Reports of Societies
1883
BMJ (Clinical Research Edition)
notice, save that he had pain along the 'left sterno-mastoid musclq; the pupils were equpl and active; he was very restless ,at night. The next day (April 28th), he said he felt well, but had pain and swelling about 'the 'ieck; he had slept Hil. On April 29th, the morning temperature was 101.2°Fahr.; there was no twitching on the left side of the neck. The bowels were acted upon. Du'ring the night, he had had attacks of convulsive twitchings dowan the left side. On April 30th, he had what he'
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... lled "-a stroke" (hp had charge of epileptics), a convulsive twitching down the left side, which drew his head and arm up towards the middle line of the body; it was over in a moment, and was followed by facial paralysis; afterwards, he had two slight attacks. In the evening, he was very restless, tossing his head dbout. May 1st. Temperature, 1.03.a'. Slight convulsiveattacks occurred in the morning; signs of left hemiplegia became manifest, and his speech was thick. On May 2nd, the temper4tnre was 102.60. The paralysis of the left hand and arrm was more marked, and he was beginning to lose power in the left leg. Six days after the accident, on May 3rd, Dr. Swain, the Medical Superintendent, telegraphed for Mr. Wherry, who found the patient calm and intelligent, but anxious 'about himself; he had wellmarked left hemiplegia, and considerable fever. There was a compound comminuted depressed fracture of the right parietal bone; the. main fracture was deep down in the middle of the wound, and ran from near the right parietal eminence forwards to the sagittal suature. Mr. De Lisle gave chloroform, and the wound in the scalp was enlarged. The fragments, of the skull were so driven in,. that the trephine was applied in two places before it was possible to remove the nine portions. Heemorrhage was profuse from a rent in the longitudinal sinus, but ceased on the complete removal of the fragments, when the dura mater, bulging with pulsations into the wound, seemed to stop the haemorrhage by its pressure. The inner table was more extensively fractured than the outer. Next day, he 'expressed himself as pretty comfortable; -but, on the evening of the day following (May 5th), his temperature rose to 103°Fahr., and he was delirious and in pain. The wound began to suppurate; the dura mater could be seen pulsating freely. A subcutaneous injection of morphia much relieved him. He continued in this condition, -still paralysed, wandering in his mind, either in stupor or delirium, and unable to recognise his wife or friends, until May 9th, when he seemed clearer in his mind, and asked for some fish. On May 10th, he startled Mr. De Lisle by saluting him, military fashion, with the left arm (previously paralysed'. He now made fair progress, -but had pains all over him, "like electric shocks ;" he had rigors on May 20th, and great frontal and occipital aches. The administration of morphia had a peculiarly soothing effect; he usually slept about eight hours after each injection, and awoke refreshed and free from pain. Towards the end of May, he grew depressed and irritable; the pains continued; he had paralysis of the left side, and slightly, also, on the right. On June 13th, fits of convulsive twitchings down. the right side occurred, and attacks of unconsciousness for short periods, with dilated pupils; the attacks were rather like epilepsy, and were preceded by great frontal pain. Now came a period of insanity; there was little pain and no fever, but he became depressed and sullen, did not know his wife or friends, had a vacant demented look, and lost his memory; afterwards, he took a dislike to his wife, and cursed his best friends, wandered about the room, did not know where he was, and passed his water in the bed. On June 20th, several pieces of bone which had exfoliated from the outer table were removed from the granulating wound, and from this time he gradually improved so far, that, at the end of June, he looked better, and, spoke rationally, no longer wet his bed, and was able to sit up daily. His memory was a blank as to his condition from the 15th to the 22nd of June. On July 8th, he could get up and dress himself, and walk about, but had a vacant absent look, and numbness in his head. On December 26th, it was noted that he appeared quite well, suffered no inconvenience from his accident, except that preceding an atmospheric depression, he felt a throbbing sensation in the wound, which was now quite healed. He engaged in farming pursuits, and seemed perfectly recovered. REBMAUKS BY MR. WHEREY.-The successful issue is, in great
doi:10.1136/bmj.1.1164.768
fatcat:a3sahorpjfdi5eysskf5duxbnq