TREATMENT.—In all wounds except very small ones the head should be shaved over a wide area, to insure thor ough and disinfection. All dirt and foreign matters should be re moved by rubbing the surface with olive-oil, washing well with Castile soap and warm water, and finally scrubbing the surface thoroughly with a solution of bichloride of mercury (1 to 1000).
If the wound be a simple cut, it will often suffice to bring the edges together with a strip or two of adhesive plaster; it is generally better to bring the edges together and secure them accurately with sutures. A generous sublimate dressing should be applied and retained by a recurrent head bandage.
Conclusions regarding contusions of the scalp as follows: 1. Contusions of scalp caused by slight blows or falls, accompanied by moderate amount of effusion, are simple and re quire little treatment.
2. Contusions of scalp caused by sharp blows or severe falls are always to be examined carefully, and a guarded prog nosis given.
3. Those accompanied by large effu sions, and especially if pulsating, should be treated by shaving scalp, incising, turning out clots (examining carefully the pericranium and skull), securing bleeding-points, closing with sutures, preferably braided silk, dressed with dry antiseptic dressing, which should only lie removed when absolutely necessary, be fore the fourth or fifth day, when sutures should be removed, and a light compress bandage applied.
4. Those accompanied by little or no swelling, when caused by severe blows, should be carefully watched, and on first appearance of local fever or swelling, freely incised, washed out, and treated as open wounds.
5. If the case is not seen until patient has had chills, hot dry skin, hard pulse, fever-coated tongue, nausea or vomiting. insomnia, nervous twitchings, or any other symptoms of meningeal inflamma tion, we should cut down and trephine at once over site of injury.
6. While inflammation of either peri cranium or the meninges is one of the things likely to follow these injuries, it may be prevented by early incision.
7. Where caries of bone or meninges occurs, the cause may generally be found to he injury of pericranium, which be comes inflamed, effusion follows, then inflammation of vessels from pressure, and then, by extension, meningitis. F. F. Lawrence (Columbus Med. Jour.; Indian Lancet, July Di, '97).
Though the scalp be bruised, lacer ated, and begrimed with dirt, as well as wounded, or a larger or smaller flap be separated from the bone, none should be cut away; but, after shaving the head and arresting hmmorrhage by liga ture or compression, it should be cleansed and disinfected thoroughly and the parts replaced in their proper posi tions. The parts may then be retained
and supported by a few strips of plaster, and silver-wire sutures may be inserted at the points of greatest traction. Usually no drainage will be required, but, if necessary, a few strands of dis infected horse-hair will meet the indica tions, to be removed, however, in a day or two. To insure an aseptic course of healing thorough and wide disinfection should be practiced.
Abscess of the Scalp.—Abscess of the scalp may follow erysipelatous inflamma tion, contusions, or the imperfect disin fection and careless dressing of wounds of the scalp.
The symptoms of abscess are an ery sipelatous condition of the scalp, ac companied with pain and usually marked oedema and pitting on pressure. There is usually some fever, at times intense and often accompanied with delirium. There is great danger from the burrow ing of the pus; if it burrow beneath the pericranium, and sometimes if more superficial, there is danger that the in (lamination may extend inward to the brain through the vascular openings in the skull and cause meningitis.
—Free incision should be made, as soon as the abscess is dis covered, at the most dependent point. Disinfection of the wound and drainage should be followed by antiseptic dress ings and drainage.
Contusions of the Scalp.—These are commonly the result of blows or falls which leave the patient more or less stunned. Localized swelling occurs at the point of impact, which is due to hemorrhage and effusion under the scalp, the latter being raised up into a soft, semifluctuating tumor, the edges of which feel hard, while the centre feels soft. In some cases this extravasation simulates a depressed fracture of the skull, especially in children, and this deceptive feeling will occur without any considerable extravasation of blood be neath the scalp, the depressed centre being due to the compression of the scalp by the blow that has inflicted it (Erichsen). In case of doubt it will be safer to make an incision so as to ex amine the state of the bone, but usually the smooth bone can be felt at the bot tom of the soft central depression.