HIS PAPER ON INJURIES OF THE HEAD.
"Utiliumque sagax rerum."
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Hor.

In estimating the practical penetration and clear judgment of Abernethy, it was almost necessary to see him placed by the side of other men.

His mind was so quick at perceiving the difficulties which lay around any subject, that it appeared to radiate on the most difficult, a luminosity that made it comparatively easy, by at least putting that which, to ordinary minds, might have been a confused puzzle, into the shape of an easy, definite, and intelligible proposition.

It was immaterial whether the difficulties were such as could be overcome, or whether they were in part insurmountable; both were clearly placed before you; and whilst the work of the quickest mind was facilitated, the slowest had the great assistance of seeing clearly what it had to do.

All this was done by Abernethy in a manner so little suggestive of effort, that, like his lecturing, it was so apparently easy, that one wondered how it happened that nobody could ever do it so well.

But when we saw him placed in juxtaposition with other men, these peculiarities, which, from the easy manner in which they were exhibited, we had perhaps estimated but lightly, were thrown into high relief, and by contrast showed the superiority of his powers.

The second series of Essays he had dedicated to his old87 master, Sir Charles Blicke. The third, the subject of our present consideration, he inscribed to his early instructor in anatomy, Sir W. Blizard. The dedication is straightforward and grateful.

The first paper of the series is interesting in two points of view. First, it was an important improvement in the management of a difficult form of a very serious class of accidents—"Injuries of the Head;" and secondly, it derives a peculiar interest from the parallelism it suggests between Abernethy and one of the most distinguished surgeons of France, the celebrated Pierre Joseph Desault—a parallelism honourable to both, yet remarkably instructive as to the superior discriminative powers of Abernethy. Desault\'s pupil, Bichat, himself one of the most accomplished anatomists of his time, has left an eloquent eulogium on Desault, which, although somewhat florid, is by no means above his merits. He says he was the father of Surgical Anatomy in France; and certainly few men evinced more sagacity, in that immediate application of a fact to practical purposes which constitutes art, than Desault.

Bichat, in his glowing analysis of Desault\'s character, amongst other things in relation to his study of the profession, observes of him that "Un esprit profond et réfléchi, ardent à entreprendre, opiniatre à continuer, le disposa de bonne heure à surmonter des dégo?ts qui précédent, et les difficultés qui accompagnent son étude. A cet age où l\'ame encore fermée à la réflexion semble ne s\'ouvrir qu\'au plaisir, apprendre fut son premier besoin—savoir sa première jouissance—devancer les autres sa première passion23."

A quick and clear perception, for the most part untrammelled by preconceived opinions, led Desault to a vivid appreciation of the immediate results of surgical proceedings; and as these were definite, successful, doubtful, or abortive, he either persevered with a characteristic tenacity of purpose, or at once and for ever abandoned them. He was remarkably happy in his selection and appreciation of the mechanical parts of surgery; and his quick88 perception disclosed to him several useful points in practice which depend on the more important truths of medical surgery.

Now almost all this, as applied to the active portion of Abernethy\'s life, is equally true of both. But Desault was by no means so deep or so original a thinker as Abernethy. Like Abernethy, he was clear and penetrative; but he did not see nearly so far, nor were his views nearly as comprehensive. Desault was quick at detecting an error in practice, and in sensibly rejecting it. Abernethy would unfold it, examine it, and, by his talents, convert the very defect into usefulness. Desault had by no means, in the same degree, that power of reflection, that suggestive faculty, which, in endeavouring to interpret the meaning of phenomena, can point out the true question which it is desired to ask of nature, as well as the mode of inquiry.

All this, and much more, was strikingly developed in Abernethy. The paper before us involves a subject which had engaged the attention both of Abernethy and Desault. They had met with the same difficulty; and the practical solution of it which each obtained, though somewhat different, was extremely characteristic. We will try to make this intelligible. In severe injuries in which the cranium is broken, it frequently happens that a portion of bone is so displaced that it presses on the brain. The consequence of this, in many cases, is a train of symptoms sufficiently alarming in themselves, but the actual cause of which many circumstances sometimes concur to complicate or obscure.

The same forces which produce the accident not unfrequently involve a violent shock to the whole body. Sometimes fracture or other injury of other parts. Sometimes the patient is deeply intoxicated. Then, again, patients are presented to the surgeon, in different cases, at extremely different intervals after the reception of the injury; so that a case may wear a very different aspect according to period or the phase at which it is first brought under his observation.

These and many other circumstances give rise to various modifications of the symptoms, and, under some complications, constitute a class of cases which yield to none in importance or difficulty. There is something in the idea of a piece of bone pressing89 on the brain, which instinctively suggests the expediency of raising it to the natural level. This is, in fact, the object of what is called "trepanning;" or, as we generally term it, "trephining."

The operation is very simple; it consists in carefully perforating the cranium, and then, by means of an instrument adapted for that purpose, restoring the piece of bone, which has been depressed, to its natural level. In many instances, the proceeding was very successful; but in many others, the cases terminated unfavourably. From what has been already hinted, it is clear that, in many injuries of the head, this trephining must have been unnecessary; in others, inapplicable; and in both (as adding to the injury), mischievous. Still, surgeons went on as before; so that, in a large class of injuries of the head, there was (if the bone was depressed) an almost uniform recourse to the trephine.

Again, in cases where it did not immediately appear that the bone was depressed, too often very unnecessary explo............