a view to an accurate determination in the future whether any change in the position of the ball had taken place, they were marked in the following way: At the points which Dr. Sweet had marked upon the shaven scalp I injected a few drops of cocaine and then ex- cised a small round piece of scalp, including the hair-follicles, so that there would be two small permanent bald spots at these points. As the boy was a very tall, well-developed lad, who had attained almost all of his growth, especially of the head, any later growth will not practically invalidate these measurements. I wished then to determine the relation of the ball to the lateral ventricle, and for this purpose made a section of a brain hardened in formalin, at a point as nearly as possible corresponding to the figures given above. Comparing this with Dalton’s vertical transverse sections through the brain, I found that it corresponded to Plate 15 of series