Indications for operation.
There is a great uniformity of opinion with regard to the indications for operation as expressed by those who have had considerable experience in wounds of this nature. One has only to glance through the works of recognized authorities—Spencer,[61] Bowlby,[62] Makins,[63] Lawford Knaggs,[64] &c.—to see that it is an accepted rule that all bullet-wounds of the skull and brain call for early operative interference, it being granted that the condition of the patient is compatible with such treatment.
Operation.
The operative details may be considered under two headings:—
(a) The exploration of the wounds of entry and exit.
(b) The search for and removal of the bullet.
Fig. 88. To illustrate the Effects produced by a Perforating Bullet-wound. 1, The inverted scalp at wound of entry; 2, Subaponeurotic hæmorrhage; 3, The wound of entry into the skull; 4, Extra-dural hæmorrhage; 5, Lacerated dura mater; 6, Subdural hæmorrhage; 7, In-driven fragments of bone; 8, The passage through the brain-substance; 9, Ventricular hæmorrhage; 10, The wound of exit through the brain; 11, Subdural hæmorrhage; 12, The wound of exit through the dura mater; 13, The wound of exit through the skull; 14, The wound of exit through the scalp.
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