The London Medical Gazette; December 27, 1828: Being a Weekly Journal of Medicine and the Collateral SciencesVarious
Science
The London Medical Gazette; December 27, 1828: Being a Weekly Journal of Medicine and the Collateral Sciences
Various
Medicine -- Periodicals
Seventh day.--A small fungus was observed in upper part of wound,
to which lint dipped in lime water was applied, and moderate
pressure. The fungus continued to increase.
On the eleventh and twelfth days he had slight bleedings from the
scalp, which stopped spontaneously. Stupor, &c. greatly increased,
but he still recognised his friends; took a very little chicken
soup or beef tea daily, with lemonade, &c. for drink.
On the evening of the thirteenth day bleeding to the extent of
℥iv. or v. took place from fungus: it was checked by application
of saturated solution of alum, but he sunk rapidly, and died that
night.
_Inspection 36 hours after death._--The fungus protruded
considerably beyond the scalp, and was rather larger than a hen's
egg, of a dirty brown colour, and a soft spongy consistence; it
completely filled up the opening made in the skull by the trephine
and removal of detached bone. The pericranium to the inferior side
of this opening was found detached from the bone, to the extent
of a crown piece, and beneath it the bone was rough, and covered
with thin purulent matter. The dura mater, for two inches around
the fungus, was covered with pus; this membrane, by sloughing,
had allowed the fungus to protrude, and its edges adjacent to the
aperture were thickened. On removing the dura mater, the fungus was
observed to arise, partly from the middle, but chiefly from the
posterior lobe of the left cerebral hemisphere: it occupied a space
about three inches in length, and an inch and a half in breadth,
extending to within a line or two of the roof of the ventricle;
at its anterior part was an abscess, containing ℥ss. of pus. The
fungus seemed to be a degeneration of the cerebral substance;
sections of it showed the cerebral matter first dotted with an
unusual number of bloody points, then assuming a greyish colour,
which gradually passed into a dirty brown. With the exception of
these bloody points, the brain presented no unusual vascularity:
it was quite firm, except in the immediate neighbourhood of the
fungus, where it gradually became softer as the colour of the
cerebral substance became deeper, till in the centre of the fungus
it was nearly of a broken down consistence. A quantity of serum was
found in each ventricle.
Another man who had been struck by the piece of iron which
fractured M'Millan's skull was brought up to the hospital at the
same time. He had received the blow on the vertex of his head. On
admission he was in a state of fury, requiring the efforts of
several men to hold him. His head was bruised out of all shape,
quite depressed behind, and a fracture also of the frontal bone;
there were evident symptoms too of fracture of the base of the
skull. The case was hopeless. Several large depressed and detached
pieces of bone were removed, but he died a few minutes after the
operation.
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