Show FIX BROKEN SKULL OPERATION BY WHICH A CHILD S LIFE WAS SAVED youngster falls five stories from window striking head on cement flagging below breaking skull yet lives patrick kelln aged four living in ye vt ork recently ell nye stories through an to the cement flagging below landing on his head and fracturing his baull dr J edward downey the physician called describes the remarkable operation b diagram showing fractured skull which the little fellow a ftfe was saved in the following narrative A hasty examination showed that the child s skull was fractured how badly he could not then tell the lit tie chap v as in a coma and it looked as though death would come before he could reach the hospital but in a very few minutes we had him on the operating table where a more thor ough examination told us that the in jury was BO great there appeared to be absolutely no chance for his life careful stimulation was applied and the operating surgeon notified A slight anesthetic waa administered as a matter of precaution in the event of returning consciousness and the operation began in an exceedingly short time after the boy s entry cutting down we found the fracture was of Y shape extending from the frontal bone backward over the parietal and down the temporal regions of the skull with a large area of the vault pressed into the brain substance the dura that tough fibrous covering of the brain had been ruptured al lowing the brain to be forced through the fracture that in itself waa enough to make tho case fatal and as we worked there came the able signs of a rapid approach of death tor complicate matters there was a profuse hemorrhage from the middle artery but this was speed lly caught up and ligatured the operating burgeon working with won darful speed soon had a button from the center of the pe pressed section and with elevators raised the vault to its nor mat position A change for the better was at once noticed in the condition of the boy and with that faint ray of hope to spur ua on the operation con the ragged ege of the were carefully trimmed while adhering fragments frag menta were re moved the brain dodty torn wa carefully and tek and the removal of a large clot of blood which covered thai part of the head successfully accod next the dura was approximated a very fine catgut suture being used but when that was finished we found there continued to be a very heavy cerebral oozing tor which we resorted to a gauze packing between the dura and the skull thus by pres sure overcoming ono ot the terrors of surgeons in their work on all brain injuries the usual form of drainage and sa completed the operation ra even then for the tact that abo patient was leaving the table alive the regular postoperative post operative treat ment tor fractured skull cases was ordered A reference to the chart gave the pulse weak alon 40 shallow temperature which was also a strange feature of the case dropping one degree every twelve hours until it had reached normal and never changing again after that for CO hours there as no sign of consciousness when at the end of that time it showed only by faint reo that Is a blinking of the eyes as a hand was passed rapidly before them about the seventy s ond hour it appeared as it the boy recognize 1 relatives though only by a kind of grunt when any of them came near him from then until the seventh day the improvement was very alow but at the end of that pe the faculty of speech had returned A unique feature of the case was that the little fellow gained in weight until when he left tho hospital three weeks later being taken home by his mother he was heavier than he bad ever been I 1 can only attribute this remark able result to the promptness in op crating its continuance even when death seemed to be close at hand and the and coolness of the surgeon who stopped at nothing coupled with the splendid vitality of the child one point I 1 feel that this case has demonstrated Is that of operating during the continuance of the primary shock tor I 1 think that much harm emust ensue when the surgeon besl tates or waits tor a seeming increase in strength thus by operating at a later late producing a secondary shock |