so SURGICAL APPLIED ANATOMY. ichap. H. 



the cranial vault necrosed and carne away. The patient 

 was a woman, and the primary cause of the mischief 

 was a fall upon the head when drunk. (See page 5.) 



Necrosis of the skull, as well as caries of the part, 

 is attended by certain special dangers that depend 

 upon the anatomical relations of the cranial bones. 



Thus, when the whole thickness of the skull is 

 involved by disease, or when the inner table is 

 especially attacked, a collection of pus may form 

 between the dura mater and the affected bone, and 

 may produce compression of the brain. When the 

 diploic tissue is implicated, the veins of that part may 

 become thrombosed, or may be the seat of a suppurative 

 phlebitis. The mischief thus commenced may spread, 

 the great intracranial sinuses may be closed by throm- 

 bus, or septic matter may be conveyed into the general 

 circulation and lead to the development of pyjemia. 



Mere local extension may also cause meningitis. 



In cases of necrosis of the external table the 

 growth of granulation tissue from the exposed and 

 vascular diploe plays a very important part in aiding 

 the exfoliation of the lamella of dead bone. 



When bone disease leads to perforation of the skull, 

 the pulsations of the brain may be visible through the 

 abnormal opening. 



Fractures of the skull. It is not easy to 

 actually fracture the skull of a young infant. The skull 

 as a whole at this age is imperfectly ossified, the sutures 

 are wide, and between the bones there is much 

 cartilage and membrane. Moreover, the bones them- 

 selves in early life are elastic, and comparatively soft 

 and yielding. If a blow be inflicted upon the vault 

 in a young child the most probable effect, so far as 

 the bone itself is concerned, is an indenting or 

 bulging in of that bone unassociated with a fracture 

 in the ordinary sense. In this particular relation, the 

 skull of an infant is to that of an old man as a 



