A Remarkable Cure Performed by John Cagua, Surgeon, at Plymouth-Dock, of a Wound of the Head Complicated with a Large Fracture and Depression of the Skull, the Dura Mater and Brain Wounded and Lacerated: Communicated in a Letter to William Cheselden, Esq; F. R. S. &c.

Fork, a Silver Spoon, made in the Handle like a modern one; the Bowl is pointed like an Olive-leaf; a Case of Surgeon's Instruments, several Kitchen Utensils, Mouse-traps, Vessels full of Rice, a Triumphal Car of Bronze, &c. VII. A remarkable Cure performed by John Cagua, Surgeon, at Plymouth-Dock, of a Wound of the Head complicated with a large Fracture and Depression of the Skull, the Dura Mater and Brain wounded and lacerated: Communicated in a Letter to William Chefelden, Esq; F. R. S. &c. JUNE 11. 1729. I was sent for to Mr. John Darton of Stonehouse near Plymouth, to see his Son, aged 10 Years, who fell down from the Top of an old Wall, as he was taking out a Sparrow's Nest, upwards of 20 Feet high, in an antient Building belonging to the Honourable Richard Edgecumbe, Esq;. When I came, I found him speechless, comatose, bloated Eyes, a wan Face, bleeding at the Nose and Ears, and a great Hemorrhage and Vomiting: On Examination, a large, long, deep, and contused Wound appeared, from the Eyebrow all over the Left Side of his Head; and after having shaved him, was surprised to feel, with my Fingers, so many rugged Splinters of the Cranium confusedly depressed through the Dura and Pia Mater into the Substance of the Brain; the Extremities whereof ap- appearing above the *Dura Mater*, I extracted to the Number of Five, as they are represented in the Draught (see Tab. IV.) in their proper Bigness and Figures, besides several other Bits and Small Pieces: In taking out the last Splinter, being Part of the superior and inferior Part of the Orbit, containing some of the Basis and inferior Part of the *Os Frontis*, joining by the *Sutura Transversalis* to the superior Part of the *Os Mala*, with Part of the said *Suture* and the upper Extremity of the *Sphenoides*, almost to the lower End of the *Sutura Coronalis* and *Squamosa*: This Splinter was the major Part of it depressed under the superior Part of the great Depression of the *Os Frontis*; on extracting of which, Two Parts or Pieces of the Substance of the Brain, with clotted Blood, came out with it, one as big as a large Kidney Bean, and the other as a large Pea; at which Time the Patient fainting and vomiting, brought up most of what was contained in his Stomach, mixed with bilious and bloody Matter. The *Dura Mater* was very much contused, lacerated, and bare, upwards of Three Inches and a quarter in Length, and at one End One Inch and a half over, the Remainder about One Inch, and the Edges rugged: From the upper Part of the Fracture, there was a Depression of the *Os Frontis*, which reached up to the *Sutura Sagittalis*, nigh the *Coronal Suture*: One Part of the *Craniun* lapt over the other, which I sawed off on the Third or Fourth Day, it being an Inch long, and occasioned me a great deal of Trouble, before I could raise it up with my Elevator, the inferior Part of the Fracture being so thin and weak: The depressed Part terminated in a long Fissure, about an Inch behind the *Coronal Suture*. ture in the Bregma: The Scalp was so much contused and lacerated, that the next Day it began to mortify, which obliged me to lay all that Side of the Coronal, and the greatest Part of the Bregma, homic to the Lamdoid Suture, bare, from the upper Part of his Head down to his Ear (as in Tab. III.): The Dura and Pia Mater were very livid, and insensible to the Touch, except those Parts where the Brain was wounded, in the dressing of which the Motion or Pulsation of the Brain was very strong, and sometimes to that Degree, that it would rise considerably above the Surface of the Cranium; which obliged me to keep it down sometimes more than Two or Three Minutes with my Fingers, and a large and thick Sindon dipt in a warm detergent Lotion, before it would cease, introducing it between the Dura Mater and the Edges of the Fracture. The upper Eye-lid in a Week's time impostumated, and formed a large Tumor as big as a Hen's Egg, which I opened, and kept it so a considerable Time, because I had therefrom a plentiful Discharge of Matter, which was at first very fetid, but afterwards became laudable, giving likewise a good Discharge from the wounded Brain through the Fracture of the upper Part of the Orbit. In about a Fortnight's time I had a very laudable Suppuration from all the Wound, and the Symptoms ceasing, the Dura Mater began to regenerate, looking very red and fresh; the livid and lacerated Parts sluft off, and the Extremities of the Fracture began to throw out their Ossifications from the Diploe and both Tables of the Cranium, like small Excrescences, or proud Flesh, which in a Month's time spread over the whole Fracture; and I made my Observation, that it grew harder harder sooner at the Extremities of the Fracture than in the Centre. The Motions or Pulsations of the Brain still continued, and were very visible for a long Time after, and were felt for some time after the Wound was cured; especially in the inferior Part of the Coronal and Bregma, over the inferior Part of the Coronal Suture, nigh the Squamosa. Except the Three or Four first Days, the Boy continued very sensible; but during the first Six Weeks would very often complain of a violent Pain in his Head, attended with a Comatose, and Fever; but would soon go off again, by giving him an emollient and laxative Clyster, or a gentle laxative Draught. The 6th of October following, before his Wound was quite well, he was taken very ill with the Small-pox, of the Flux-kind, and though he had them very severe, and delirious in their coming out, yet recovered. The 11th of November following, the Wound was perfectly cured; but in the latter End several Exfoliations were taken out of the upper Part of the Coronal. He is now, and hath been ever since, very well, strong and healthy; has his Sight in both Eyes, is a very sensible and forward Lad, for his Age, and has been upwards of Four Years at Sea, in his MAJESTY's and the Merchants Services. Plymouth-Dock, March 1. 1736. John Cagua. Tab. III. Represents the Boy's Head, with the Wound, as it appeared to View, and Part of the Cranium laid bare. Tab. Tab. IV. Represents the Skull, with the Fractures made in it, and the several Splinters, that were taken out. A... Is the external Part of the Splinter, adjacent to the superior Part of the Os Malæ, and the upper Part of the Orbit, in its proper Bigness and Figure. 1. Is the thick Protuberance of the Basis and inferior Part of the Os Frontis, broke off and separated from the superior Extremity of the Os Malæ in the transverse Suture. 2. Is the lower Part of it broke off from the upper Part of the Os Sphenoides. 3. Is Part of the Sutura Transversalis. 4. Is the Diploe, and its Thickness, being very rugged and irregular. B... Is the internal and concave Parts, with the Thickness of the same Splinter. 1. Is Part of the Concavity of the upper Part of the Orbit. 2. The superior Part, with its Thickness and Diploe. 6 and 7. The external and internal Tables. 3. The inferior and internal Part separated from the Os Sphenoides: The Middle of it is a deep Concavity. 4. A rugged Ridge arising from its Cavity, and likewise from the great and middle one. 5. The internal and concave Part. 8. Part of the Sutura Transversalis. C... Is Part of the inferior and Basis of the Os Frontis and Bregma, with some of the lower Part of the Sutura Coronalis; being very thin in the Middle where the Suture is, it shews its proper Bigness and Figure. 1. The Diploe. D.D.D. Three other Splinters in their proper Bignesses and Figures. I.I.I. The Diploe and both Tables. E... The Splinter that lapt over the Depression, which was sawed off. F. The Stone mentioned in the next Paper. VIII. A Case communicated by Mr. J. Mac-karness, Apothecary, in Chipping-Norton, in Oxfordshire, of an extraordinary Stone voided by the Anus. Mrs. Mary Smith, Wife of John Smith, of Chadlington in the County of Oxon, aged about 31, a tall well-shaped strong-made Woman, was seized with a violent Fever, accompanied with great Heat, Restlessness, Pain in the Head, Twitchings of the Tendons, pale Urine, unequal Pulse, Difficulty of breathing, great Costiveness, and without Thirst. She had a hard Labour about Three Weeks before. This Fever seized her the 2d of January 1727, and lasted till the 17th, during which Time she was very costive, and continued so till she had another Child, which was the latter End of February 1728, and was frequently subject to Attacks