Show N ir OPERATION BY WHICH A CHILDS LJ LIFE FE WAS SAVED 1 le Y youngster oun aste r falls five stories from wind window ow striking head on cement V Flag flagging jIng below breake breaking ng i skull yet lives patrick kerin aged four living in new york recently fell fall five stories thi through ough an all shaft t to ilithe the cement fla nag 9 ging below landing landin 9 on his head a and r f fracturing his skull dr J edward downey the physician ca called bed describes the remarkable operation by which the little littie fellows life was saved 1 in the following nar narrative yative A hasty examination showed that the childs skull was fractured how badly he could not noi then tell the lit JI t tle tie chap was in it a coma I 1 and it looked as thou though h 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 mord thorough examination told us fh th atthe injury was so great there ther eap appeared eared to be absolutely no chance for his life careful stimulation was applied and t the he operating surgeon I 1 notified A r slight anesthetic anesther was administered as a matter matte of precaution in the event of returning consciousness and the oper V OF 0 ROLAN FRACTURE cind 0 depression 1 1 tr diagram showing fractured skull aaion began in an exceedingly short 7 time after the boys entry cutting down we found the fracture was of Ys hape extending from the frontal bone backward over the parietal and down the temporal regions of afie he skull with a large area of bf the vault pressed into the brain substance the dura that tough fibrous covering of the brain had been ruptured allowing the brain to be forced through the fraet fracture tire that in itself was enough to make the case fatal and as we worked there came the unmistakable signs of a rapid approach of death to complicate matters there was a profuse hemorrhage from the middle artery but this was speedily caught up tip and ligatured the op orating crating su surgeon ageon working with wonderful speed soon had a button from the center 0 of f the pe pressed section and with perl osteal elevators raised the vault to its normal 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 us on the operation was continued the ragged edges of the fracture were carefully trimmed while adhering fragments were removed the brain tissue though badly torn was carefully and gently pressed back and the removal of a large clot of blood which covered that part of the head successfully accomplished shed ed 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 for which we resorted to a gauze packing between the dura and the sl skull thus by pressure overcoming one of the terrors of surgeons in their work on all brain injuries the regular postoperative post operative treatment for fractured skull cases was ordered A reference to the chait chai t gave the pulse weak resura 4 A A H li tion 40 shallow temperature which was also a strange astrande feature of the case dropping one degree avei every y twelve hours until it had reached maland nor abid never changing ag again ain a after f ter that for 60 hours there here was no sign of consciousness when at the end of 0 that time it showed only dorily by faint recognition o ignition tion that is a blinking of the eyes as a hand was vas passed rapidly before them about the seventy sec ond hour it appeared as if the boy recognized relatives yela relatives tives though only by y a kind of gr grunt int when any of them came near him from then until the seventh day t the he improvement was very slow but at the end of that period rao the tha faculty of speech had r returned ed A unique feature of the case was that the little fellow gained in weight until when he left the hospital three weeks later being taken home by his mother he was heavier than he had ever been I 1 can only attribute this remarkable result to the ille promptness in op er crating t its continuance even when death seemed to be closest clo close seat at handland hand han dand and the sk skill illand and coolness of the surgeon who stopped at nothing coupled with the splendid vitality of the child one I 1 point J I 1 feel that this this case has demonstrated is that ot of operating during the continuance of the primary shock for 1 I think that much harm must ensue when the surgeon lies tates or walts waits for a seeming jn increase crease in strength thus by operating at a later date pro producing aucin a secondary dary shocks shock |