Fractures of the Skull. 49 



" On the evening of the 17th inst. (February 1828) William Murray 

 ■was admitted with a compound fracture of the skull, attended with very 

 considerable depression of the bone. The patient was quite irrational, 

 •and very violent when any attempt was made to examine the wound in 

 the forehead. This was enlarged in the course of the fracture, and a 

 small portion of the bone which was completely detached from the con- 

 tiguous parts was then removed. This gave room for the introduction of 

 the levator, by which the remainder of the depressed portions lying 

 transversely across the forehead were first elevated, and subsequently 

 removed with a pair of tooth forceps, leaving an oblong aperture of about 

 two inches in length by three-fourths of an inch in its greatest breadth. 

 A small portion of the brain also made its escape through the wound, 

 although the breach in the dura mater was not perceived at the time of 

 the operation. 



"This patient instantly recovered liis senses, and answered questions 

 rationally ; he soon, however, lapsed into a state bordering on coma, was 

 extremely averse to being disturbed, his pulse 126 and thready, his 

 extremities cold, and his respiration tranquil until the morning of the 

 18th, when it suddenly became stertorous. You saw him at the usual 

 hour of visit evidently moribund, and he sank immediately afterwards, 

 having survived the receipt of the injury not quite forty-eight hours. 



' ' On the same evening you saw the head opened in the theatre. The 

 fracture was found extending backwards from the two extreme points of 

 the opening through both orbitar plates of the frontal bone, and passing 

 transversely across the ethmoid behind the crista galli. Opposite to the 

 fissures in the roof of either orbit the dura mater was found lacerated to a 

 considerable extent, and portions of the brain protruding ; its anterior 

 lobes were found completely disorganised and broken down, and, what was 

 remarkable, a distinct appearance of purulent matter was seen upon the 

 tunica arachnoides covering each hemisphere of the brain, although the 

 patient had survived the accident for so short a time, had lost a very 

 considerable quantity of blood from the wound, and had manifested no 

 inflammatory symptoms. " (Sir G. Ballingall's Clinical Lectures, No. 3, 

 p. 5.) G, C. 1102. 



Presented by Sir George Ballingall. 



3. 26. Fracture of the Skull. — Two portions of a parietal bone 

 — macerated — from a case of fracture. 



One portion came away immediately after the accident, the other 

 a "very considerable time " (some weeks ?) after. 



The edges of the larger portion show indications of having 

 been separated by a process of granulation. G. C. 1166. 



Presented by Professor Jame.s Russell. 

 D 



