. Railway surgery : a handbook on the management of injuries . moving all thehair by shaving, and applying a crinoline cap firmly overall. It is unnecessary to state that these cases should beredressed every day, and if any packing is left in the wound it should be gradu-ally withdrawn as the cav-ity closes by pus should form, thedioxide of hydrogen may beused to keep the woundclean. The after-care of suchcases is to watch carefullyfor symptoms marking fur-ther damage. Sepsis willmake its presence knownby a sudden rise in fever,with probable chills. Im-mediate exploration of th
. Railway surgery : a handbook on the management of injuries . moving all thehair by shaving, and applying a crinoline cap firmly overall. It is unnecessary to state that these cases should beredressed every day, and if any packing is left in the wound it should be gradu-ally withdrawn as the cav-ity closes by pus should form, thedioxide of hydrogen may beused to keep the woundclean. The after-care of suchcases is to watch carefullyfor symptoms marking fur-ther damage. Sepsis willmake its presence knownby a sudden rise in fever,with probable chills. Im-mediate exploration of thedepths of the wound is then indicated, together with anti-phlogistics and supporting treatment. Paralysis or twitch-ings also mark the condition of deeper and positive dam-age to the brain, requiring a reopening of the wound todiscover the offending particle. The bladder and bowels are always to be carefullylooked after, as to relief and antisepsis. As a subsequent condition following fracture of theskull, when there is an external opening left, may be men-. FlG. 40.—Hernia Cerebri. (Case of theauthors.) FRACTURE OF THE SKULL. 95 tioned that of hernia cerebri, or a profusion of peculiarformation through the opening (see Fig. 40). The ap-pearance of this is similar to wound granulations, redand bleeding, but in no particular resembling brain mat-ter. There is no seriousness whatever in the condition,and the treatment consists in paring off the excess, ap-plying mild astringents and firm pressure, under whichtreatment it gradually disappears. As to the opening in the skull, if small, it may be leftalone, as a fibrous membrane will usually form across itfrom the periosteum, with enough rigidity to protect thebrain. Never try to put back pieces of bone, or trephinedbuttons which have been completely severed. They willnot affix themselves, but will become carious, and thusnecessitate subsequent removal. When the space is large,and doubts are entertained as to its being closed to
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