Killed by a cough

brain forcedIn 1734 James Jamieson, a surgeon from Thurso in the Scottish borders reported this case in the Medical Essays and Observations.  It began with a common-or-garden accident:

Some Slates falling from the Roof of a House four Storeys high, upon the Head of a Girl about thirteen Years of Age, broke and shattered her Cranium at the Place where the sagittal and coronal Sutures meet, making a Depression of the Bone of about four Inches Diameter.

Eighteenth-century surgeons were accustomed to dealing with skull fractures, which were frequently encountered.

The Symptoms attending this Accident were common, viz. an universal Stupor, bleeding at the Nose, Difficulty of breathing, with a full irregular Pulse. Immediately took twelve Ounces of Blood from her Arm, and sent for all the Physicians and Surgeons of this Place, who agreed to trepan her speedily, which I performed.

Trepanning entailed making a small opening to ease the pressure inside the skull.

When I endeavoured to raise the depressed Pieces of Bone, they were all found separated from the neighbouring sound Bone, and therefore were all brought away, and so left a terrible Chasm in the Cranium.

patternThe doctor could do little more than place a dressing (with a ‘little Tincture of Myrrh’) over the exposed surface of the brain. The girl was put to bed and given an enema which ‘procured two plentiful Stools’. By the evening,

she recovered the Use of her Tongue, and all the other Parts of her Body, except the left Arm which continued in a paralytick State for eight Days.

Within three months she was apparently cured; new skin had formed over the original head wound, though there remained a large hole in her skull. Mr Jamieson took precautions to protect this weak spot, a lead plate which he insisted she wear over her dressings.

Notwithstanding the Wound being skinned over, I recommended the constant use of the Plate of Lead laid over a Compress upon the Cicatrice [scar], to supply the Want of Bone; and she kept it on two Months after I left off seeing her.

But then catastrophe struck.

skullThinking herself secure, she laid it aside, and continued well seven Months more, when the Chin-cough [whooping cough], then epidemick in this Place, seized her; and was so violent one Night when she was in Bed, that the Cicatrice in her Head was lacerated, and the Brain was pushed out at the Teguments. Being instantly called for, I found above two Ounces of the Brain lying on the Scalp: After cleansing this away, I applied Dressings with the Plate of Lead over them, thereby preventing a greater Discharge.

Alas, further intervention was in vain.

The Symptoms that followed this direful Accident were an entire Paralysis of the Limbs, she retaining still the Use of her Reason and Tongue but much inclined to Sleep, with a low depressed Pulse and Anxietas ardis, and her Urine was discharged involuntarily. In this Condition she continued five Days, and then died.

Little good can come from such a disaster, but our surgeon believes that his colleagues can learn a few useful lessons from the tale:

This Girl’s Case will teach us how little we need be surprised at tormenting Head-achs being brought on by frequent violent coughing, when the Brain must be so strongly pressed on the Cranium. We may likewise learn, from the unhappy Accident that occasioned this Girl’s Death, to be very careful to supply any Part of the Cranium that is wanting, especially after the Bones of it are so firmly joined as to prevent their yielding, and thereby enlarging the Cavity within them.

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