Excerpt from Progressive Medicine, Vol. 1: A Quarterly Digest of Advances, Discoveries, and Improvements in the Medical and Surgical Sciences; March, 1907
In his paper he refers to the series of 146 fatal cases of fractures of the skull which were studied by Dwight; in only 6 of these was there a localized fissure of the vault alone. As to the unreliability of the clinical signs, it was shown that in 31 per cent. Of fractures of the middle fossa itself there was no bleeding from the ear, in 29 per cent. Of the cases there was not one fracture of the vault extending into or through the middle fossa, but the fracture ruptured the branches of the middle meningeal artery and death was believed to be due to cere bral compression. As showing the frequency with which serious lesions of the brain are associated with fractures, it was noted in Dwight's series that out of 138 cases, in only 22, or 14 per cent., was there no lesion of the brain. In determining the question of operation, one must take into consideration four kinds of evidence: the nature of the blow, as to whether it is likely to shock and lacerate the brain or rupture a vessel; the general symptoms, such as coma, temperature, and pulse, etc.; the neurological conditions, and the surgical evidence of injury to the skull.
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