OUR HARD HEADS.

Dunstan Times, Issue 3141, 30 October 1922, Page 2

OUR HARD HEADS.

(By Emily Z. Friedkin). Heads are commonly known as fragile, but current opinion and truth are often widely separated. It is sometimes quite difficult to die of injuries to the head, even with the most aggressive suicidal intent. The histories of cases of brain injuries show that the head is a hardy member of the body and that the tolerance of foreign bodies in the brain is marvellous. This was amply verified during the war. Dr Charles Chatelin. a British surgeon whose experience covered 5000 war cases, says that "all the cases that have come under our notice went about without experiencing the least inconvenience from the presence of the projectile within their brains, so much so that they were quite ignorant that they had such a condition. "This being so, we are of the opinion that given the absence of anv infection, an intro-cerebral projoctile does not of itself, cause any ri.sk to the patient; therefore, innocuous, nonseptic foreign bodies should not be removed." In the New York Medical Journal Dr John Chalmers Da Costa cites instances of survival for from six to thirteen years with a foreign body in the brain ; he also mentions two cases of recovery after the removal of the foreign body—six weeks and eight months after the respective injuries. He concludes with the opinion that if death does not follow from shock or hemorrhage, the patient may recover. An interesting case is described bv Dr Henry S. Wieder of Philadelphia, in American Medicine. W. G. fell 20ft from a scaffold and was hurried to a. hospital. His brains were scattered all over the scalp; one-fourth of their substance had to be removed. "Jt war; while removing this brain tissue and cleaning up the site of the wound that I was astounded to see the man deliberately put his right hand into his hip pocket, pull out a* handkerchief, leisurely wipe the blood from his face and then replace the handkerchief. "This was the first suspicion," Dr Wieder comments, "we had of the mail's consciousness. We interrogated him. Ho gave his history and asked us not to inform his family of his slight injury." W. G. subsequently died of this "slight injury." Many of the histories are unbelievable and as hairraising as dime novels, but their source guarantees their authenticity. Drs Gould and Pyle have compiled in their "Anomalies and Peculiarities of Medicine" evidence of the head's hardihood.

Quoting l)r Dubrisay in the London journal Lancet, (iould and Pylo tell the story of a man of 44 who. with suicidal intent, drove a dagger ten eentimers long and one centimeter wide into his brain. He had deliberately held the dagger in his left hand and with a mallet in his right hand struck the steel several blows. When seen two hours later the dagger was sticking out of his head, but lie claimed that he experienced no pain, or half an hour efforts at extraction were made but with no avail. He was placed on the ground and held by two persons while traction was made with carpenter's pliers. This ailing he was taken to a coppersmith's, where he was fastened by rings to the ground and strong pincers were placed over the dagger and attached to a chain which was fastened to a cylinder revolved by steam force. At the second turn of the cylinder the dagger came out. During all the efforts at extraction the patient remained perfectly cool and complained of no pain. A few drops of blood escaped from the wound after the removal of the dagger, and in a few minutes the man walked to a hospital, where he remained a few days without lever or pain. The wound healed and lie soon returned to work. By experiments on the cadaver Dubrisy found that the difficulty in extraction was due to rust on the 'steel and by the serrated edges of the wound in the bone. l)r Harold Swanberg, in charge of United States General Hospital 28. Fort Sheridan, Illinois, reports, hi the American Journal of Roentgenology. August. 1021, a case of brain penetration and retention of foreign body in which there was an absence of the symptom* of vertigo and convulsions lor fifteen months after the onset. Again, where the bullet passed through the entire right temporal lobe no paralysis followed the injury. In "all. Or Swanberg gives eleven cases: of these three were fatal; of the eight living seven still bad the foreign bodies i ( n the brain. "The general health is fairly good." the report continues. "In no case does the foreign body appear to be causing any special symptom: a.s far as we are able to ascertain the function of that portion of the brain in which the foreign body is located is not disturbed as a result of its presence." Returning to the invaluable (iould iiii<l Pyle we learn of the history, in 1 be-ancient chronicles of Koenigsberg, of a man who for fourteen years carried in bis head a piece of iron as large as his linger. Its long lodgment discommoded the man little; it finally came out by the palatine arch. They' also tell of an old record of a ball lying near the sella turiciea for more than a year, when the patient suddenly died in a new accident. The Medical and Surgical Reporter of Philadelphia records the case of a. Viennese bookbinder of 45 who died in the Vienna Hospital in 1884. He had always passed as an intelligent man. but had. at irregular intervals, suffered from epileptic convusions. An iron nail covered with 'rust was discovered in his brain ; from the history of bis life and from the appearance of the nail it was judged that it had evidently been lodged in the cerebrum sinco childhood. The British Medical Journal. London, mentions tlie impaction of a portion of a breech of a gun in the forebead of a man for twelve, years, with subsequent removal and recovery. Xo story of marvellous brain injuries and recoveries would be complete without inclusion of the famous "American crowbar cases." The Boston Medical and Surgical Journal gives the details. Phineas P. Gage, aged 25, a foreman on the Rutland and Burlington Railroad, was charging a hole with poW}de*r preparatory to b{ast|ng on September 3, 1847. A premature explosion drove a tamping iron, three feet seven inches long, one a.nd onequarter inches in diameter, weighing thirteen and one-quarter pounds, completely through the man's head. The iron was round and comparatively smooth. .It entered the centre of the skull by the pointed end, but turned obliquely, striking the left side of the face and coming out just above the jaw. Fn its course the bar shot the eyeball out from behind, protruding it nearly one-half of its diameter Gage was thrown back, gave a few convulsive movements of the extremities, but was not unconscious. In his slightly dazed condition he was taken to a hotel three-quarters of a mile away. On arrival at the hotel he dismounted from the conveyance and, without assistance, walked up a long flight of stairs to the hall, where hi.s wound was to be dressed. Harlow, the physician in the ease, saw him at about 6 o'clock in the evening, and from his condition could hardly credit the story of his injury, although his blood. His scalp was shaved, the person and his bed were drenched with

coagula and debris removed, and among other portions of bone discarded were pieces of the parietal bones and of the frontal bone, leaving an opening of three and one-half inches in diameter. At 10 p.m. of the day of the injury Gage was perfectly rational and asked about his work and after his friends. After a while delirium set in for a few days and on the eleventh day he lost tlio vision in the left eye. During his convalescence he discharged pieces of bone and cerebral substance from the mouth; otherwise it was a rapid and uneventful period. Prof. Bigelow examined the patient in January, 1850, more than two years after the injury, and reported that the patient had quite recovered his physical and mental faculties except that he had lost the sight of the ejected eye. Upon his head, now well covered with hair, was a large unequal depression and elevation.