The characters of the hedra, or superficial injury of the cranium, and the difficulty of forming a correct estimate of it, when complicated by the presence of a suture, are strongly insisted upon (§ 12).
The principles upon which the treatment of injuries situated in different parts of the head should be treated, are carefully defined and stated. Great, and as now would be thought, superfluous directions are given, for ascertaining whether or not a fissure exists in the bone. The treatment, as far as applications go, is to be mild and desiccant. When a fracture cannot be made to disappear by scraping, the trepan is to be applied (§§ 13, 14).
The dangers which the bone incurs of becoming affected from the soft parts, are strongly insisted upon, and applications of a drying nature are prescribed (§ 15).
The condition of a piece of bone which is going to exfoliate is correctly and strikingly described (§ 16).
The treatment of depression is laid down, and the danger of applying the trepan in this case is strongly insisted upon (§ 17).
The peculiarities in the case of children are pointed out. Under certain circumstances, when there is contusion combined with the fracture, he admits of perforating the skull with a small trepan (§ 18).
When, after a severe injury, symptoms of irritation and inflammation appear to be coming on, the surgeon is to lose no time in proceeding to the operation. Some correct observations are made on the consequences of injuries of the head on other parts of the body (§ 19).
The treatment of erysipelatous inflammation is distinctly laid down (§20).
The operation of trepanning the skull is circumstantially described, and an interesting description is given of a mode of doing the operation peculiar to our author[758] (§ 21).
This, then, as far as I know, is the first exposition ever made of a highly important subject in surgery, upon which professional men are still greatly divided in opinion. I cannot, then, resist the temptation to offer some remarks on the views of practice here recommended, and to institute a comparison between them and certain methods of treatment which have been in vogue of late years.