PARTICIILAR SURGICAL ataracre.
The great number of these, and the limits prescribed by the nature of this work, render it necessary for us to pass over several, and attend only to the more important.
Injuries of the head. Fractures of the skull are not dangerous in themselves, but they indicate that considerable violence has been inflicted. We must guard against inflammation of the contents of the cranium, and continue the antiphlo gistic regimen for three or four weeks. If the bone be even slightly depressed, the same plan may be pursued. Bleed ing from the arm or temporal artery, sa line purges, and diaphoretics, are usual means.
Cotnprenion of the brain may be caused by fracture with depression, or from ex travasation of blood under the skull. Its symptoms are, insensibility, dilated and unmovable pupil, slow and labouring pulse, difficult and stertorous respiration. These demand the application of the trephine, for the purpose of elevating depresied bone, or removing effused blood. Compression may also be caused by suppuration of the dura mater. This happens several clays after the accident, is indicated by peculiar symptoms, as pain, feel of tightness, and puffy tumour of the integuments; and demands the use of the trephine.
Concussion of the brain is an injury of that organ produced by the blow, inde pendent of actual fracture of the skull. After the first stunning subsides, there is sickness, contracted pupil, a degree of sensibility and irritability, and free respi ration: The patient gradually goes into a state of phrenitis. Copious and repeat ed bleedings from the temporal artery and arm, saline purges, low diet, &c. are the only means of safety, and must be fol lowed up until the symptoms are subdued.
Trepanning consists in removing, by means of a circular saw, a portion of the skull, in order to allow the elevation of depressed bone, or the evacuation of blood or matter. The scalp must be divid ed by an incision down to the bone, and the sides of the cut turned up ; these are laid down again, and approximated, after the operation. Trepanning is not to be performed merely because there is a frac ture or depression ; but only when symp toms exist, showing that the brain is suf fering from pressure.
Tinea capitie, or scald-head, is a super ficial ulceration of the scalp, covered by thick dry scabs. Cleanliness is the most essential part of the treatment. The
scabs must be removed, the head kept closely shaved, and the ulcers dressed with the ung. picis cum sulphure, or ung. hydr. nitr. or lotion of kali sul phuratum. Alterative medicines must be given at the same time.
is a deformitity existing from birth, attended frequently with a fissure in the jaw and palate. Its cure consists in paring the margin of the fissure, and bringing the edges into contact, where they are held by means of pins, and the twisted suture ; which is a thread passed over the pins in the form of the figure 8. They thus unite by the first intention. It should not be performed on very young children, as they are less manageable, and are liable to convul sions. The removal of the edge of the fissure is performed by means of fqrceps, by which the lip is held firmly, leaving out the part which is to be cut off, and which the surgeon removes at one stroke of the knife.
The same operation is necessary for cancerous ulcers of the lip, which com mence in ulcerated, wart-like excres cences, and spread very destructively. They should be removed as soon as we can ascertain that they do not yield to our remedies.
Diseases of the antrum are, inflammation and suppuration of that cavity, and fun gous growth from its surface. The for mer requires an by the extrac tion of one of the grinders, and the introduction of a pointed instrument through the socket. In the latter, the cavity should be trephined, and the fun gus removed.
The noli me eangere, or spreading her petic ulcer about the nose, is a very un tmctible complaint Alterative medi. tines should be given internally, together with cicuta, and even arsenic : ung. hydr.-nitr. ung. picis., solution of lunar caustic, and of arsenic, as topical appli cations.
Flionda lachrymalis arises from obstruc tion of the ductus nasalis, which causes a swelling in the corner of the eye, flux of the tears over the cheek, and afterwards a fistulous opening from the lachrymal bag. Its cure, in an early state, is by injecting warm water through the punc using a collyrium of white vitriol, and smearing the edges of the eye-lids with ung. hydr. nitr. In a more advanc ed state, an incision into the lachrymal bag is required, together with a torei ble removal of the obstruction, and the introduction of a straight silver nail headed style.