An inquiry into the causation, diagnosis, and treatment of fracture of the internal table of the skull / by William Frederic Teevan.

Teevan, W. F. (William Frederic), 1834-1887.

Date:: 1865

Credit: An inquiry into the causation, diagnosis, and treatment of fracture of the internal table of the skull / by William Frederic Teevan. Source: Wellcome Collection.

Provider: This material has been provided by The Royal College of Surgeons of England. The original may be consulted at The Royal College of Surgeons of England.

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$to the external table ; if there was a fissure the case would be one of complete fracture of both tables, with depression of the inner one only. Now, if the patient was insensible from the first, it is evident that the above symptons might result from an intra-cerebral extravasation of blood on the side on which the blow was received and hence a diagnosis would be impossible. But it must be recollected that the compression produced by depressed bone is rarely so complete as that caused by an extravasation of blood, and that when the internal table only is depressed, the symptoms of compression wiU not be nearly so strongly marked as when both tables are driven into the brain. Hence, the less definite the symptoms of compression, the greater the reason to believe that they are caused by the internal table only. There are two cases in which the diagnosis may be made with almost certainty. Firstly; when a person recovers immediately after the blow, but finds there is paralysis of some part of the body opposite to the side struck, and examination fails to detect any injury to the bone. Secondly ; when, after the blow, no evil consequences arise at first, but, in the comse of time the patient begins to complain of fixed pain in the part struck, and aU the symptoms of chronic cerebral irritation show themselves, although the surgeon cannot find any injury to the external table. Inasmuch, therefore, as fracture of the internal table only, can never be seen during life, and can only be diagnosed by the occur- rence of certain symptoms after a certain injury, it is evident that its treatment can never be preventive. There can be no doubt that there is, both at home and abroad, a yearly increasing dislike to resort to the use of the trephine, resulting not only from the very great mortality which attaches to every violence, whether surgical or accidental, to the head, but also from the fact that the patient will often die, although the trephine may have effected the end proposed, and it is very certain that, in the present day, lives are saved, which, in time past would have been lost. But, inasmuch as the treatment now pursued is chiefly one of expeetancy, it is necessarily fraught with much danger in certain cases. Surgeons of the present time ai-e$