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AIR UNDERNEATH THE DURA MATER IN FRACTURE OF THE SKULL.
248 I come now to notice an unworthy piece of diplomacy ; shall I call it by its true name-cunning, deceit? The 11 Address" is dated August 13th, the new and fourth Medical Bill bears date July 28th. How comes it, then, that the Committee, in the Address, do not notice that Bill? The answer is very apparent: it would have shown too palpably the groundless nature of many of the assertions contained in that Address,for in it are no clauses for ensuring to thefuture general practitioners the title of surgeon, The nor to the College control over the education of its viembey-s. Committee, therefore, is silent; and silent on a Bill so incompatible with its own statements, so unpalatable to its own wishes, it intends to remain for the next two months, it having purposely adjourned its meetings until the last week in October ! Further comment on this is unnecessary, so for the present I will leave the Association, and conclude by subscribing myself yours very
arrangements about the neck, allow the head to fall in like ner ; and what is there to prevent a similar result?
man-
A theory which accounts for so many puzzling phenomena as the one under consideration cannot be called idle, even though it should be false. It accounts for the frequent occurrence of extravasation on the side diametrically opposite to the seat of injury of the skull; for the exsanguine state of the brain in the cases of concussion occurring to Mr. Watson Beaver: it gives a reason why the brain should sink upon itself and be reduced in volume in concussion ;,why concussion should occur from the mere commotion of the body, without any external injury of the head; and I must still be permitted to it explains how the air got access under the dura mater in the case we have related. It gives a happy solution of the question, why progression, attended with abrupt movements in a rarefied atmosphere, causes staggering, dizziness, and sickness, while during the comparatively easy faithfully, ARTHUR H. HASSALL, movements of a balloon these symptoms are absent. ITASSALL, F.L.S., M.R.C.S. Eng. Even grant for a moment that the reviewer’s explanation of the Norland Villa, Addison-road North, Kensington, Aug. 26th, 20th, 1845. presence of air under the dura mater be correct, our theory remains unaffected; it was advanced long before the case occurred, and rests upon a sure and simple foundation, the inertia of matter. AIR UNDERNEATH THE DURA MATER IN The truth lies, not in a well nor on the surface, but within the FRACTURE OF THE SKULL. small compass of a snuff-box, the preliminary tap and the accuTo the Editor of THE LANCET. mulation of snuff towards the side struck, illustrating the law of SiR,—May I request the favour of the insertion of this letter in nature upon which our theory is founded. THE LANCET ? It relates to a criticism on a case of injury of the Before concluding, I would express the reasonable wish that head, in which air was found under the dura mater. The re- objectors to our theory, instead of calling it an idle and groundviewer confidently states his conviction that the presence of the air less speculation, would address themselves to overturn the arguwas caused in the following manner:-" In raising the calvarium ments which support it. from the dura mater, and in separating the firm adhesions which I am, Sir, your most obedient servant, THOMAS HAWORTH, constantly connect them, the dura mater had been raised from the Bolton, August, 1845. HAWORTII, M.D. surface of the brain, and a vacuum being then and thus produced, It is unnecessary for us to enter at any length on this dis** air entered through the fracture at the base." This explanation cussion. Dr. Haworth has a theory, and is unwilling to abandon is very plausible, and is at the first sight satisfactory, and I must what he believes to be a ready illustration of his view. Were it confess it ought to have occurred to me; but will it bear ex- otherwise, he would perhaps accept an explanation which at" first amination ? I ask any one familiar with subjects of this kind, if sight seemed and which ought to have occurred" to satisfactory, the raising of the dura mater from the upper surface of the brain him, without some more sufficient reason than that which he would draw air from a small slit in the dura mater at the base of offers-without reading correctly, as well as quoting, that explanathe brain, there being also a fracture of the skull opposite the slit, tion. It is a fact that air will enter through any external opening affording a communication with the external air. The effect of leading into the cavity of the dura mater, when an attempt is the surface of the upper any attempt to raise the dura mater from made to raise the calvarium from that membrane and not that brain, would be to bring the former into closer contact with the membrane from the brain. Experiment has proved it, and we sides and under surface of the latter, and also to cause the hemi- remain convinced that the air found under the dura mater in this spheres of the brain to press more forcibly towards each other, so case, was a post-mortem effect, produced as we have explained. as effectually to prevent any passage of air from the base to the Dr. Haworth’s objection, that the anterior lobes were compressed upper surface, between the brain and the dura mater, or between in the situation where the air was found, is overthrown by the the two hemispheres. fact that there were no symptoms of compression during life. The It is of importance to bear in mind, that the anterior lobes of blanched appearance was but the natural result of the blood grathe brain were compressed, and sensibly diminished in volume, the vitating to the posterior part of the brain, where, as the writer surface being quite hale, without any appearance of blood what- describes, it was found. The compression, we suspect, was more This could not have been ever in the vessels of the membranes. apparent than real. Respecting Dr. Haworth’s theory of the proa post-mortem appearance; there was less violence used than duction of a vacuum we shall have but little to say ; the subject usual in opening the head. What, then, filled the space left is an unprofitable one, for other explanations can be offered of empty after this diminution of bulk ; what but the air found under the phenomena which this gentleman would seek to explain by a the dura mater, for there was neither serum nor effused blood to reference to his views. The contents of the skull may be made occupy it. I might almost say that the surface of the brain was to vary in their relative proportions and in their distribution, but dry, at least it appeared to me drier than usual; it was also clean, we must have other proof of the possibility of. finding a vacuum and untinted by effused blood. If this diminution of volume took there than that afforded by the fall of a " bottle full of brains" or place during the accident in the way I have described, then the of a trunkless head.-ED. L. vacuum, or the tendency to one, occurred before death; and if so, it is not necessary to inquire into the effects which might follow INOCULATION FORBIDDEN BY LAW. the raising up of the calvarium. Perhaps, when it is considered To the Editor of THE LANCET. that the above is not the only case in which the brain has been diminished in volume after concussion, the minds of some may be SiR,-In THE LANCET of August 9th, I observed an answer to relieved of any doubt of the accuracy of the fact. Littre, Sabatier, one of your correspondents, PniL.0," respecting the legality of and O’Halloran, all state their conviction, from the result of post- inoculation for the small-pox, and as there were, some time since, mortem examinations, that the brain is sometimes reduced in bulk ’, printed papers circulated to the medical gentlemen of this, the in cases of concussion. The case I have recorded is only one Dunmow Union, as well as for general distribution, containing more in addition. extracts from an Act passed in the 4th year of her Majesty, The reviewer has a difficulty in believing " that water contained Queen Victoria, I beg to transcribe such clauses as bear immein an inverted bottle closed by a valve, presents a correct analogy diately upon the matter referred to, not doubting but that you to the brain enclosed in its bony case, with its foramina of exit will confer the favour of insertion, for the benefit of those who and entrance, and consequently that a vacuum produced in the may not be aware of such an Act, as well as for the public former affords any indication of the changes which occur in the generally. I have practised vaccination for more than twentylatter." The resemblance is only in respect to some of the phy- years, have vaccinated the populations of nearly twenty parishes, sical circumstances. The conception of the analogy will be some two or three times over, have put it to the most scrutinising aided, if we suppose the bottle to be filled with a mass of brain tests, and only know of three instances of small-pox after vaccisupplied with its proportion of blood, and suppose, also, that the nation, and then modified, and I am convinced of its security, and vessels containing it unite in one trunk which passes through the that it is capable of annihilating so disgusting a disease, if but neck of the bottle, and which may or may not be supplied with a attention be given to it. The importance of the subject being so valve. I think it will not be denied, that if this bottle were fixed vast, I am sure you will excuse my troubling you with this corto the frame and allowed to fall, a vacuum would be formed just respondence :" as easily as if it were filled with water, though not to the same It is also to be observed, that in consequence of the great Or, what would be better, and beyond all cavil, let a sub- number of deaths, and of the evils, including blindness, which extent. ject for dissection be decapitated, and having made the necessary have been occasioned by the inoculation of children with the
say,
"
arrangements about the neck, allow the head to fall in like ner ; and what is there to prevent a similar result?
man-
A theory which accounts for so many puzzling phenomena as the one under consideration cannot be called idle, even though it should be false. It accounts for the frequent occurrence of extravasation on the side diametrically opposite to the seat of injury of the skull; for the exsanguine state of the brain in the cases of concussion occurring to Mr. Watson Beaver: it gives a reason why the brain should sink upon itself and be reduced in volume in concussion ;,why concussion should occur from the mere commotion of the body, without any external injury of the head; and I must still be permitted to it explains how the air got access under the dura mater in the case we have related. It gives a happy solution of the question, why progression, attended with abrupt movements in a rarefied atmosphere, causes staggering, dizziness, and sickness, while during the comparatively easy faithfully, ARTHUR H. HASSALL, movements of a balloon these symptoms are absent. ITASSALL, F.L.S., M.R.C.S. Eng. Even grant for a moment that the reviewer’s explanation of the Norland Villa, Addison-road North, Kensington, Aug. 26th, 20th, 1845. presence of air under the dura mater be correct, our theory remains unaffected; it was advanced long before the case occurred, and rests upon a sure and simple foundation, the inertia of matter. AIR UNDERNEATH THE DURA MATER IN The truth lies, not in a well nor on the surface, but within the FRACTURE OF THE SKULL. small compass of a snuff-box, the preliminary tap and the accuTo the Editor of THE LANCET. mulation of snuff towards the side struck, illustrating the law of SiR,—May I request the favour of the insertion of this letter in nature upon which our theory is founded. THE LANCET ? It relates to a criticism on a case of injury of the Before concluding, I would express the reasonable wish that head, in which air was found under the dura mater. The re- objectors to our theory, instead of calling it an idle and groundviewer confidently states his conviction that the presence of the air less speculation, would address themselves to overturn the arguwas caused in the following manner:-" In raising the calvarium ments which support it. from the dura mater, and in separating the firm adhesions which I am, Sir, your most obedient servant, THOMAS HAWORTH, constantly connect them, the dura mater had been raised from the Bolton, August, 1845. HAWORTII, M.D. surface of the brain, and a vacuum being then and thus produced, It is unnecessary for us to enter at any length on this dis** air entered through the fracture at the base." This explanation cussion. Dr. Haworth has a theory, and is unwilling to abandon is very plausible, and is at the first sight satisfactory, and I must what he believes to be a ready illustration of his view. Were it confess it ought to have occurred to me; but will it bear ex- otherwise, he would perhaps accept an explanation which at" first amination ? I ask any one familiar with subjects of this kind, if sight seemed and which ought to have occurred" to satisfactory, the raising of the dura mater from the upper surface of the brain him, without some more sufficient reason than that which he would draw air from a small slit in the dura mater at the base of offers-without reading correctly, as well as quoting, that explanathe brain, there being also a fracture of the skull opposite the slit, tion. It is a fact that air will enter through any external opening affording a communication with the external air. The effect of leading into the cavity of the dura mater, when an attempt is the surface of the upper any attempt to raise the dura mater from made to raise the calvarium from that membrane and not that brain, would be to bring the former into closer contact with the membrane from the brain. Experiment has proved it, and we sides and under surface of the latter, and also to cause the hemi- remain convinced that the air found under the dura mater in this spheres of the brain to press more forcibly towards each other, so case, was a post-mortem effect, produced as we have explained. as effectually to prevent any passage of air from the base to the Dr. Haworth’s objection, that the anterior lobes were compressed upper surface, between the brain and the dura mater, or between in the situation where the air was found, is overthrown by the the two hemispheres. fact that there were no symptoms of compression during life. The It is of importance to bear in mind, that the anterior lobes of blanched appearance was but the natural result of the blood grathe brain were compressed, and sensibly diminished in volume, the vitating to the posterior part of the brain, where, as the writer surface being quite hale, without any appearance of blood what- describes, it was found. The compression, we suspect, was more This could not have been ever in the vessels of the membranes. apparent than real. Respecting Dr. Haworth’s theory of the proa post-mortem appearance; there was less violence used than duction of a vacuum we shall have but little to say ; the subject usual in opening the head. What, then, filled the space left is an unprofitable one, for other explanations can be offered of empty after this diminution of bulk ; what but the air found under the phenomena which this gentleman would seek to explain by a the dura mater, for there was neither serum nor effused blood to reference to his views. The contents of the skull may be made occupy it. I might almost say that the surface of the brain was to vary in their relative proportions and in their distribution, but dry, at least it appeared to me drier than usual; it was also clean, we must have other proof of the possibility of. finding a vacuum and untinted by effused blood. If this diminution of volume took there than that afforded by the fall of a " bottle full of brains" or place during the accident in the way I have described, then the of a trunkless head.-ED. L. vacuum, or the tendency to one, occurred before death; and if so, it is not necessary to inquire into the effects which might follow INOCULATION FORBIDDEN BY LAW. the raising up of the calvarium. Perhaps, when it is considered To the Editor of THE LANCET. that the above is not the only case in which the brain has been diminished in volume after concussion, the minds of some may be SiR,-In THE LANCET of August 9th, I observed an answer to relieved of any doubt of the accuracy of the fact. Littre, Sabatier, one of your correspondents, PniL.0," respecting the legality of and O’Halloran, all state their conviction, from the result of post- inoculation for the small-pox, and as there were, some time since, mortem examinations, that the brain is sometimes reduced in bulk ’, printed papers circulated to the medical gentlemen of this, the in cases of concussion. The case I have recorded is only one Dunmow Union, as well as for general distribution, containing more in addition. extracts from an Act passed in the 4th year of her Majesty, The reviewer has a difficulty in believing " that water contained Queen Victoria, I beg to transcribe such clauses as bear immein an inverted bottle closed by a valve, presents a correct analogy diately upon the matter referred to, not doubting but that you to the brain enclosed in its bony case, with its foramina of exit will confer the favour of insertion, for the benefit of those who and entrance, and consequently that a vacuum produced in the may not be aware of such an Act, as well as for the public former affords any indication of the changes which occur in the generally. I have practised vaccination for more than twentylatter." The resemblance is only in respect to some of the phy- years, have vaccinated the populations of nearly twenty parishes, sical circumstances. The conception of the analogy will be some two or three times over, have put it to the most scrutinising aided, if we suppose the bottle to be filled with a mass of brain tests, and only know of three instances of small-pox after vaccisupplied with its proportion of blood, and suppose, also, that the nation, and then modified, and I am convinced of its security, and vessels containing it unite in one trunk which passes through the that it is capable of annihilating so disgusting a disease, if but neck of the bottle, and which may or may not be supplied with a attention be given to it. The importance of the subject being so valve. I think it will not be denied, that if this bottle were fixed vast, I am sure you will excuse my troubling you with this corto the frame and allowed to fall, a vacuum would be formed just respondence :" as easily as if it were filled with water, though not to the same It is also to be observed, that in consequence of the great Or, what would be better, and beyond all cavil, let a sub- number of deaths, and of the evils, including blindness, which extent. ject for dissection be decapitated, and having made the necessary have been occasioned by the inoculation of children with the
say,
"