. Medical and surgical therapy . ll bylumbar puncture. Further on we shall see that oneought not to try to reduce the intra-cranial pressurein the early stages, for the increase of pressure luckilyopposes extension of the meningitic phenomena thatalways exist at the level of injury when the wound isa penetrating one. It is also of interest to ascertain,by examining for motor, sensitive, and sensorytroubles, to what extent the cerebrum and the cere-bellum have been injured, and to what extent acomplete cure of the patient may be hoped examination is unfortunately seldom carriedout beca
. Medical and surgical therapy . ll bylumbar puncture. Further on we shall see that oneought not to try to reduce the intra-cranial pressurein the early stages, for the increase of pressure luckilyopposes extension of the meningitic phenomena thatalways exist at the level of injury when the wound isa penetrating one. It is also of interest to ascertain,by examining for motor, sensitive, and sensorytroubles, to what extent the cerebrum and the cere-bellum have been injured, and to what extent acomplete cure of the patient may be hoped examination is unfortunately seldom carriedout because of its difficulty and length, which makeit almost impossible when there is a great rush ofwounded. When it can be carried out, it allows the GENERAL CONSIDERATIONS 775 surgeon: first, to form an opinion as to the extentof the cerebral lesions, although the bulk of thesymptoms may disappear and may be due merelyto concussion and cerebral oedema; second, to makeout how far the patients condition is ameliorated Projectile Scalp. Dura fluid. Brain. r-Foramina of Majendieand Luschka. Fig. 7.—This diagram shows that the meninges and the brain adherearound the area of injury, and that this adhesion shuts off thegeneral meningeal cavity. The projectile is seen very near the ven-tricular cavity, and it can be understood that incautious handlingwould open a septic focus into that cavity, provoking a rapidlyfatal central meningitis. or aggravated after the operation, and to draw fromit inferences which may be useful. An outline of the anatomy of the skull and itscontents from which deductions may be drawn thatwill prevent the surgeon from adopting unsuitablemeasures. The skull, the brain, and its dura matral covering(which is the only one of the meninges that really rr6 WOUNDS of the skull matters from a sur<:yical point of view) can be rouj^lilyrepresented as follows : — 1. The skull is a rigid shell continuous with thevertebral canal and formed
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Keywords: ., bookcentury1900, bookdecade1910, booksubjectsurgery, bookyear1918
