B
Fig. 43. An Explosive Fracture of the Vault of the Skull. A shows the right side of the skull and the site of entry of the bullet. B shows the extension of the fracture round the left half of the skull. In the left upper parietal region (Fig. B) a fissured fracture is seen where the bullet failed to perforate the skull.
Chronic fixed pain, some days or weeks afterwards, with symptoms of brain-irritation or encephalitis, and even suppuration, suggesting irritation of the meninges and brain by spicules of bone.
Compression and paralysis on the opposite side of the body some hours afterwards, as the result of injury to the middle meningeal artery.
Symptoms of compression early and slight, combined with partial paralysis of the opposite side of the body.
‘The less definite the symptoms of compression, the greater the reason to believe that they are caused by the internal table only.’
Before entering into the question of treatment of fractures of the skull, it is essential that allusion should be made to the temperature in its relation to head-injuries. The great importance of temperature changes in the consideration of operative treatment will be manifest when discussing the treatment of fractures of the base.
The temperature in its relation to head-injuries.
The various temperature changes observed in cases of head-injury have afforded a subject prolific in discussion. Broca, Battle, Guyon, Walsham, and others have endeavoured to deduce facts from the examination of head cases, but the results have been rather indefinite. In over 300 cases that have come under my observation, accurate records of the temperature charts were obtained, the patients were watched throughout their illness, and in the case of death, the autopsies were attended.
The following deductions were made:—