Start Typhlitis consolidating with high dose arac

Typhlitis consolidating with high dose arac

This delay will, perhaps, be excused when it is remembered what time and trouble are needed for an attempt to bring a book like this up to date, and to make the needful alterations and additions. a Larg G Sarcoma ' causing Hemianopsia, from the Occipital Lobe IXS- • . By further removal of bone the mass to which the dura mater was adherent was completely exposed.

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. (After Eeid.) for cerebral tumour, used the following simple method of expos* the fissure of Rolando in its middle third :— J (1) A line was drawn between the frontal and occipital § tuberances. ' ^ this ^ ^ S3, ^gjitly altered, h M o Lt T Sf n Tw^! PO, Parieto-occipital fissure between the parietal and occipital lobes. (After Turner.) The occipitoparietal or larabdoidal suture, the posterior limit of she parietal bone, will be marked out by a line which starts from \ point 2f inches above the external occipital protuberance, and runs forwards and downwards to its termination, which will be ound on a level with the zygoma, ri inch behind the meatus As the occipital lobe is not limited to the upper portion of the occipital bone, but extends forwards under cover of the posterior )art of the parietal, the parieto-occipital fissure lies about f inch n tront of the apex of the lambdoid suture (Fig. As, however, there was a tender spot on the scalp 2 inches anterior to this, the first opening was made (with a trephine 1 inch in diameter) between the two.* The dura mater was normal ; after a crucial incision was made in it, the brain was thought to bulge abnormally, and to be rather more yellow than usual, otherwise it was healthy.

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. Ca Se UDder th bec ° ua ' ™ * 1 ana 2 /» , second temporo-spheuoidal tions. Between P ° mt S ' Pa SSing ratll6r ° bli( * uel y forwards, lies this 'eent S 2? E, Fissure of Eolando, separating the parietal from the frontal lobe. The outlines of the coronal, squamoso-parietal, and larabdoidal sutures are also seen. ™ th C av ^ge^ist7nce in eleven .skulls as »■ ^cas-Champiomuere inch behind the diagonal line, and about 1 4- inch from the median longitudinal line.

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). If a diagonal line (/.e) is now drawn from the posterior superior to the anterior inferior angle of this space, the line will he over the fissure of Rolando. The upper end is situated 2.2 inches behind the bregma (vide infra). From the very end of the external orbital process, where this rises up to join the temporal crest draw a horizontal line of 2 \ inches, and from the extreme end of this draw a vertical line of a little over 1 inch. 2 1 9 under the frontal bone, but extends backwards under the anterior part of the parietal, the fissure of Rolando, which forms the pos- terior boundary of the frontal lobe, lying from I i to 2 inches be- hind the coronal suture.* Fig. The above view of the brain in situ shows the relations of the surface convo- lutions to the regions of the skull.

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. Ander* and Makins in a paocr on " Cranio-cerebral Topography {Jou,«. There is then described on the surface of the head a four-sided figure bounded above and below by the lines for the longitudinal fissure and horizontal limb of the fissure of Sylvius respectively, and in front and behind by the two perpendicular fines. infra tit.) di- rections for finding the- fissure of Rolando.

Such a lesion, if localisable and to be got at, should be attacked, because if left alone it will aro on causino- trouble indefinitely, and further the compression and wasting of adjacent nerve tissue which it will set up, will in time become irreparable.

I only wish that my book deserved better the kind things which they have written of it. Hughlings Jackson, in the discussion or i Piot ^ ^ ^ tl it was proved that the « thumb centre "-i.e., that pait o ^ fcy ^ ITs Jecial movements of ^^^t'^Z the most delic^e fact that while the parent could move his urn ^ rfd of his subject to fits becoming universal. 233 trial has been given to mercury and potassium iodide,'"* there is no doubt whatever that a syphilitic lesion may reach a stage here as elsewhere, in which it has quite got beyond the reach of specific remedies.

Elsewhere the skin was brought accurately ST f Ant ™ Vt[G P recautions ng -*« and clot - witt ' TV \^ cerebral stricture.

The b^Tr ™\ d ™ wn t0 S ether sutures, and a drainage-tube msertea beneath it.

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. Its size was now somewhat diminished, and the forefinger could be passed between the cranium and tumour, and by its aid the delicate cellular attachments that held the mass in place were felt to yield easily, enucleation now became possible, and the base was finally reached. At frequent intervals every day the patient's thumb would commence twitching, but the progress of the convulsion could often be arrested by stretching the thumb or applying a ligature. There was frequently severe headache, beginning at the occiput and shooting forward, especially to the right parietal region. It was decided to explore the junction of the middle and lower thirds of the ascending frontal and parie- tal convolutions, a spot at which Prof. Beevor had shown that the movement of opposition of the thumb and finger could be elicited.

Operation having been decided upon, a U-shaped flap was raised, and a 1 -inch trephine applied at 1 inch above the occipital protuberance, and the same distance from the middle line, beyond the limits of both the longitudinal and lateral sinuses, and the bone removed until an oval opening 2 J by 2 \ inches was made, exposing a dura mater of a deeper hue than normal ; section of this exposed the tumour, the outlying edges and base of which could not be reached in spite of further removal of the cranium, it was therefore incised and some of its softened, granular and fatty-looking contents forced out. The right lower limb was next attacked, and finally the right upper limb.

The plan of the book, with which some of my judges found fault, remains unchanged. His happy combination of Art and Medicine, and his friendly patience in carrying out my wishes, have been to me a saving of much trouble. Churchill I owe the opportunity of making use of some of those drawings by Thomas and William Bagg which were so well known in the pages of that master of his craft, Sir W. It appeared to be only \ inch broad, but as the brain substaijce all around it for more than \ inch appeared dusky and hvid, the part apparently diseased was all freely removed.