Identifier: railwaysurgeryha00herr (find matches)
Title: Railway surgery : a handbook on the management of injuries
Year: 1899 (1890s)
Authors: Herrick, Clinton B. (Clinton Bradford), b. 1859
Subjects: Railroad accidents Surgery Emergencies Railroads Wounds and Injuries
Publisher: New York : W. Wood and company
Contributing Library: Francis A. Countway Library of Medicine
Digitizing Sponsor: Open Knowledge Commons and Harvard Medical School

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i^aPVsrvArvtf Fig. 37.—Fracture and Depression of only the Outer Table of the Skull. has been struck a slanting blow which has glided off beforeits force could penetrate to the inner table (see Fig. 37).There may be a condition of fracture or splintering of theinner table without any sign of injury in the outer layer.This can occur only when the blow has depressed an un-usually elastic skull just to the point of Assuring the innertable, which would here first occur. At this point theforce recedes or diminishes, permitting the outer table toresume, through its elasticity, its normal contour. Depressed fractures are never seen at the base, butusually a fissure runs from the anterior or posterior con- 86 RAILWAY SURGERY. dyloid fossa, irregularly up on the sides of the base of theskull (see Fig. 38). All fractures of the vertex are associated with a lesionof the soft parts, and are frequently in a state of comminu-
Text Appearing After Image:
FiG. 38.—Fracture of the Base of the Skull, showing the radiating lines of the fissures. tion. One edge of the fractured portion may yet retain itsrelation with the uninjured bone surface, while the other FRACTURE OF THE SKULL. 87 end dips down into the brain substance, or extends underthe edge of the surrounding bone; or the piece which isfractured may sink entirely below the level of the normalcontour of the skull. Signs and Symptoms. The symptoms which these conditions give rise to arequite varied, and do not always seem to be just in accordwith the injury. We have noted individuals who havewalked great distances after having received a compound,comminuted, depressed fracture of the skull, and on theother hand have seen patients presenting the gravest trainof symptoms, in whom no evidence of a lesion to theskull could be made out, and not found even on autopsy.Usually, however, the symptoms follow quite close alongthe lines the injury would indicate. A freely bleeding wound, suff

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