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Related post: fomid the hearmg normal. Taste and smell unimpaired.
Dr. Dercum reported no Babinski reflex, no ankle clonus,
no paradoxical reflex, no OppcMiheim reflex, superficial re-
flexes preserved. The knee jerk and Achilles tendon re-
flex increased on both sides. No observed sensory abnor-
mality. Stereognosis preserved. Bladder and rectum nor-
mal. There were complaints of horrible headache, which
was general but worst in the occipital region, and \vl)en
patient stood erect ; greatly aggravated by tapping the head
anywhere or by making any movement ; but relieved some-
what by lying down and keeping quiet ; the pain kept him
awake. The urine normal except for rather low specific
gravity, 1.008; passed about fifty ounces a day.
Blood report : 9,400 leucocytes ; 4,300,000 erythrocytes ;
eighty-one per cent, hasmoglobin.
Dr. Manges made the x ray examination. He determined
by stereoscopic skiagraphs that the bullet lay in or almost
in the median line of the skull and at a depth of over two
inches from where the sagittal suture joins the lambdoidal
suture.
Fig. 3. — This picture shows siniiily tlie shadows of the transverse
view. As the bullet was located practically in the median line the
shadows of the anteroposterior view would not show in this sec-
tion. The small dark spot is a fragment of the bullet probably
lodged in the petrous jiart of the temporal bone. The irregular dark
spot above the middle of the zygoma shows point of entrance of
bullet.
Because of the depth at which this bullet lay the local-
izing apparatus was taken into the operating room, ster-
ilised, and used ns a guide just before opening the skull.
On February 6 the patient was anrcsthetized. It was
determined to seek for this bullet by way of the longitudi-
nal fissure and not by incising the brain along the track
of the ball. An osteoplastic flap was made by the method
of Gushing. The base of the flap was over the occiput.
The dura was opened, and the brain appeared Purchase Neggram Online normal. The
right hemisphere was retracted outward. I passed my fin-
ger along the falx cerebri in the median fissure and at a
depth of over two inches felt the missile. The bullet was
lodged in (he falx and against the superior surface of the
straight sinus. The whirr of the blood in that sinus was
very distinct as the finger pushed against the bullet. The
falx was Buy Neggram Online incised, the bullet was exposed and removed with
bullet forceps. On its removal there was a great gush of
blood, presumably from the sinus. The' bleeding was ar-
rested by gauze packing which made much pressure on the
falx and tentorium. Because of the large amoimt of gauze
employed, the fear of further haemorrhage, and the appre-
hension as to the results of compression, the bone flap was
removed and the scalp sutured about the protruding gauze.
He reacted quickly from the ether and a few hours after
the operation was perfectly conscious and free from pain.
The packing was not removed for nine days. On its re-
moval there was x\o bleeding. Order Neggram
The patient was sent home February 25 feeling well and
cheerful, entirely free from pam, and with the wound near-
ly healed. At present he is in excellent health' and is
working as a stevedore.
In this case the melancholia was improving when I op-
erated and was completely recovered from soon after the Order Neggram Online
operation.
Entering the longitudinal fissure to reach the bullet
saved injury to Purchase Neggram the brain which would have proved most
disastrous had any attempt been made to follow the track
of the ball through the right hemisphere to the falx.
The lodgment in the falx explains the violent headache.
An interesting postoperative phenomenon was an enor-
mous increase in the amount of urine. The Buy Neggram day after the
operation 7300 c. c. were passed. The eighth day after
the operation 4600 c. c. were passed. It was judged that
the pressure of the gauze was responsible for this. On re-
moval of the gauze the amount dropped during the subse-
quent twenty-four hours to 2750 c. c, and gradually the
daily output became normal. The daily urine was care-
fully estimated by Dr. Rumbaugh, to whom I am greatly
indebted for the skillful and unremitting care he gave this
patient.
Irritation of the medulla may cause polyuria and per-
haps this is the explanation of its occurrence in this case.
At times the urine showed a trace of albumin but never
sugar, acteone, a diacetic acid.
DEMONSTRATION OF A SIMPLIFIED TECHNIQUE
FOR Buy Cheap Neggram X RAY LOCALIZATION OF BULLETS IN
THE THICKER PORTIONS OF THE BODY.*
By Sinclair Tousey, A. M., M. D.,
New York.

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