An inquiry into the causation, diagnosis, and treatment of fracture of the internal table of the skull / by William Frederic Teevan.

  • Teevan, W. F. (William Frederic), 1834-1887.
Date:
1865
Catalogue details

Licence: Public Domain Mark

Credit: An inquiry into the causation, diagnosis, and treatment of fracture of the internal table of the skull / by William Frederic Teevan. 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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    unanimous in stating that no such success follows the use of the trephine in their hands as attached to its employment by surgeons of the past, and they explain the discrepancy by alleging, what is no doubt perfectly true, that the operation was often unneces- sarily performed on persons who had nothing tbe matter with them. If, therefore, that were so, it would clearly prove that the use of the trephine, on a healthy subject, is not, j^er se, the very dangerous operation it is stated to be. All surgical experience shows that the mortality which will attach to an operation per- formed on parts before they are in a state of inflammation, must be very much less than that which will foUow interference with parts acutely inflamed; consequently, the use of the trephine as a preventive means is widely difierent from the employment of the same instrument as a dernier ressort. In the present day surgeons rarely apply the trephine at once except in cases of punctured fractures. Now, I have already stated that the efiects produced by a fracture of the internal table, are most likely to be similar to those caused by the punctured fracture, but we cannot thereupon foUow the treatment adopted in tbe latter case, inasmuch as fracture of the internal table can never be seen on its immediate occurrence, but only suspected at a later period by the advent of certain symptoms. Hence, the urgency, or persistency, of the symptoms can alone justify the use of the trephine in suspected instances of fracture of the internal table; consequently a surgeon would be warranted in trephining, on the spot struck, if all the symptons of intra-cranial suppuration were well marked, and there was paralysis of the side opposite to the injury ; so also if the violence had been applied in the course of the middle meningeal artery, and the symptons of compression were urgent and persistent, together with paralysis of the opposite side; and, likewise, if the patient had been insensible from the first, with obstinate symptoms of compression and paralysis of the side opposite. It happens sometimes that a patient is never rendered insensible by the blow, but finds he has paralysis of some part of the side of the body opposite to that struck. Now, if, in the course of some weeks, the paralysis does not disappear, the use of the trephine, to the part struck, would be indicated.