Fractures of the Skull. 4tJ 



fragments, while the Hey saw has also been used for a similar 

 purpose. A limited fissure below and in front of the seat of 

 fracture indicates that the bone had been forced in by the 

 injury. The calvarium is interesting anatomically in its having 

 a permanent frontal suture and in its presenting several 

 wormian bones at the lambdoidal suture. B. C. 1. 2. M. 7. 



3. 21. Compound depressed Fracture of Skull— Inter- 

 cranial Suppuration— Death.— Skull-cap of a boy, show- 

 ing a localised fracture at the junction of the sagittal and 

 coronal sutures. 



"The boy from whom this skull-cap was taken received a kick from 

 a horse. Four fissures radiated from the point where the sagittal suture 

 joins the coronal, and there was slight depression in one part. In eight 

 days he had no bad symptoms. The wound was dressed with a dossil of 

 oiled lint. After that time he began to have sickness, and vomiting, and 

 severe headache. For four more days his breathing was stertorous, the left 

 side of his body was paralysed, and he had convulsive twitchings of the 

 right side. Pus oozed through the fissures in the skull ; the operation of 

 trepanning was performed. The external la3'er of bone separated before 

 the internal layer was sawed through ; a quantity of pus was washed 

 away from the dura mater. The symptoms were not improved, and the 

 boy died next day. 



^^ Dissection. — There was extensive ulceration of the dura mater over 

 the longitudinal sinus, and on each side of it ; around the ulcer there 

 were blotches of red inflamed parts. The dura mater was greatly thick- 

 ened, and the ulcer had a shreddy surface, which was covered with pus of 

 a bright yellow colour. The veins which entered into the longitudinal 

 sinus were filled with dark coagulated blood, which could not be drawn 

 out from the vessels. Anterior to the ulcer the longitudinal sinus was 

 choked with a firm and light-coloured coagulum ; posteriorly a quantity of 

 pus was squeezed out from the sinus. Under the ulcer of the dura mater, 

 there was also ulceration of the surface of the brain in both the hemi- 

 spheres. The pia mater was turgid with blood. There was inflamma- 

 tion of the substance of the brain in the neighbourhood of the ulcer, 

 but the rest of the brain appeared healthy. There was no fluid in the 

 ventricles. " 



The fissures on the surface indicate that the bone was 

 driven in at the moment of impact. The case has been one of 

 compound depressed fracture, followed by death from sepsis. 



B. C. 1. 2. M. 14a. 



