Fractures of the Skull. 55 



Evidently this was , a case of pyaemia and septicaemia 

 following a compound fracture of the skull. 



On the outside the bone is slightly roughened by inflamma- 

 tion below and behind the trephine opening, and internally new 

 bone has been thrown out in the main groove for the middle 

 meningeal artery. G. C. 1010. 



3. 39. Compound Fracture of the Skull— Consecutive 



Abscess — Death. — Calvarium of a boy — macerated — showing 

 a hole in the right half of the frontal bone. Two portions of 

 the bone which were removed from the hole immediately after 

 the accident are wired in position near it. 



" The boy was kicked by a horse, and for four weeks was treated in the 

 Royal Infirmary, Edinburgh. At the end of that time he left, apparently 

 quite well, and with the wound healed. About five weeks after his dis- 

 missal he was twice seized with fits, and was re-admitted into the Hospital. 

 The wound was now tumid and painful. A small speck Of bone was 

 removed from it. He lay in bed, listless and without complaining until 

 he became suddenly blind ; he remained sensible, and could recognise 

 his dresser's voice ; by his mother's account, his appetite was good. He 

 died in strong convulsions. 



^^ Dissection. — The scalp and dura mater adhered firmly together at 

 the place of the cicatrix ; the edges of the bone and dura mater were 

 separate. A very extensive abscess was found to occupy almost the whole 

 of the right hemisphere of the brain. The thinnest parts of the walls of 

 this abscess were opposite to the wound and at the base of the brain near 

 the optic nerves. It was calculated that about eight ounces of pus wfere 

 ■evacuated from the abscess. There was no dead bone found on dissection." 



The margins of the hole in the bone are rounded by the 

 vital processes following the injury, whereas the margins of the 

 loose fragments, removed at the time of the accident, are sharp. 

 There are marks of increased vascularity all over the calvarium, 

 especially on the inner side. B. C. 1. 2. M. 1-i c. 



3.40. Septic Osteo-myelitis of the Skull, foUowingr 



Injury. — Calvarium — macerated — with a portion of dead bone 

 in process of separation on the right side of the frontal bone. 



"This man lay with the surface of the cranium exposed, and 



