Volume 1

Descriptive catalogue of the specimens illustrating surgical pathology in the museum of University College, London.

  • University College, London. Museum.
Date:
1899-1906
Catalogue details

Licence: Attribution-NonCommercial 4.0 International (CC BY-NC 4.0)

Credit: Descriptive catalogue of the specimens illustrating surgical pathology in the museum of University College, London. Source: Wellcome Collection.

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    fractuhes. The patient was a boy 11 years of age, who had received a blow on the head. A puffy sweUine formed and was incised, alter which the patient became subject to fits, which were relieved bv the evacuation of pus from the wound. Exfoliation of the cranium, accompanied by a collec- tion of pus between the dura mater and the bone, ensued ; a portion of the bone was reuioved by the trephine and cutting pliers, after which the dura mater became rapidly united to the ntegument of the head. Some time afterwards the patient complained of pain in the back of the neck, and an abscess pointed below the right scapula, and was opened; paralysis of the righ upper and of both lower extremities suddenly supervened, and the patient died After dea 1. the cervical portion of the spinal cord was found much softened, and its substance mtiitratea with purulent fluid. Peacxuees op the Skull and xheie Complications. The following are the varieties of fracture of the skull, which are illustrated in the specimens, and the chief points to be observed :— 1. Fissured Fractures (93, 94).—Fissured fractures always start from the point at which the violence was directly applied. The point struck can usually be recognized by two or three fissures radiating from it (93). There is no specimen in the Museum of the so-called fracture by co^iirecowp, and it is dotibtful if such a condition exists. Pissured fractures may be limited entirely to the vault of the skull (93); but frequently they extend into the base (127). To reach the base the fissure often leaves the bone and runs for a short distance along a suture, after which it re- enters the bones (131). In the base fissures may extend into the anterior (134), the middle (129, 137), or the posterior fossa (133, 134). In the anterior fossa they may implicate the cribriform plate or olivary eminence, and so open the cavity of the nose or pharynx (132, 134), or they may extend through the roof of the orbit (132). In the middle fossa they often cross the petrous portion of the temporal bone, generally opening into the cavity of the tympanum (137). Fracture of the base may also arise from the impact of the spine upon the con- dyles of the occipital bone (132). 2. Fractures luith I)ej)ression (102, 104).—In these sometimes the outer table is partly fractured and partly bent (102, 131); sometimes the depressed fraginent is completely loose. Many of these specimens show the results of operations undertaken for relief of the depression (116). 3. Punctured and Incised Fractures.—The chief point to be noticed in these is that the inner table is much more extensively splintered than the outer (126, 128). If the bone be perforated from within, as by a bullet completely traversing the skull (61, 62), it will be observed that the outer table is more extensively comminuted than the inner. Amongst the most important complications of fractures of the skull are:— 1. Intracranial Hcemorrhage, with or without laceration of the cerebral substance. Extensive extravasation between the bone and dura mater may result from rupture of a large-branch of a meningeal artery (98, 135), and serious hajmorrhage may result from wound of one of the large venous sinuses (107). Extravasation may also occur into the subdural or subarachnoid space or into the substance of the brain. 2. Intracranial >Suppuration.—This may be subcranial, meningeal, or cerebral. Localized suppuration is most frequently subcranial or cerebral, and is particularly likely to complicate-puncttired fractures (126) and gunshot fractures (63). ^ Septic phlebitis of the sinuses, occasionally followed by pyaemia, may also occur (107). 3. Hernia Cerebri.—In fractures with loss of bone and wound of the dura mater the brain-substance may protrude as the result of increased intracranial pressure. When, as is usually the case, this condition is complicated with sepsis, the protruding mass consists of brain-substance mixed with inflammatory products (117).