Head injuries, he asserts, have been treated in ‘a much more rational manner’ in the previous 15 years as a result of discoveries and ‘valuable publications’ over that period. He describes the rationale for his treatment and how this changed over time as his knowledge and understanding of the problems progressively increased. He gives ‘a historical view of the gradual progress of the improvements made by others as well as by myself.’
His first patient, a five-year-old boy, sustained a depressed frontal fracture associated with an epidural haematoma (EDH). When the fracture was elevated and the haematoma drained by trepanning the skull, the boy ‘immediately recovered his senses’ but after some days the ‘stupor’ returned, indicating that some matter was lodged under the meninges’. Hill made a cruciate incision in the meninges to drain the haematoma with beneficial effect. Ganz regarded this as the first ever description of a lucid interval associated with a subdural haematoma. This case also demonstrates Hills understanding of the clinical features of cerebral compression: ‘The smallest compression brought on a stupor, a low intermittent pulse, nausea, vomiting and sometimes convulsive twitches.’ From case 3 onwards he avoided dressings which compressed the trepanned area. In case 3 he again relieved the features of cerebral compression by a trepan with drainage of an EDH. In case 5 drainage of a large EDH resulted in restoration of consciousness and resolution of a right sided weakness.
An overriding aorta is a congenital heart defect where the aorta is positioned directly over a ventricular septal defect (VSD), instead of over the left ventricle. The result is that the aorta receives some blood from the right ventricle, causing mixing of oxygenated and deoxygenated blood, and thereby reducing the amount of oxygen delivered to the tissues. It is one of the four findings in the classic tetralogy of Fallot. The other three findings are right ventricular outflow tract (RVOT) obstruction (most often subpulmonary stenosis), right ventricular hypertrophy (RVH), and ventricular septal defect (VSD). References


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