W. M. æt. 28, while returning home during the night in a state
of intoxication, fell from a height of ten feet, into a court
paved with stone. He was rendered insensible for some time, but
on recovering was able to crawl to the nearest door, and was
conveyed home. Medical assistance was immediately procured. On
the forehead, about an inch above the nasal process of the frontal
bone, was a cut an inch and a half in length, extending obliquely
downwards from the right side; through this a triangular fracture
was felt, the base of which was in the direction of the external
wound, and the apex pointing downwards; the fractured portion
of the bone was slightly depressed; the bones of the nose were
also fractured, and there was great discharge of blood from the
nostrils. One third, or nearly, of the upper lip was cut off, and a
good deal of blood had been lost from the labial artery; the lower
jaw at the symphysis was fractured and comminuted, and several
pieces were perceived to be loose. Was quite sensible, remembering
every thing up to the period of the accident. Pulse 80; has vomited
frequently. Wound of forehead was dressed with adhesive plaister;
the loose pieces of bone were removed from the lower jaw, and it
was afterwards retained in juxta-position by a chin bandage.
Early next morning he was bled to ℥xii. and had a purge of jalap
and calomel, by which his bowels were freely opened. That night he
felt considerable pain of head; pulse 90, full, and strong. He was
bled again to ℥xxv. Blood first drawn had the buffy coat. After
the bleeding the pain of head diminished, and he continued to do
well. When the swelling and tenderness of face had subsided, it was
observed that the fracture communicated with the frontal sinus. On
holding his nose and attempting to blow it, matter and air escaped
by the fracture. The man was anxious for a speedy cure, and for
this purpose an operation to remove the depressed piece of bone was
at one time thought of; there was no constitutional disturbance,
however, and the case was left to nature. The discharge gradually
diminished, and the wound healed up in about a month. The bones
of the nose retained their position, and the broken ends of the
jaw, after the swelling had subsided, were kept in their proper
situation by a pasteboard splint till re-union took place. The lip
also healed easily, and no deformity is now observable.