Another theory (Fritsch) states that stasis is not so much responsi ble for the occurrence of a cephaltematoma as is the mechanical loosen ing of the periosteum by means of a trauma, such as may occur, more over, during the course of normal labor. The fatal head becomes fixed in the birth canal and the scalp sticks tightly to the maternal soft parts; in the interim between pains the head recedes, thus pulling on the scalp and separating the periosteum from the cranium.
Other authors assume only a localized pressure operating on the cranium with a resultant rupture of blood vessels. Runge's explana tion is the most plausible; but it must be conceded that the assumption of a pressure operating locally, makes the explanation more easily under standable. Otherwise it would not be possible to explain the occur rence of cephaltematoma in places where the blades of forceps have pressed on the head. The cases, happily rare, where a fracture has been followed by a cephaltematoma also argue for this. In the vast ma jority of instances, however, cephaltematomata occur in uneventful, uncomplicated labors.
From a large number of observations concerning the circumstances under which cephaltematomata occur the following conclusions are drawn by F. Beck.
Cephaltematomata occur most frequently over the right parietal bone; four-fifths of all cases occur in primiparte; primiparte constitute about one-half of all births, The rigidity of the maternal soft parts has, therefore, a considerable influence; this is also shown by the fact that the cephalagnatomata occur more frequently in the children of elderly primiparte than those of younger mothers. Slightly contracted maternal pelves, abnormal fatal positions and premature rupture of the amniotic sac are of importance since thereby the head may be easily subjected to irregularly or -sporadically applied pressure.
The infants in whom cephahumatomata occurred were, for the most part, full-term children, but premature infants are not immune. It is a striking fact that all statistics show a- substantial preponderance of male over female infants (about two to one); this probably depends on the larger head measurements in male children. A considerable
1111 mber of the children are born asphyctic; asphyxia conduces to the formation of cephalicinatoina by causing increased hyperemia and also because of the fact that under its influence the nutrition of the vessel walls suffers.
The diagnosis is in general easily established. Only in the first clays, a caput suceedaneum, which often accompanies a cephaltema toma, may possibly cause doubt. It is easily differentiated from trau matic meningocele since the latter swells when the child cries and can be emptied by pressure. A cephahematoma subaponeuroticum, haunorrhage between the scalp and the periosteum, is easily differen tiated from the subperiosteal form by the fact that it is not limited by the suture lines, which it oversteps.
The prognosis is good. Complications are rare.
The therapy as a rule should be conservative. Protection from pressure by means of heavy cotton padding fixed by means of a hood, almost always insures a nice healing of the swelling. Incision is to be considered_ only in the cases where the tumor is very large; and here, under the strictest asepsis, it is to be preferred to all other procedures. The majority of physicians, however, rightly oppose operative inter ference since thereby the danger of infection is substantially increased. Incision must be employed, however, in every case where the skin over the swelling becomes red and (edematous; for then there is suppuration of the effusion and only timely and thorough opening and dressing with dermatol gauze or other antiseptics can halt the spread of the inflamma tion. The employment of puncture for the purpose of emptying the blood and the use of compression bandages are recommended: it is very difficult to apply bandages which really exert compression and this procedure is apt to injure the scalp.