[757] This letter was very varied in form. See Galen and Foës.
[758] The operation consisted in sawing the bone nearly through, and leaving it in this state until it exfoliated, or until the bone could be separated from the dura mater without violence. See below.
[759] It is no doubt true that a simple cut in the outer table of the bone, when accompanied with concussion or contusion, may produce fatal effects within, and this, in fact, is stated by our author; but, of itself, as he says, the simple incision or hedra cannot be of a dangerous nature, nor require any recourse to instruments. The cases related by M. Littré in the Argument were all evidently complicated with contusion, and are thus referable to the second class of these injuries. It is most worthy of remark, that in the very interesting account of “slicing cuts,” given in Mr. Guthrie’s excellent work, On Injuries of the Head, the result, without any operation, by the most simple system of treatment, was in general very favorable. (pp. 95, 96.) On these cuts and superficial injuries of the skull, see further Hennen (pp. 283, 284), Thomson (pp. 51, 52), and Chelius (vol. i., p. 388).
[760] London and Edinburgh Medical Journal, 1844.
[761] Although, as we have stated, Dr. Laurie’s rule of practice now be to use the trephine on the preventive principle, it is probable that most of his cases occurred at a period when the practice of Mr. Abernethy was universally followed. His statistics therefore are no test of the results of the operation, when performed on the preventive principle.
[762] See Lawrence’s Clinical Lecture in the Medical Gazette, vol. xxi., p. 345; and Guthrie’s work, On Injuries of the Head, p. 113.
[763] See De Articulis, § 50; and Mochlicus, § 36.
[764] On hypertrophy and swelling of the brain after injuries, see the very interesting observations made by Mr. Guthrie, in his work on Injuries of the Head, p. 125.
[765] It is proper to mention in this place that Quesnay, with great good sense, discusses the question, whether or nor the separation of the pericrunium in this case be a sure indication of matter being collected within the cranium. He decides in the negative. (p. 17, Syd. Soc. edition of Selected Mem. of the Acad. of Surgery.)
[766] I ought to mention, however, in this place, that in simple undepressed fractures, Pott allows of the operation as a preventive; that, at least, is one of his objects in having recourse to the operation. (p. 130.)