8. Ball partial!; a little above and behind the right: headache, for 23 days, he was sent to tb day after journey, headache increased, and other head symptoms Ball then easily removed, but as the hemorrhage which caused much faintness, deeply depressed portions of hone were not interfered with. Relief followed the immediate removal of the hull, hut his sym; having progressed, the trephine was applied next day. The dura mater was extensively lacerated. Improvement for two days, and then hernia cerebri, Mid profuse purulent, discharge. Hernia treated by sliein;.:. eatntic, and pressure. Flow of pus suddenly ceased, and fungus rapidly increased by the 25th day after the operation. Became rapidly comatose. By means of a grooved director, much pus was evacuated during the next two days, and he a train became sensible.
He continued so for 3 days, the hernial protrusion h. in the meantime, sloughed away. He again became comatose, notwithstanding the free escape of pus, and he died two months af.er the receipt of the wound. and 34 days after the operation. Nearly the whole right hemsphere, as far as the ventricle, was found converted into an abscess with a distinct lining. I'us was found in the other ventricles, and lymph abundantly effused at the base and other parts. Another and distinct abscess was found at the base of the middle lobe of the left hemisphere. 9. Depressed fracture of occipital bone with round ball impacted, which was removed bv the trephine 3 days after its introduction. The withdrawal of a small spiculum of bone which had penetrated the torcular herophili was followed by easily-arrested venous haemorrhage.
The dura mater was intact. He had no bad symptoms for 12 days, when he was seized with what appeared to be congestion of the lungs and died in a week, the wound being then nearly healed. Nothing except signs of recovery were found in the head. 10, Iiound ball lodged deep in temporal muscle, with extensive fracture of the bone. No symptoms except headache for 3 days, when signs of compression appeared. By the trephine, 12 fragments of bone and a clot of blood were removed, but he never rallied, and died in 36 hours. The treatment from the tirst had been strictly antiphlogistic; but this patient was a very bad Mibjt c.t, being plethoric and intemperate. No post-mortem.
1'. Depressed fracture of right temporal and parietal bones, followed by well-marked signs of compression. Trephined. Dura mater torn, and a slight escape of cerebral matter. Became immediately sensible, and went on improving till the formation of a large hernia cerebri days after injury hcadaehe and stupor sei in. followed by paralysis of the. left f-ide. and d-ath f>!' days;:fter wound and operation. Dura 7"und depressed fracture rusforafort: then those of compression. Death. Membranes much inflamed, ait I i into the brain. operation. No relief; 5 days after oi>erati. of the brain and abscess. 14. frontal bone. illegible in the scan of the first
[fragment illegible in the scan of the first edition]
In four, very extensive and deep injury and laceration of the face, including the tongne, had been inflicted; two were complicated with extensive burns from explosion, and in the remaining three the cause of death is not specially reported. Among the officers no fatal case occurred." The following case is well worthy of being extracted: " Private Robert Cnthbert, age 19, 31st regiment, was wounded on 2nd September by a grape-shot, which struck him in the face, badly fracturing the lower jaw. On removing the bandages which had been placed on the parts in the trenches, the fractured bone, with its muscles, glands, Ac., fell down on the cheek, dragging the tongue with it, and exposing the interior of the mouth and throat as far as the root of the tongue, and the. wound extended into the anterior triangle of the neck, exposing the carotid artery.
The bone was so comminuted, that no choice was left but to remove the fragments, and the jagged ends of the bone were sawn even on each side. No part anterior to the angles of the bone could be saved: the soft parts were then brought together, and retained by sutures, and a few adhesive strips and wet lint applied. The patient was now able to lie down, which he could not do before, as the tongue, by falling back, closed the glottis; but even now, when in the recumbent position, he had frequently to lay hold of the tongue, and draw it forwards, to facilitate breathing. A considerable portion of the injured integuments of the chin sloughed away, but by careful feeding, dressing, and bandaging, the deformity was ultimately much less than could have been expected.