The good old days: Injuries of the cranial bones

Contusions to the cranial bones are always serious and may lead to suppuration and cerebral abscess. When suppuration occurs, a circumscribed oedematous swelling may form, known as Pott’s puffy tumour.

Simple fissured fractures may result from a direct blow, such as with a hatchet, and one or more of the fragments may be pressed inwards. Sometimes a portion of the bone may be raised and this is seen especially with sabre wounds. This type of wound results from an oblique blow and is seen in young adults, when the bones of the skull are still relatively soft.

Raising any depressed fragment is of great importance, because of the risk of inflammation of the brain. Progressive mental inability, epilepsy and insanity may all otherwise supervene. In children, transverse pressure can cause a depressed fracture to spring back, like a dint in a felt hat.

But atrophy can take place, exposing a gap through which the pulsations of the brain can be perceived.

Another serious and frequent injury to which the brain is exposed is concussion. The effect may be but momentary, there is transient unconsciousness and the individual ‘comes to himself’ without further symptoms. But if the concussion be severe, the state of unconsciousness continues, the power of motion is almost or entirely lost, the breathing is slow and quiet and the pupils frequently contracted, but sometimes dilated. Very generally there is vomiting and the pulse is small and weak.

The patient should be put to bed and if there is extreme depression, a little sal volatile or brandy and water may be given sparingly. The diet should consist entirely of milk.

The hair must be cut or shaven off and the head kept cool with cold or iced applications.

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