Surgical diagnosis / Daniel N. Eisendrath.

  • Eisendrath, Daniel N. (Daniel Nathan), 1867-
Date:
[1909], ©1909
Catalogue details

Licence: In copyright

Credit: Surgical diagnosis / Daniel N. Eisendrath. Source: Wellcome Collection.

Provider: This material has been provided by The University of Leeds Library. The original may be consulted at The University of Leeds Library.

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    neck are of value in the diagnosis of basal fracture, if the blow has not been received over the region in which the subcutaneous hemorrhages have occurred, and especially if the latter begin to appear some hours after the injury, and increase in amount in the first few days. Orbital (subconjunctival) hemorrhages are quite frequently present, and, if excessive, an exophthalmos may be produced, which is almost positive evidence of a basal fracture. Escape of air into the subcutaneous tissues, producing emphysema or a crackling sensation of the skin upon palpa- tion, occurs rarely after fractures communicating with the mastoid cells or frontal sinuses, and when found, is positive evidence of a fracture. 2. Escape of Blood, etc, from the Ear, Nose, and Mouth.—^The escape of blood from the ear from other causes than a fracture of the base, is of short duration and small in amount. Bleeding may occur from one ear alone, or it may take place from both. If there is spurting of the blood, the internal carotid artery must have been torn. If it occurs in very large quantity without pulsation, a large sinus has been lacerated. Bleeding from the ear can be said to be due to a basal fracture, if after cleansing the ear and wiping out the blood, one excludes the following sources of hemorrhage: Tearing of the cartilaginous auditory canal in its anterior or posterior wall, simple rupture of the membrana tympani, and flow of blood from wounds of the scalp or external ear into the canal. The first and last of these can be eliminated by cleansing the ear and then observing the reaccumulation of blood. The rupture of the membrana tympani causes only a slight and transitory hemorrhage. Blood escaping from the nose or mouth is only of diagnostic value if one can exclude local injury, and if it persists for a number of hours. Very rarely one can observe hemorrhage in the retropharygneal struc- tures or the escape of blood from the Eustachian tube, when the mem- brana tympani is not torn. In an article' upon 530 cases of fracture of the base of the skull ob- served in the Boston City Hospital, Crandon and Wilson state that 74 per cent, had bleeding from the ears, nose or mouth, usually from one ear only. The ear drum was always broken. Pharyngeal bleeding was to be interpreted as a sign of severe injury. The escape of cerebrospinal fluid from, the ear or nose was only noted in 27 cases—less than 5 per cent. The flow of cerebrospinal fluid most often occurs from the car, and can be distinguished from blood-serum by the large quantity of watery fluid, the high percentage of sodium chlorid and the small per- centage of albumin which it contains. ' Annals of Surgery, December, 1906.