PEDIATRICS Vol. 54 No. 3 September 1974, pp. 319
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An Account of the Successful Outcome of a Compound Skull Fracture in a Six-year-old Boy-Reported in 1763

T. E. C. Jr. M.D.

The case history below attests to the vis mediatrix naturae because the patient survived a serious head injury without any of the supportive therapeutic aids which would be considered routine today.

Thomas Walker, a child about six years of age, living at Caton, being asleep near the fire, a stone about half a hundred-weight fell from the top of the chimney upon the side of his head, and fractured his skull in a most terrible manner. The poor lad lay as dead for several hours; but his parents being persuaded to carry him to Dr. Brachen of Lancaster, they immediately followed the advice. The doctor made a proper incision, in order to clear the skull from the pericranium, and discover the fracture; when he found the parietal bone fractured in twenty pieces (some as large as a shilling piece) with their sharp points sticking down in the brain, the dura and the pia being both destroyed, and a considerable effusion of blood from the vessels of the brain.

The bones were removed with great care and dexterity, for as their points went so far into the brain, the nicety consisted in removing them so that the instrument might not pass too far into the substance of the brain, and consequently destroy the patient. In time the boy recovered beyond expectations, and is now entirely well, though it is three months since he received the hurt. Therefore, the said Dr. Brachan inserts this for the information of those who are bigoted to an opinion, that if the brain was wounded till the lobe or particular part of the brain was rotted or consumed away, the case would be desperate.