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doses night and morning, until his mouth was sore, which happened soon. The same was continued. His mouth kept tender during the whole of his quarantine, 41 days. He had no complaint during the time, except once or twice a slight headach, which was always removed by a calomel purge. He had a generous diet all the time, and generally a pint of wine a day.
During the time the battalion was infected with plague, we had between 30 and 40 cases of tumour in axilla, attended with slight fever. They were all treated in the same manner, the calomel purges were given, and the ungt. hydr. rubbed in the course of the absorbents. They all did well; some suppurated, and some were absorbed. These cases were not supposed to be plague, as none died.
In detailing these cases, my intention was merely to relate facts, my mode of treatment, and the results; avoiding all theory or reasonings about it; knowing, that if you deem this paper of sufficient importance to merit a place in your valuable Journal, it will call the attention of men of the first abilities, who will do the subject more justice than I can. I am near sixty, and it is long since I was at school. This regiment was twice infected with plague; and though it appeared in every company in it, you will be surprised to hear, that we lost on the whole only eleven men. It is not my intention to claim any merit on this account. That is entirely due to the commanding officer Major C. Bayley, to whose almost sleepless zeal and attention for nine months it is owing that our loss was so small: To his wise regulations, and constant superintendence, the safety of a great part of the battalion must be owing.
It will be expected that I say something on the use of oil as a preventive. I am clearly of opinion it was very useful, after the men had used it some time; suspicious cases less frequently occurred; and, although we were several months in strict quarantine, the men sleeping on the bare boards, with only a blanket to cover them, and this during the winter months, we had not a single case of rheumatism, very few cases of simple fevers, dysenteries less frequent, and easier managed. Though the men did the same duty in quarantine they did before, their general health seemed much improved, many of them got into flesh, and the battalion has been much healthier than I ever knew it before. It must be left to future experiments to ascertain whether this plan of treating plague will lessen the number of deaths or not. For myself, I should feel less hesitation in meeting it in a British garrison now than I had.
Malta, 26th June 1815.
Case of Fracture of the Skull, in which a Quantity of Brain was lost, and a real Hernia Cerebri successfully treated by Pressure ; and an Account of the good Effects of a Tincture of Bay-leave's to Wounds, Ulcers, Burns, &c. and of Charcoal internally in Dysentery. By C. K. CRAWFORD, Surgeon, R. N.
N the 25th June 1813, being on a visit to my relations in the north of Ireland, I was called, in conjunction with Mr. Thomas Miller, a navy surgeon, then practising in NewtonStewart, to visit James Hamilton, a fine boy, betwixt two and three years of age, who had the preceding evening, while at play in the fields with other children, received an injury of the head. He complained on his return home of pain; but there not being an external wound bigger than might be inflicted by the point of a pin, little notice was taken of it at the time.
During the night he was very restless, with heat of skin and other symptoms of fever. He complained so much of the pain in his head, that his father's attention, with whom he slept, was towards morning directed to the place of which he complained, where there was an evident depression of the cranium, and the pulsation of the brain very susceptible,
Though, when we saw him, there were no conspicuous symptoms of compression, and, notwithstanding the generally received rule, not to interfere with fractures of the cranium, unless such symptoms do actually occur, we did not hesitate in making the necessary incisions for examining the state of the skull.
The skalp was divided in the shape of the letter T. The first incision horizontally forwards, near, and in the direction of the superior margin of the fracture. The other, from that at right angles, down the middle of the depression, On exposing the cranium, we found the left parietal bone fractured, and depressed rather behind, and above the attachment of the temporal muscle. More than two inches in length, and one in breadth, was entirely broken from the surrounding bone, comminuted and sunk near an inch into the brain, at the posterior angle of the fracture. From this a fissure extended down through the temporal bone towards the back of the ear, part of the bone being likewise depressed. The cavity formed by the deepest
part of the fracture, was filled with protruded brain, the vessels of which caused the pulsation observable before the removal of the hair. About the bulk of a walnut of brain, consisting both of the cortical and medullary substance, was lost.
Finding we could not elevate or remove the broken bone without a saw, the trephine was applied at the anterior part of the fracture, where the detached portion was the least sunk into the brain. Besides that, in the crown of the trephine, all the separated bone was removed, the depressed portion elevated as near to its proper level as practicable, and the ragged edges of the surrounding bone taken away, the scalp was brought together, and a stitch put in at the angular points of the wound. Not having adhesive straps at hand, the other parts of the incisions were only kept together by compresses of lint at each side, a pledget of digestive ointment, and a tar compress. The doubleheaded roller was applied moderately tight; a handkerchief and night-cap over all. After the operation, the boy was more lively, and did not lament the pain in his head so much.
The dressings were not removed until the morning of the second day, at which time he seemed duller than usual. This his father afterwards accounted for, by his being disturbed and kept from his sleep for some time in the night. The discharge had made its way through the night-cap; the wound looked very well, and had adhered where the stitch was applied; the other parts were not in contact.
The stitch was cut, and the whole brought together by adhesive straps. The other dressings were applied as at first, except that the bandage was not put on with such firmness, as it was thought his dulness that ensuing night had proceeded from undue pressure on the brain,
The wound was dressed, daily, much after the same manner. About the third or fourth dressing, the brain was observed to protrude from the opening in the dura mater, which was large enough to admit the point of my middle-finger. When the protrusion rose above the scalp, it put on the appearance of fungous granulations from a wound; it enlarged very rapidly for more than a week, and a discharge of a sanious matter kept pace with
it in increase.
The only means hitherto tried to keep it down, were drawing the edges of the wound as near as possible, without too much force, by adhesive straps brought over the protrusion, a compress of doubled lint, a pledget of ointment, and a toe compress, with the bandage applied somewhat tighter than at the second dressing.
Notwithstanding this, its bulk was every day augmenting,
and the discharge from the wound increasing in quantity, and getting of a worse quality. From the sloughy appearance it at one time put on, and the smallness of its base, it was for some time expected to have fallen off; but its surface above the scalp now putting on a healthy appearance, with granulations, discharging good pus, showed our hopes in this respect to be fallacious.
It was at this time as large as a pullet's egg, and had separated the adhesion formed at the angle of the incisions. The boy's health was good, the feverish symptoms having entirely disappeared, though reduced in flesh by the discharge, &c. The tumour, from its appearance and pulsation, was considered to be a protrusion of the brain.
In this state of the case, though contrary to the directions given by every author on Hernia Cerebri, to which we could then refer, it was determined to try firm but gentle pressure, in order gradually to reduce the protruded brain within the bounds of the cranium, watching with due circumspection its effects, to obviate any symptom of compression that might intervene.
This was done by putting larger straps over the tumour, and bringing the lower edges of the scalp as near together as we possibly could. Over the straps was put a fourfold compress of thick lint; the other dressings as before; and the bandage applied with a degree of tightness sufficient to answer our intention. Orders were left to make us immediately acquainted with any extraordinary symptom that might occur.
He passed a very good day, and rested well in the night. Next morning, on removing the dressings, the good effect of the pressure was very evident. It was therefore continued in much the same manner. In a few days the tumour was much diminished, and an adhesion formed betwixt the dura mater and side of the protrusion. As this was perfected, and the communication with the interior of the cranium shut, the discharge decreased and became of a better quality. The incisions healed soon; and, by continuing the pressure, the tumour receded very fast, its surface still discharging good pus.
By the time the skinning process came to this part of the wound, it had just come to the level of the scalp, and was consequently the last place covered with skin, leaving the pulsation of the arteries as remarkable as when the fracture was first examined.
About an inch of bone, entirely deprived of its pericranium, appeared at the time when the discharge and the protrusion were greatest, which was afterwards covered by the scalp without any exfoliation,
The only internal medicines found necessary were a cathartic and saline mixtures, at the time of the accident, and afterwards aperients. Throughout the cure, although weak, his health may be called good. I saw him last in the middle of November 1813. He was then lusty, and growing tall. The pulsation of the brain could be plainly seen. The vacancy in the bone seem→ ed filled up. He is a very clever, healthy, apt child, and not in the least injured by the accident.
In the above case, had the lips of the incision been at first kept in contact by straps, or the suture duly assisted by compress and bandages, that support given by dressings, which was removed by the breach in the cranium and meninges of the brain, and which naturally confine within due bounds the expansive force of its arteries, is it not likely that the wound, partly healing by the first intention, no such untoward circumstance as hernia cerebri would have occurred?
Would it not from this case appear, that the proper method of treating a real hernia cerebri, when the patient's health and every thing else are favourable, is by using that degree of pressure necessary to reduce the exuberant brain into its natural situation in the cavity of the cranium?
I shall now mention two remedies, which, though well known to the medical gentlemen in the army and navy in the West Indies, yet not being published in any work I at present know, it may be of some use to communicate to others.
The first is the application of spirit of wine, camphorated spirits, rum, or bay rum, that is, rum impregnated with bay leaves (Laurus nobilis) either pure or diluted, as stimulants to ulcers, wounds, burns, &c.
I saw these applications for the first time in the hands of the late Mr Murphy, surgeon of the naval-hospital at Jamaica, in 1809. He, I believe, learned the practice from Dr Macarthur, then surgeon of the Barbadoes hospital.
The ulcers to which they are serviceable are, the irritable bleeding ulcer, where the strap of Mr Baynton is not applicable. Indeed, I find the strap not so serviceable in the West Indies as in a colder climate. I have mostly found the spirit of wine, pure or diluted, the best application. Some ulcers require so strong a stimulus as camphorated spirits; while other practitioners prefer the bay rum, which is a sovereign remedy for headach, and various complaints among the natives of Barba does. Even rum, or rum diluted with water, is very good, when the others are not at hand.
To the sloughing, contagious, and phagedæpic ulcers, they