MUNIZ—ME GEE] OPERATION ON DEPRESSED FRACTURE 43 
restored, and everything to indicate that death supervened about this 
Stage. 
It may be observed that this specimen displays decided facial distor- 
tion, the mouth, nose, and tongue being strongly drawn toward the 
right. Whether this distortion was in any way connected with the 
wound or the operation is an interesting question, but one that need 
not be pursued for the present, since it would seem impossible to arrive 
at certain or useful results. 
CRANIUM 15 
(Plates XX X-X XXTT) 
The specimen is in excellent condition, the bones being perfectly pre- 
served, and a considerable part of the scalp and other tissues remaining. 
The skull is strong, with the usual rugose attachments. Its thickness 
varies from 34 to 5 mm. about the single artificial aperture. The teeth 
are only fairly mature and anchylosis of the sutures is but moderately 
advanced, indicating that the individual died in his prime. 
The incomplete operation, which reveals the methods of the operator 
with gratifying clearness, was located by a fracture near the posterior 
angle of the left parietal, extending to within 15 mm. of the sagittal and 
lambdoid sutures. The initial wound depressed a tract of bone about 
47 mm. long and rather over 20 mm. wide, measured on the outer table. 
Toward the sagittal suture and along the lower margin the inner table 
is undercut 2 to 5 mm. The indications are that the bone was com- 
pletely severed more than halfway around the oblong aperture, remain- 
ing hinged at the upper and anterior margins. In addition the outer 
table was cracked concentrically with the central part of the wound, 
parallel with the upper margin and some 10 mm. from it, as shown 
clearly in plate xxx1r. The instrumentation comprised three definite 
incisions. The most conspicuous of these is an approximately recti- 
linear cut 37 mm. long, skirting the upper part of the fracture and 
penetrating the inner table for a distance of 12 mm. The projecting 
extremities are of the usual V-shape section and termination, and longi- 
tudinal strive appear in the remaining wall of the incision, showing that 
the instrument was of the kind indicated in other operations. The 
second incision in extent describes the upper and posterior side of the 
aperture, originating near the extremity of the first incision. It is 27 
mm. long, extending somewhat farther in a narrow scratch, and pene- 
trating the inner table for 5 or 6 mm. near its anterior termination. 
The third incision describes a part of the anterior margin of the aper- 
ture, crossing the extremity of the principal incision. It is about 20 
mm. long, but extended farther on the tongue of bone subsequently 
removed. A few shallow cuts are placed obliquely to this incision, 
originating at the intersection of this with the first incision and extend- 
ing directly downward. These marks appear to represent a prelimi- 
nary or exploratory cutting, which was abandoned when the deeper 
