54 Injuries of Bone. 



upwards into the vault, while there is also a horizontal fissure 

 in the frontal bone, starting from the fissure already noted there, 

 and extending nearly to the fissure in the left temporal fossa. 

 This specimen is important as showing that extensive comminu- 

 tion of the vault and of the base, extending also into the bones 

 of the face, may result from a fall upon the head. 



iS"© dislocation of the cervical vertebrae existed. A large 

 hsematoma had produced the swelling in the pharynx. 



G. C. 3095. 

 Presented by Macdonai.d Brown, F.R.C.S.E. 



3. 38. Compound Fracture of the Vault of the Skull 

 extending into the Base— Pyaemia — Death. — Calvarium 



— macerated — from a man aged 20, with separation of the left 

 half of the coronal suture, and a small localised fracture just 

 above the temporal ridge on the left side. 



On 27th July 1815 the patient was admitted to the Royallnfirmary, 

 Edinburgh, witli the history of having fallen a height of 30 feet on to his 

 liead. He had a scalp wound over the seat of fracture, and another above 

 the left eye-brow. There was no bleeding from the nose or ears, and the 

 patient was quite sensible. Pulse 66. He had slight vomiting at times, 

 and his face had an anxious look. In the evening, as his pulse was 74, and 

 as he complained of headache and restlessness, he was bled to 16 ounces, 

 with little benefit. 



Next day four leeches were applied to each temple. On the third 

 day the patient seemed wonderfully well, but some inflammation had 

 begun round the temple wound. 



On the seventh day this wound was suppurating, and the bone below 

 v,-as bare. Five leeches were applied to each temple. The Avound was 

 poulticed, and antimony and saline mixture were given internally. From 

 this time, in spite of repeated leeching and bleeding, he grew gradually 

 worse, with headache, rapid pulse, and at first restlessness. Afterwards 

 he became drowsy, and before death comatose. Rigors and vomiting 

 •occurred on the seventeenth and eighteenth days. On the nineteenth day he 

 was trepanned, and the diploe was found to be purulent. On the twentieth 

 day after the accident he died. And on August 16th, at the post-mortem 

 examination, about four ounces of blood was found lying over the left orbit. 

 The dura mater below the seat of operation was sloughy externally, and 

 internally was covered by purulent matter for some distance round. The 

 fracture on the frontal bone was traced down to the base of the sknll. 



