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pezius muscle almost one…half the distance to the shoulder blade。 The right ear was torn across in its lower third； and hung by the side of the neck by a piece of skin less than five mm。 wide。 The exposed surface of the wound measured 40 cm。 from before back； and 34 cm。 in width near the temporal portion。 The cranial sutures were distinctly seen in several places； and only a few muscular fibers of the temporal were left on each side。 Hemorrhage was profuse from the temporal； occipital； and posterior auricular arteries； which were tied。 The patient was seen three…quarters of an hour after the injury； and the mangled scalp was thoroughly washed in warm carbolized water； and stitched back in position； after the hair was cut from the outer surface。 Six weeks after the injury suppuration was still free； and skin…grafting was commenced。 In all； 4800 grafts were used； the patient supplying at different times 1800 small grafts。 Her own skin invariably did better than foreign grafts。 In ten months she had almost completely recovered； and sight and hearing had returned。 Figure 191 shows the extent of the injury； and the ultimate results of the treatment。
Schaeffer also reports the case of a woman working in a button factory at Union City； Conn。； in 1871； who placed her head under a swiftly turning shaft to pick up a button； when her hair caught in the shaft； taking off her scalp from the nape of the neck to the eyebrows。 The scalp was cleansed by her physician； Dr。 Bartlett； and placed on her head about two hours after the accident； but it did not stay in position。 Then the head was covered twice by skin…grafts； but each time the grafts were lost； but the third time a successful grafting was performed and she was enabled to work after a period of two years。 The same authority also quotes Wilson and Way of Bristol； Conn。； in an account of a complete avulsion of the scalp； together with tearing of the eyelid and ear。 The result of the skin…grafting was not given。 Powell of Chicago gives an account of a girl of nineteen who lost her scalp while working in the Elgin Watch Factory at Elgin； Illinois。 The wound extended across the forehead above the eyebrows； but the ears were untouched。 Skin… grafting was tried in this case but with no result； and the woman afterward lost an eye by exposure； from retraction of the eyelid。
In some cases extensive wounds of the scalp heal without artificial aid by simply cicatrizing over。 Gross mentions such a case in a young lady； who； in 1869； lost her scalp in a factory。 There is reported an account of a conductor on the Union Pacific Railroad； who； near Cheyenne； in 1869； was scalped by Sioux Indians。 He suffered an elliptic wound； ten by eight cm。； a portion of the outer table of the cranium being removed； yet the wound healed over。
Cerebral Injuries。The recent advances in brain…surgery have； in a measure； diminished the interest and wonder of some of the older instances of major injuries of the cerebral contents with unimportant after…results； and in reviewing the older cases we must remember that the recoveries were made under the most unfavorable conditions； and without the slightest knowledge of all important asepsis and antisepsis。
Penetration or even complete transfixion of the brain is not always attended with serious symptoms。 Dubrisay is accredited with the description of a man of forty…four； who； with suicidal intent； drove a dagger ten cm。 long and one cm。 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 he claimed that he experienced no pain； and the dagger was sticking out of his head。 For 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 failing； he was taken to a coppersmith's； where he was fastened by rings to the ground； and strong pinchers 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 fever or pain。 The wound healed； and he soon returned to work。 By experiments on the cadaver Dubrisay found that the difficulty in extraction was due to rust on the steel； and by the serrated edges of the wound in the bone。
Warren describes a case of epilepsy of seven months' standing； from depression of the skull caused by a red hot poker thrown at the subject's head。 Striking the frontal bone just above the orbit； it entered three inches into the cerebral substance。 Kesteven reports the history of a boy of thirteen who； while holding a fork in his hand； fell from the top of a load of straw。 One of the prongs entered the head one inch behind and on a line with the lobe of the left ear and passed upward and slightly backward to almost its entire length。 With some difficulty it was withdrawn by a fellow workman； the point was bent on itself to the extent of two inches。 The patient lived nine days。 Abel and Colman have reported a case of puncture of the brain with loss of memory； of which the following extract is an epitome： 〃A railway…fireman； thirty…six years old； while carrying an oil…feeder in his hand； slipped and fell forward； the spout of the can being driven forcibly into his face。 There was transitory loss of consciousness； followed by twitching and jerking movements of the limbs； most marked on the left side； the legs being drawn up and the body bent forward。 There was no hemorrhage from mouth； nose； or ears。 The metallic spout of the oil…can was firmly fixed in the base of the skull； and was only removed from the grasp of the bone by firm traction with forceps。 It had passed upward and toward the middle line； with its concavity directed from the middle line。 Its end was firmly plugged by bone from the base of the skull。 No hemorrhage followed its removal。 The wound was cleansed and a simple iodoform…dressing applied。 The violent jerking movements were replaced by a few occasional twitchings。 It was now found that the left side of the face and the left arm were paralyzed； with inability to close the left eye completely。 The man became drowsy and confused； and was unable to give replies to any but the simplest questions。 The temperature rose to 102 degrees； the pupils became contracted； the right in a greater degree than the left； both reacted to light。 The left leg began to lose power。 There was complete anesthesia of the right eyebrow and of both eyelids and of the right cheek for an uncertain distance below the lower eyelid。 The conjunctiva of the right eye became congested； and a small ulcer formed on the right cornea； which healed without much trouble。 In the course of a few days power began to return； first in the left leg and afterward； though to a much less extent； in the left arm。 For two weeks there was drowsiness； and the man slept considerably。 He was apathetic； an