Every surgeon in the army can recount many such cases. If any patients were lost from not having been operated on, I never saw any of them; but I do know of some patients who died. because they were subjected to operation. The wonderful manner in which the brain accommodates itself to pressure, has been remarked in all times, and the crania in our museums show how extensive the depression may be, and yet the brain escape injury, or in which, although the central mass may be pressed upon or hurt, recovery has yet followed. In the cases of fracture with depression which have presented themselves to me during the war, the symptoms and the amount of depression have seldom been in But, in order to attain favourable results, it is Henman. in particular, refers to a case in which bone was depressed in " a funnel shape," to the extent of an inch and a half, and yet the patient lived in comfort for thirteen years.
Stromeyer mentions forty-one cases of fracture with depression from gun-shot, and in many of which it is probable that the brain was injured, although that could not be ascertained. Of these cases only seven died, and one of these perished by typhus fever. All the rest recovered, and in only one case was there any operative interference, although signs of secondary compression appeared in several. The antiphlogistic treatment, carefully carried out, was alone adhered to. Seutin, who was at the head of the medical service at Antwerp when it was besieged in 1832, gives us the results of his experience in the following words: "Far be it from us the pretension to decide the question which divides practitioners of the greatest merit; we will not take up the defence of either the oiie IN n KII:> 01 Tin; l!U absolutely necessary tliat attention be paid to the mana-vnient ot' the patient, of whu-h shall speak more wards.
Those who have read with attention the records of eainMS, must have often lren struck with the numerous instances which are there recounted where men, with I fractures of the skull, have recovered in circuiiistanees which forbadr any attention being paid to them. I hiring hurried retreats and forced marches, this has often occurred. When privation was added to the absence of all surgical interference, these happy results were the more marked. In Larrey, Guthrie, Ballinirull, and in the Indian reports, many illustrations of this are found. Dease, also, long ago recorded the observation, that " those patients who neglected all precepts, and lived as they pleased, just did as well as those. but we think that it is necessary to limit to a small number the cases of fracture whi<-h demand the operation of trephining an operation which often causes grave accidents, and the success of whirl i is always very uncertain.
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Thus it would seem as if severe fatigue, irregular, and it might be diet, are less injurious to men with fracture of the skull than the probings, pickings, and trephinings which form the more orthodox and approved practice. Deputy-inspector Taylor, in his able report on the wounded of the 29th in India, after referring to several wonderful recoveries from gun-shot depressed fracture of the skull, very appropriately remarks, that he attributed the fortunate results in these cases " to the system adopted of very cautious meddling with the I cannot deny myself the pleasure of recording a case which lately occurred in the practice of Dr. George Willis of Baillieston, in the neighbourhood of Glasgow, which is remarkable for the extent of the lesion, the period when the trephine was applied, and the perfect and rapid cure.
William Donald, aged 36, a pit-sinker, a man of intemperate habits, but of strong frame, was struck on the 20th of June last, at 4 o'clock in the afternoon, on the left'side of the head, by a piece of stone weighing thirty pounds, which had been thrown high into the air by the explosion of a mine he had constructed in the prosecution of his work. He immediately fell down insensible, and was put, in that condition, into a cart, and conveyed to his house, which lay two and a half miles from the place where he met with the accident. In about half an hour from the moment he was struck, and before he readied home, he slowly regained consciousness, and on his arrival at his own door he was able to walk into the house with assistance.