The Surgery of the Skull and BrainRawling, Louis Bathe
Science
The Surgery of the Skull and Brain
Rawling, Louis Bathe
Brain -- Surgery; Skull -- Surgery
3. After doses of Urotropin, within therapeutic limits, a sufficient
amount of the drug appears in the cerebro-spinal fluid to exercise a
decided inhibitory effect on the growth of organisms inoculated into
this fluid after its removal from the body.
4. Following a subdural inoculation of dogs and rabbits with
streptococcus, 60-80 grains of Urotropin a day, given under conditions
which insure absorption, will markedly defer, and in some cases prevent,
the onset of a fatal meningitis.
5. In view of these observations, the prompt administration of Urotropin
is advised in all clinical cases in which meningitis is a possible or
threatened complication, or even when meningeal infection has actually
occurred.
[Illustration: FIG. 44. A TEMPERATURE CHART ILLUSTRATING THE CHANGES IN
TEMPERATURE OBSERVED IN HEAD-INJURIES.
(For description, see text.)]
Acting on these suggestions, I am accustomed to treat all head cases
with this drug, 10-20 grains three times a day by mouth. It may be given
per rectum, though probably with less satisfactory results. Traumatic
cases are treated as soon as possible, other cases receive their dose
for two or three days previous to the operation, the drug being
continued till all fear of possible meningeal infection has vanished.
In discussing the general treatment of basic fractures, it must be
accepted that the basic fracture in itself requires no treatment. Danger
or death is dependent on intracranial complications, and an
uncomplicated basic fracture demands no active surgical treatment. The
special treatment applicable to cases complicated by hæmorrhages, both
external to and beneath the dura mater, is discussed in the next
chapter. It is therefore only necessary to enter into those cases of
fractured base which are associated with concussion, irritation, and
compression of the brain--in other words, the _average_ case of fracture
of the base of the skull.
The surgeon must always be guided by the general condition of the
patient--the blood-pressure, character of pulse, state of respiration,
depth of unconsciousness, &c.--but, in my opinion, the temperature chart
affords perhaps the most valuable basis on which rules can be formulated
guiding the surgeon in his general line of treatment.
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