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Late or secondary infection, not unknown following iridectomy, may follow the trephine operation, and already some fifteen or sixteen cases have been reported. At present, as pointed out by Meller, whose statistics Dr.
Chauliac not only used the trephine, but laid down very exact indications for its application. Expectant treatment was to be the rule in wounds of the head, yet when necessary, interference was counselled as of great value. His prognosis of brain injuries was much better than that of his predecessors.
Then he started to search hither and thither for the precious mahogany case which held the amputating knives, the tourniquets and the trephine. The Zappo Zap was no use, as he did not know anything about the stores, and had never even seen the instrument case, so Adams had to conduct the search alone, in a hurry, and over half an acre of ground.
It is, moreover, much safer than any other operation I know of, and is no less certain in its results. I do not advise trephining in the secondary glaucoma following intumescent cataract, for in such cases the semi-fluid lens bulges into and blocks the trephine hole.
But the point I refer to is this: the old instrument, the trepan, had a handle like a wimble, what we call a brace or bit-stock. The trephine is not mentioned at all in Peter Lowe's book, London, 1634; nor in Wiseman's great work on Surgery, London, 1676; nor in the translation of Dionis, published by Jacob Tonson, in 1710.
The suffusion of the brain will increase quickly, so we must trephine at once or it may be too late." As he was speaking there was a soft tapping at the door. I went over and opened it and found in the corridor without, Arthur and Quincey in pajamas and slippers; the former spoke, "I heard your man call up Dr. Van Helsing and tell him of an accident.
Then we must have recourse to the trephine." He lifted the instrument as he spoke, and gazed at it with every mark of affection. "This is one of the most beautiful of all the instruments of modern surgery. A lovely instrument, a lovely instrument, indeed. Let us secure our firm surface. That seems satisfactory," beginning to bore. This was too much for Ike.
To illustrate the latter first, even one thickness of bone is difficult to penetrate, so that the attempt to skiagraph the opening which had been made in a skull of a living person by a trephine entirely failed, since the bone upon the opposite side of the skull formed so dense an obstacle that not the slightest indication of the trephine opening appeared.
Unlike the trephine operation which was evolved from it, the Lagrange operation requires the same kind of an opening of the eyeball as required for a well executed iridectomy, and a properly placed section entirely in scleral tissue, with a good sized conjunctival flap, are elements which enter into the ultimate success or failure of the procedure.
But the point I refer to is this: the old instrument, the trepan, had a handle like a wimble, what we call a brace or bit-stock. The trephine is not mentioned at all in Peter Lowe's book, London, 1634; nor in Wiseman's great work on Surgery, London, 1676; nor in the translation of Dionis, published by Jacob Tonson, in 1710.
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