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Fracture of the Skull.The extent and shape of the fracture, as well as its location in the skull, vary with the amount and direction of the force. A blow with a large blunt weapon, such as a hammer, or a fall upon the head, usually results in a long, irregular fracture ; a blow with a sharp instrument is apt to cause a star-shaped fracture or series of fractures. In many cases the skull is broken at a part somewhat distant from the point at which the force was applied. Thus, if an individual be precipitated from a height, and strike upon the top of the head, there may be only a severe bruise and laceration of the scalp at the point where the head strikes the pavement, without any fracture of the bones ; yet there is apt to be an extensive fracture at the base of the skull, which may entirely escape notice. Symptoms*-The symptoms and the effects accompanying a fracture of the skull depend largely upon the damage done to the brain. In some cases fracture of the skull causes but little more injury than a severe scalp wound ; while in other instances a fracture which is insignificant in appearance may cause speedy death. The effects vary also with the age and condition of the patient. A child endures such a fracture far better than an adult. The features which render fracture of the skull dangerous to life are these : Concussion of the brain. Bleeding inside of the skull. The splintering of fragments from the skull bones, which penetrate the substance of the brain or cause pressure upon it. Inflammation of the brain and its membranes consequent upon the injury to them by the fragments of bone. Fractures of the skull are usually compound-that is, the scalp is wounded at the place where the bone is fractured. In any case it will be possible to feel the edge of the bone at the point of fracture. If the scalp be uninjured, this edge cannot, of course, be felt with the same distinctness, but is, nevertheless, perceptible in the great majority of cases. There are certain other conditions which may sometimes be mistaken by the inexperienced for a fracture of the skull bone. Thus a blow upon the head sometimes causes the formation of a blood clot under the scalp which may cause a ridge similar to that produced by the edge of a broken bone. If there be a wound of the scalp at the point of injury to the bone, the finger inserted into the wound will readily feel a rough, jagged edge, projecting above a bony surface. It sometimes happens that fracture of the inner layer of the skull bones occurs without any break in the outer layer. To understand this we must remember that the bones of the skull are somewhat peculiarly constituted. There are, in fact, three distinct layers, the outer one somewhat flexible, the middle spongy, like a honeycomb, and the inner one extremely hard and brittle. In consequence of these qualities, it sometimes happens that a severe blow will cause merely a slight depression of the outer layer, which by virtue of its elasticity, rebounds again without breaking ; while the inner layer, because of its extreme brittleness, is broken. These fractures of the " inner table " of the skull are extremely difficult of detection. Since there is no break in the outer part of the skull, we are unable to feel the roughness which may actually exist in the inner part of the bone at the surface of the brain. In fact, this fracture can be recognized only by the symptoms which indicate the presence of bone splinters in the brain substance. In many cases a blow upon the head causes symptoms similar to those of fracture, which may be due to an escape of blood onto the surface of the brain or to simple concussion without any fracture. In such cases the exact cause of the symptoms may remain in doubt for some days. If there be no fracture, the symptoms usually subside in the course of a week or two, while if there be a fracture, the difficulty is apt to persist much longer. In children the bones of the skull are much softer and thinner than in adults ; hence depressions of the skull may be produced without any actual breaking of the bones. Such depressions usually result in complete recovery. Fractures at the base of the skull are especially dangerous, because of the important nature of the parts of the brain adjacent to the base of the skull. Such fractures usually result fatally. They may be suspected if there be some of the following symptoms : Profuse bleeding from one of the ears. The blood is usually of a dark rather than of a bright red color. The escape of a clear watery fluid through the ear. The absence of fracture on the top of the head, if the patient have fallen directly upon this part, Stupor or semi-unconsciousness ; paralysis of muscles of the face ; loss of feeling in one part of the face or tongue. The ultimate result in cases of fracture of the skull varies much with the location and extent of the injury, as well as with the age and condition of the patient. In every case such an injury is, of course, serious. In some instances the danger seems to proceed almost entirely from pressure of the fragments upon the brain. When this pressure is removed by raising the fragments to their former position, so that they no longer press upon the brain, the serious symptoms subside. In other cases it becomes necessary to remove splinters of bone which have penetrated the substance of the brain. So long as these remain in the brain the individual fails to recover his usual functions. In many cases the patient ultimately recovers entirely, even though the original injury was an extensive and serious one. In other cases the patient suffers for many years from occasional derangements of the mental functions. Epilepsy has been known to result from the pressure of the fragments upon the brain. The disease has been repeatedly cured by removing pieces of bone at the seat of the injury. Other affections manifested in various parts of the nervous system, as well as in the operations of the mind, sometimes result from injury to the brain caused by a fracture of the skull. Treatment.- A fracture of the skull is always a most serious and dangerous accident. A little mismanagement may cause the death of the patient, while the exercise of proper care and skill may restore him to a perfectly natural condition. It is, therefore, very important that the services of a surgeon be immediately secured; yet, since it sometimes happens that many hours, or even several days must elapse before the arrival of the surgeon, simple directions will be given for the management of these cases, aside from the part which consists in operations. The fracture will usually be accompanied by a wound of the scalp, which often bleeds profusely. The first requirement is, therefore, an effort to check the bleeding, directions for which have been given on a previous page. After the bleeding has ceased, the wound may be carefully washed with water containing carbolic acid (one ounce of the acid to a quart of water), or with a solution of listerine (one ounce of listerine to five of water). Extreme care must be taken that no foreign material of any sort be introduced into the wound by means of instruments, fingers, sponges, etc. It is also necessary to keep the hair out of the wound ; for this purpose the scalp should be closely clipped, or even shaven, for a distance of two inches around the edges of the wound. It will not be advisable for a non-professional person to meddle with the fragments themselves. For it is to be remembered that the most delicate and one of the most essential organs of the body, the brain, lies immediately under and in contact with the broken bones; hence any awkwardness in manipulating instruments might result in serious and even fatal damage to the brain. After the wound has been cleansed and the bleeding stopped, a compress - that is, a piece of lint or soft cloth folded so as to make three or four thicknesses - should be wet with cold water and applied over the wound, covering its edges completely. This compress should be moistened every half hour or hour ; it may be retained in position by a bandage lightly applied. The attention is then directed to the general condition of the patient. So far as the wound in the head itself is concerned, nothing more can be done except by means of an operation ; the danger to be apprehended is that inflammation of the brain may occur, and this can be best averted by the application of cold water to the head, and by the measures to be presently described. The patient should be kept perfectly quiet in a darkened room ; the head should be laid rather low. Noise and all other influences which could disturb the sufferer must be carefully avoided. The inquiries of curious friends should not be permitted to disturb the patient ; hence it would be better to admit no one to the room except those whose attention is necessary. Free evacuation of the bowels must be secured ; a teaspoonful of Rochelle salts given once a day will usually accomplish the desired object. In addition the patient should take one drop of the tincture of aconite every half hour or hour. This is a very powerful remedy and its effect must be carefully observed ; so soon as the pulse at the wrist shows a decided decrease of strength, the remedy should be discontinued or administered in smaller quantities. This treatment is adapted to those cases in which the patient is perfectly conscious and shows no impairment of the mental functions. There are, of course, instances which require especial treatment. Thus sometimes the patient suffers from shock, a condition which has been already described. In this case we must employ the treatment which has been recommended in discussing the subject; hot bottles should be applied around the patient's body, ammonia (hartshorn) held near his nostrils, and a teaspoonful of whisky mixed with the same quantity of milk or water, should be given by the mouth or by the rectum, as occasion requires. Sometimes the patient's condition resembles apoplexy. In fact, fracture of the skull often induces precisely the same condition as that which we call apoplexy, when it occurs without a wound - that is, an escape of blood into the brain. In this case we should employ essentially the same treatment as that which has been recommended in treating of this disease. The danger is augmented somewhat if the brain itself be wounded. Yet, we cannot predict in every case just what the effect of this complication will be, for many instances are known, in which a portion of the brain has been entirely removed without preventing or even retarding recovery. The well-known case in which a tamping-iron was driven clear through a man's skull, creating an immense wound, from which he recovered perfectly, is a familiar example. If foreign bodies are lodged in the brain, the danger of inflammation, and hence of a fatal result, is somewhat increased. Such bodies should be removed as soon as possible. There sometimes results from a fracture of the skull, a protrusion of the brain through the wound, a condition called hernia of the brain. This can sometimes be cured by pressure upon the protruding part, made by applying a bandage tightly over it; but the treatment of such a complication should always be left to the surgeon. It is impossible to give in detail the measures which may be required in various injuries of the brain ; each case must be seen and treated by itself. It may be said in general, that surgeons have in later years acquired more confidence and success in operating upon the skull and the brain. In former times the surgeon was inclined to avoid most scrupulously any interference with this delicate portion of the body ; within the last ten or twenty years, however, the brain has been frequently and successfully operated on in case of injury. One of the authors of this book once found it necessary to open a passage with the knife almost into the middle of the brain, and to introduce a rubber tube to this point, where it was allowed to remain for several weeks. The patient recovered completely. One of the most serious complications arising in connection with fractures of the skull, is But first, if you want to come back to this web site again, just add it to your bookmarks or favorites now! Then you'll find it easy! Also, please consider sharing our helpful website with your online friends.
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