Surgery; its theory and practice . ot appear forsome time. It is incom-plete and locaUzed, and pro-bably affects only one hmbor a single group of the central lesion, on theother hand, the paralysis oc-curs immediately after theinjury; it is more completeand extensive, and thewhole of one side, at least,will probably be paralyzed. The treatment should be directed to the prevention of inflam-mation in the way already described. If there is a wound, withprotrusion of the brain, the contused and protruded portions andany fragments pressing upon or penetrating the brain substanceshould b
Surgery; its theory and practice . ot appear forsome time. It is incom-plete and locaUzed, and pro-bably affects only one hmbor a single group of the central lesion, on theother hand, the paralysis oc-curs immediately after theinjury; it is more completeand extensive, and thewhole of one side, at least,will probably be paralyzed. The treatment should be directed to the prevention of inflam-mation in the way already described. If there is a wound, withprotrusion of the brain, the contused and protruded portions andany fragments pressing upon or penetrating the brain substanceshould be removed, the wound cleansed with antiseptics, thescalp replaced, and its union by the first intention sought. Inthe case of a gunshot wound the bullet should be removed if itcan easily be got at, otherwise it should be left in situ. Wherethere is no wound, but signs of local irritation or of compressionof the cortical motor area from blood-extravasation, the indica-tions are to trephine. The guide to the spot for perforation ^is. The situation of the line of Rolando. 344 INJURIES OF REGIONS. the line of the fissure of Rolando on the side opposite to that ofthe localized spasm or paralysis. This line may be found in var-ious ways. M. Lucas-Championniere employs the followingmethod (see Fig. 114) : He first finds the bregma, /. e., the spotwhere the coronal joins the sagittal suture, by carrying a line di-rectly over the vortex from one external auditory meatus to theother. The upper end of the Rolandic fissure is situated about2 inches behind the bregma. The lower end of the fissure cor-responds to a spot 2 3/_^ inches behind the external angular processand about i inch above it. We have already seen that the corti-cal motor centres are grouped around the Rolandic fissure. Iftherefore there is general hemiplegia, the perforation should bemade over the middle of the line ; if paralysis of the arm and leg,over the upper part of the line ; if paralysis of the arm only, infront of
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Keywords: ., bookcentury1800, bookdecade1890, booksubjectsurgery, bookyear1896
