Beruflich Dokumente
Kultur Dokumente
JUL
22
_96,IMx)o
unrelieved.
Initial
Pressure.
R?eadivfs.
Quantity and
ChrctroFud
CliemacteroefFluid
Reoe.
Pressure
after
Removal
of Fluid.
1915.
Aug. 19
straw-colouredflnid
16.5 cmn.
10)nw
0
CASE IV.
Private S. was admitted on December 31st, 1915. The wound,
a fairly clean punctured wound, was situated in the frontal
region.
X-ray examination showed a track leadinig from the woun(d
of entry down to the occipital region, where lay several shell
fragments embedded in the under aspect of the right occipital
pole.
the track.
We may reasonably assume that in this case it was the
sudden removal of a certain quantity of supporting cerebrospinal fluid that had just been sufficient to start tho
liaemorrhage.
Except for this unfortunate accident, and the other case
already described, in whlich fatal meningitis followed the
rapid involution of a liernia after lumbar puncture, we
lhave had no deatli attribntable, either directly or indirectly,
to the performance of lumbar puncture.
I am much indebted to Lieutenant-Colonel Sargent,
R.A.M.C., and Lieutenant-Colonel Gordon Holmes,
R.A.M.C., for their help in the preparation of tAis
65 cm.
REFERENCEs.
white shreds
wound, even
infection.
OF
ico6
,THU Bal-rism I
MLPDICAL JOURNAL
riULY
22,- x9x6
septic le3thl present; or (3) were wearing dentures, wlicl filled witlh old "imodelling " composition. The
FIG. 1.-Writer's noiiflcation
disappeai-e 1 at tlle timiies of tlle injury.
Tlhese being tlle conditiolns, it is necessary to select splints are
o Kingsley
splint,
Sp mnade in thiree ~~~~~~cavity,
conwhich
is showing
filled witli
some nietlhod of treatmnent whicih vill conform to them and
sizes-small, meditiim, and " modelling " com-position.
wlhiel will reduce any future deformnity or disability to a laige.
minimmUM.
The
'
folwiaing are the instructions sent out with eacl
ln the first place I wi'll briefly review the better set of splints:
known metilods and splints, and slhow in whlat wvay they
Thlie "Pickerill " Splint.
fall slhort of requiremenits.
lThe Foiur-tailed Bandage.
I.
II. Intterdental
Splints.
case.
two ends togeth6r and wire thlem would eitlher be inpossible ol grotesque, and would not result in a jaw wlich
could be used subsequently for masticatioln. This method
lhowever, be employed in a modified manner as
nmay,
described below.
SUGGESTED IMMEDIATE METHODS OF TREA.TMENT.
In view of the conditions of the injury and tihe disabilities pertaining to usual miietlhod's of treatmenit outlined
above, I lhave utilized the following methoods and found
1. Splinzt.
From wlat lhas been written above it imiiglht be inferred
tllat I would not suggest the use of any formii of splint,
but in the one to be described it is believed all the
are
2. Intermaxillary
Lacing .1
This coinsists essentially in absolutely im-
Bamin
DXCAL _o~
_~~~~~~~~~~~~~~~~~~~~~~~~~~~~EIA
ngpinthpld
together.
1. Holes are (drilled through thle jaw at the level of the roots
-df the teeth, and about tihree-quarters of an inichi away from
the erids of each fracture liine. Stout silver wire is thein
passed through the holes and the fragments approximated if
possible.
2. Further holes are drilled in the reglionrof the lateral incisors of both upper and lower jaws, or other suitable l)ositions,
frequently with
4. Wir7ing,.
Thlis methlod is dlesirable unlder twXo conditions:
injucry.
REFREENCES.
2BRITIS13 MEDICAL
Selection of Cases.
Venesection is not required for all cases. The two types
I called the "cyanotic" -and thle "cardiac failure." The
latter are pallid, collapsed, and requive ino bleeding. They
* It is sometimes stated that tthere i.s considorable difficulty in
returning the wire throtuh tio hio!es, but wibih a few coimwou-sense
precautions this is really a very sinip0e matt.er.