Wounds with bone-fragments or projectile opening ventricle : brain ,, VI1.-Wounds rnvolvlng ( a ) orbito-nasal, ( b ) auro-petrosal region : brain ,, VIII.-Perforating wounds cerebral injury severe. ,, IX.-Bursting fractures . extensive cerebral contusion. cerebral injury contusion. extruding. V -Penetrating wounds with projectile lodged ; bram usually extruding. usually extruding. exposed meninges opened. THE UNOPERATED CASES. TnE COMPLICATIONS k w n END-RESULTS. THE OPERATIVE PROCEDURE.
FOREWORD.WHEK novel surgical experiences, no matter how numerous, are crowded into the period of a few weeks, it is unsafe to dram too many deductions therefrom. The past three years have shown how often favourable opinions which were not based on the study of end-results have had to bc retracted-how often unfavourable opinions, based on improperly conducted operations, have had to give way to the results of those better planned. One needs but recall the story of many of the antiseptics, of abdominal operations, of experiences with wounds of the thorax and joints, of primary and secondary suture of wounds. Hence, what may be said in these pages is said with all reservation and with full admission of a brief apprenticeship.After these three years there is possibly less unanimity of opinion as regards the principles of treatment of cranio-cerebral injuries than of any other type of wounds.Anything classified as neurological is looked upon by many of us as baffling and difficult, and a feeling prevails that the ultimate functional results after recovery from serious cranial injuries are, to say the least, forlorn. Few medical officers had received training in the surgery of the central nervous system before the Reasons are not far to seek. something over 50 per cent. There were no prescribed rules of procedure, aside from the regulation t h a t after operation cases should be retained for ten days, as transportation was supposed t o favour the post-operative complications so frequently seen. Unoperated cases, on the other hand, with the exception of those with a rapid pulse, could if necessary be forwarded t o the base ; indeed, there was some contention t h a t all cases should be sent t o base hospitals for their operation, as there was no harm and possibly some advantagc in the delay.Our early operations, under a general anaesthetic, with flap exposures and imperfect cleansing of the track, did very badly, and the mortality, usually due t o infection, ranged between 50 and GO per cent. The usual line of treatment and sequel may be told by a case report. Case 1 . R f m . J. Y (Serial No. 7). Left parietal penetratmg wound. Incomplete operation bone fragments and small projectile retained. Abscess ; fungus cerebri. Death. encephalitis, 12th day. Admisszm to C.C.S. July 29, 1917, 9 a.m.-Wounded about eight hours previously, wearing helmet. Stunned, but no loss of consciousness. Headache. General Condition.-Good , fully conscious, warm , pulse 96. Wounds.-Two small scalp wounds of left occiput ; a small penetrating wound just below ...