NOTE ON A CASE OF COMPOUND DEPRESSED FRACTURE OF THE VAULT OF THE SKULL; OPERATION AND RECOVERY

HanwayR. Beale
1908 The Lancet  
Clinical and other Notes 609 extension from the inflamed liver, and its complete resolution. (0) The subsequent period of apyrexia for over three weeks, during which time the abscess must have been forming. (d) The insidious extension of the suppurative process to the pleura. (e) The great severity of the inflammatory process locally. I regret that I did not immediately explore the liver again, after finding the empyema, but it was thought that the " pe~cant " abscess was the one previously
more » ... ed, the temporary improvement following the operation seeming to support this view. ON May 22nd, at Meerut, Bengal, Lieutenant S. was galloped into, at polo, with tremendous force, the two ponies and riders rolling over and over. Lieutenant S. never left the saddle and was lying on his back on his pony's loins, with his head on his pony's quarters, and before I could get hold of the officer's head and shoulders, and jamb my leg against the pony's quarters, the pony gave two more rolls off and on to Lieutenant S. 's head and shoulders, crushing the head between his quarters and the ground. The patient was quite unconscious, with stertorous breathing and violent vibrations of the right arm which lasted for about two minutes; by which time his leg was cleared from under the flap of the saddle, and we had carried him back a yard or two. He then became deeply cyanosed and appeared to be dying. This condition, however, somewhat improved, and getting him into a dhooly, I went with him to the hospital, about a mile off, sending on ahead to have an officer's ward opened. When nearly there, he again became deeply cyanosed, and I then thought him dead. On placing the dhooly on the verandah I made the pulse out again-44 beats to the minute-and the cyanosis passed off; I let him rest for an hour, fanning him awhile. He was then lifted on to a bed, and for the next fifteen minutes he was very sick. During the following half hour he lay quite still, the pulse falling to 40 beats in the minute; I gave 2 drachms of brandy in some water and the pulse returned to 44. He was wearing a sola topee at the time of the accident, but without cross bands inside; the crown was completely crushed in and the front and left side of the brim broken downwards. His forehead, left eye, elhows and shoulders were much contused. At 10 p.m. he was given 4 grains of calomel in butter on his tongue, and
doi:10.1016/s0140-6736(00)67449-4 fatcat:lxcoyz6dcva7jk5ilwpxmturjy