With respect to alteration in temperature on the two sides of the body, the clinical value of such changes must, from my own observations, be regarded as of a very indefinite nature.
It now remains to discuss the value of temperature changes with respect to treatment.
Treatment of Fracture of the Base of the Skull.
In the earlier paragraphs of this chapter the special treatment of aural and nasal hæmorrhages and cerebro-spinal discharge was discussed, and some allusion was made to the necessity of exploring the middle fossa in cases of profuse arterial or venous aural bleeding. The general treatment of basic fractures now requires description, previous to which, however, space must be made for a short account of the routine treatment by Urotropin—as advised by Crowe and Cushing—as a prophylactic against the development of meningeal infection. The following is a summary of Crowe’s paper[25] on the ‘excretion of Urotropin in the cerebro-spinal fluid and its therapeutic value in meningitis’.
1. Urotropin, when given by the mouth, invariably appears in the cerebro-spinal fluid.
2. The largest amount of Urotropin is present in the cerebro-spinal fluid from thirty minutes to an hour after the ingestion of the drug.
3. After doses of Urotropin, within therapeutic limits, a sufficient amount of the drug appears in the cerebro-spinal fluid to exercise a decided inhibitory effect on the growth of organisms inoculated into this fluid after its removal from the body.
4. Following a subdural inoculation of dogs and rabbits with streptococcus, 60-80 grains of Urotropin a day, given under conditions which insure absorption, will markedly defer, and in some cases prevent, the onset of a fatal meningitis.
5. In view of these observations, the prompt administration of Urotropin is advised in all clinical cases in which meningitis is a possible or threatened complication, or even when meningeal infection has actually occurred.
