. Modern surgery, general and operative. 33 trans-sphenoidal operations there were 2 cases of meningitis. One of these cases(which was inaugurated by violent sneezing) was fatal. Cushing now doesmuch work upon the skull and brain \\ath the aid of local anesthesia. HebeUeves that any watery solution damages brain tissue and in cases requiringthe direct appUcation of an antiseptic employs dichloramin-T. Trephining for a Fracture of the Skull.—The patient should be anes-thetized unless he is unconscious, and should be placed upon the back withthe shoulders a little raised. A sand-pillow is placed
. Modern surgery, general and operative. 33 trans-sphenoidal operations there were 2 cases of meningitis. One of these cases(which was inaugurated by violent sneezing) was fatal. Cushing now doesmuch work upon the skull and brain \\ath the aid of local anesthesia. HebeUeves that any watery solution damages brain tissue and in cases requiringthe direct appUcation of an antiseptic employs dichloramin-T. Trephining for a Fracture of the Skull.—The patient should be anes-thetized unless he is unconscious, and should be placed upon the back withthe shoulders a little raised. A sand-pillow is placed under the neck, andhis head is turned away from the side to be operated upon. The positionof the surgeon is such that the patients head is a httle to his left. A largesemilunar incision is made with the base down, which incision goes throughthe periosteum, and the flap is lifted. The bleeding vessels of the flap arecaught by forceps. The fracture is sought for and found. The pin of the tre- Trephining for a Fracture of the Skull 931. Fig. 590.—Gaits conical trephine. phine is projecled beyond the crown and is set upon sound bone, the crownoverhanging the line or edge of the fracture. The surgeon tries to avoid theregion of a sinus or large artery. A gutter is cut in the bone, the pin of the in-strument is withdrawn, and the trephining is completed. In going through thediploe bleeding is copious. In a young child the diploe may be inner table feels very dense. Stop from time to time, clean out the gutterin the bone with gauze, and try the bone with an elevator to see if it is an old person the skull may be much thinned by absorption. Bear in mindHoldens valuable admonition:Think that you are operating onthe thinnest skull ever seen, andthinner in one portion of the circlethan the other. When the frag-ment is loose enough, pry it out. Ifthe surgeon desires to replace the button, hand it to an assistant, who places it at once in a bowl of warm normalsalt s
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