Medical Societies.

Abstract

after trephining and the removal of so many fragments of bone. The fall must have been broken in some way, and the patient thus saved.J. M-, aged thirty-one, admitted September 25th, 1863.Family history good, yielding no evidence of any hereditary diathesis. Patient says he has never been laid up by any illness ; he is a healthy, robust-looking man. For some years I past he has led a very debauched and dissipated life. On the night of the 24th he had been drinking up to a late hour, and, I returning home in a state of intoxication, he wandered from the road into aai adjacent field, and walked over the edge of a stone quarry, falling a distance of eighty feet. He was discovered some hours afterwards, and brought to the hospital.On admission, a large lacerated and contused wound was found, slightly above the left frontal eminence. On introducing the finger through this wound, an extensive comn-iinuted fracture was detected in the frontal bone, near the coronal suture, and somewhat to the left of the vertex, encroaching upon the left parietal. The fragments were firmly impacted and considerably depressed. The patient was perfectly conscious, there being no sign whatever of compression of the brain. About six hours after the accident the patient, at his own request, was placed under the influence of chloroform, and Mr. Whipple twice applied the trephine, subsequently removing eighteen fragments of bone, which in the aggregate weighed four drachms. These pieces of bone, when collected and accurately placed in sit-u, covered a space measuring 3 in. by 1 in. in diameter. The longitudinal sinus was opened, from which a rather profuse hæmorrhage ensued. No i sutures were used to the wound, a simple water-dressing alone being applied to it, and the shaven scalp kept cool by means of a damp cloth. Ordered to have milk diet; perfect quietude to be enforced; and a purge to be administered in the morning.Sept. 26th. -Passed a comfortable night ; no noticeable headache; face quite natural; tongue somewhat furred; pulse 66, full. 27th.-Some twitchings of the upper extremity were noticed by the night nurse during sleep. Pupils natural. No sign of paralysis. Appetite moderately good; complains of thirst. i Pulse 76. Ordered an effervescing mixture of citric acid and potash. 28th.-Complains of severe pain in the head; tongue much ! furred; pulse 68. He is rather more drowsy than usual; pupils somewhat torpid on exposure to a strong light. Bowels freely acted upon by an aperient, affording him great relief. ! 30th.-Going on favourably. Wound suppurating; discharge rather offensive. To be cleansed with a solution of Condy's fluid, and a poultice to be applied.