FRACTURES OF THE SKULL.
Fractures of the bones of the skull are, as a rule, so difficult of detection and require such skilful treatment that a surgeon's advice and attention are always necessary. A brief refer ence, therefore, is all that is required here.
The usual places for fractures of the skull are the vault or roof, and the base. The vault is usually broken by a direct blow, the base of the skull indirectly. Thus when a man is struck on the top of the head with a stone or stick, that is, by a sharp concentrated blow, fracture of the vault is likely to occur ; but when a man has fallen from a height upon his head, or when his head has been caught between two opposing forces, it is the base that is commonly the seat of fracture. Fracture at the base also occurs by a person falling from a height and landing on his feet or in the sitting posture, the force, being up the back-bone, causing the break to occur.
The bones of the skull consist of two plates of dense bone, one without and one within, and a layer of spongy bone—the diploe—between. Now a fracture may consist of a crack or fissure, or of a breaking inwards of one or other of these dense plates, or of both together.
In Fractures of the Vault the forcing in wards of one or other or both bony plates is the most common form. Thus, there may be simple fracture or fracture with displacement, and as the displacement is almost invariably inwards it is called fracture with depression. The broken bone may be depressed in a piece, or it may have been broken into fragments and the fragments driven inwards. The fracture may or may not be accompanied by a wound.
The symptoms are not easy to make out. If it is a simple fissure there may be no signs of any moment. When the bone has been de pressed, the hollow may be made out by careful examination with the fingers after shaving the part. The hollow will be surrounded by a pro jecting ridge. Care must be taken not to con found this feeling of a depression with the sensation caused by a mass of bl.xod-clot forming
within the scalp, which will yield to firm pres sure with the finger. Where a wound exists the forcing inwards of the bone will be more easily made out, and examination with a probe will reveal the mischief more fully. It must be remembered, however, that the inner table may be splintered and depressed and little corre sponding injury be present in the outer table.
The treatment cohsists in putting the patient to bed, keeping him lying on his back, quite quiet, applying cold•water cloths to the head, and giving opening medicine. The fall or blow may have brought on unconsciousness, in which case the patient is simply to be kept quiet, and to be made warm by clothing and the application of heat to the feet. If consciousness does not soon return, and if the breathing is slow and laboured, the skin cold, and the pulse weak, a serious condition of the brain is indicated, due, likely, to depression of bone. This can be remedied only by raising the depressed bone, which no one but a surgeon can undertake to perform.
Fracture of the Base of the Skull is usu ally determined by the kind of injury, by bleed ing from the nose and from the ear, and by the oozing from the ear of a clear fluid after bleed ing has ceased. This fluid conies from the membranes covering the brain, and is a very sure sign of fracture at the base of the skull. There may be other symptoms present, such as deafness, drawing of the face to one side owing to paralysis of the other, inability to swallow, and other signs due to injury of certain nerves. The eyes also may be completely bloodshot. There is likely to be extreme stupor, quick pulse, hot skin, and maybe delirium.
Treatment consists in perfect quiet and rest, shaving the head, and applying cold-water or iced cloths, giving opening medicine and low diet.
Fracture at the base of the skull is very fatal.