Typhlitis consolidating with high dose arac
In such cases as where it is spreading from the roof of the tympanum up over the temporal lobe into the Sylvian fissure, Mr. 68) in which this was very likely the case, but, owing to the patient's happy recovery, this could not be verified. been found in fifty-three cases in which a post-mortem examim tion was obtained. 72) gives the following m portant abstract of a most carefui paper by Dr. The influence upon recovery of tl removal or retention of the foreign body was most marked. Ether was given, and under the protection of copious irrigations of corrosive sublimate solution (1 in 1000), the wound of entrance, nearly in the centre of the forehead, was enlarged, including also the wound m the skull.
Operations on the Arm.— Ligature of brachial artery. —Excision in continuity of the shaft of the humerus. Constant irrigation with bichloride solution (1 in 2000) should be employed, and iodoform thoroughly used. — This, when diffuse, will probably always be hopeless. Barker, in his Hunterian Lectures, which have done so much to aid others in this subject, believes that a plastic localized form of meningitis is not infrequently met with in these cases, especially over the tympanum and squamous bone, or over the sulcus lateralis in the posterior fossa. 06 ad V ' i Se S n0t t0 pass a Mature round The usual termination is cerebral abscess, this condition haviir. Tarn 1879) in which 316 cases of foreign bodies lodged in the brain are analysed, these, 160 recovered, while 156 proved fatal.
I was unprepared for the rapid sale of the first edition, and the book has consequently been out of print for twelve months.
ASSISTANT-SURGEON GUV's HOSPITAL', LECTURER ON ANATOMY. LATE TEACHER OF OPERATIVE SURGERY IN THE MEDICAL SCHOOL: SURGEON To THE ROYAL HOSPITAL fott CHILDREN AND WOMEN SECOND EDITION WITH TWO HUNDRED AND THIRTY-FIVE ILLUSTRATIONS \WELLCOME INSTITUTE X LIBRARY Coll. TO THREE OLD FRIENDS ARTHUR EDWARD DURHAM JAMES FREDERIC GOOD1IART EDWIN CLIMSON GREENWOOD 3- He£ucate tbis 3Book AS SOME SLIGHT TOKEN OF MY GRATITUDE AND AFFECTIONATE RESPECT i PREFACE TO THE SECOND EDITION. While it testifies to the carefulness of his reading, I trust that allowance will be made for its length by those who know some- thing of the calls upon my time.
— Ligature of the brachial at the bend of the elbow 53-82 V. Operations on the Axilla and Shoulder.— Ligature of axil- lary artery. If necessary, the sinus can easily be plugged or seized with ordinary artery-forceps.* The jugular having been tied,t the outer wall of the sinus should be slit up as far as the limits of the opening in the bone will allow, and as much as possible of its contents removed with sharp spoon and syringe.
t The term exostosis is sometimes applied to the depressed bone ; this, when 1 circumscribed and osteophyte, is easily dealt with. The dura mater was adherent, the bon much thickened and covered with thorn-like processes pressing on, but no perforating, the dura. It is difficult to say how the trephining ciu'ed in these cases ; the symptoms had lasted many years, and yet ceased after the opera- tion. 116), in a most excellent paper, in which large personal experience throws much light upon the subject, speaks of having had five such cases. § Or this structure may be raised together with the flaps.
Operations in the Neighbourhood of the Elbow-joint.— Amputation at elbow. The frequency and meaning of optic neuritis has already been alluded to, p. While headache may be as marked a feature in cerebral or cerebellar abscess as in meningitis, I am inclined to think that in the last of these it is more persistent ; in the later stages of abscess it is not uncommon for the headache to remit. The probable explanation of those cases in which if symptoms have been present for long periods, but in which deafcj has rapidly followed upon the sudden development of braa^ symptoms, is that quoted by Wharton from Flourens. In the remaimi 210 no attempt at removal was made, and only 88 recovered, 122 dying, further analysis shows that, amongst those cases classed as recoveries, dea ultimately took place in 10 at periods varying from three to ten years, and m manv of the patients suffered from such after-effects as vertigo, incapacity 1 physical exertion, loss of sight or hearing, epilepsy, and deteriorated nient powers. 209 The following is an interesting instance of successful operation for the removal of a bullet penetrating the brain. 52 a, 6, Track of bullet and situ of the trepbine-openings. (Fluhrer.) The patient,* aged nineteen, shot himself with a pistol held • very near to the centre of his forehead. The track of the ball through the brain was then examined by a straight Nelaton's probe,t and the *&,ms).
Barker thinks that free removal of bone with irrigation and drainage would save many a patient. As to symptoms of meningitis, I fear we have none reliable save involvement of the cranial nerves, and, when we get such evidence as squint, the case has gone beyond interference. Apoplexy is an occasional cause of death, , i is pressure of the foreign body on the venous trunks, inducir: ventricular effusion and consequent compression of the cranii nerves. The foreign boc was removed in 106 cases, 72 recovering, while only 34 died. This procedure was complicated by most profuse haemorrhage from a branch of the anterior cerebral artery, which was finally controlled by small compression-forceps left in situ 10 this arterial bleeding was added a considerable venous flow from the superior longitudinal sinus, which, like the artery, had been cut across by the bullet.
Under the above heading such bodies as bullets, knife-points, &c, are included. As to the fatality of wounds of the different portions of tt brain, 5 8 deaths took place out of 1 3 2 cases where the foreig: body entered through the frontal bone ; 5 8 wounds of the parietr showed 2 7 deaths and 3 1 recoveries.
OPERATIVE INTERFERENCE IN THE CASE OP FOREIGN BODIES IN THE BRAIN. Tht observer found that bullets introduced into different portions | the upper parts of the hemispheres and the cerebellum gradual; penetrated the brain substance, ultimately reaching the basis crami the bullet tracks healing after them (Nancrede, from Wharton). About twelve hours afterwards, when seen by the surgeon, he was semi-conscious, aphasic, with complete loss of motion, without loss of sensation on the right side below the head.