MUNIZ—MC GEE] OPERATION REPEATED OR CONTINUED 49 
explored the bone extensively, and finally located the uppermost radial 
fissure, and proceeded to develop the principal aperture, completing the 
operation by grinding down the sharp edges. It seems probable that 
shortly afterward, perhaps within a few hours, exploration was extended 
toward the center of the wound so far as to reveal the fracture follow- 
ing the temporo-parietal suture and the transverse fissure across the 
temporal bone, and that rude cutting and elevating followed in such 
manner as to produce the irregularly triangular aperture and widen the 
opening through the bridge separating it from the circular aperture. 
Remnants of tissue clinging to the bone below the second aperture and 
still covering the anterior extremity of the curvilinear track indicate 
that the scalp and upper portion of the ear were not laid back much 
below the point of impact on or near the suture; and there are indica- 
tions that at this stage the exploration was diverted and carried down- 
ward and backward across the curvilinear fissure and thence along 
the posterior portion of the suture, and this work seems to have been 
followed by the scratching or rasping transverse to the lines of fracture. 
Undoubtedly the last important step in the operation or series of opera- 
tions was the development of the canoe-shape incision, which euts across 
and interrupts or terminates the striz and incisions produced in the 
earlier work; this was apparently the first step in a projected operation 
of greater extent, which was carried no further, presumptively by rea- 
son of the death of the patient, which must have been hastened, or even 
produced, by the clumsy invasion of the meninges in the central part of 
the incision. It is barely possible, though by no means probable, that 
the period intervening between the completion of the principal opera- 
tion and the beginning of the incomplete treatment was of considerable 
duration and that the two were not connected with the same wound. 
There is nothing to indicate that any part of the operation was post- 
mortem, while the abandonment of cutting at an evidently initial stage 
in an extensive operation seems explicable only on the supposition that 
it resulted from death under the knife. 
In addition to the lesions about the wound, the cranium reveals an 
old wound in the form of a deep scratch or groove toward the right 
margin of the frontal bone, nearly parallel with the coronal suture, 
extending upward 25 mm. from a point 55 mm. above the outer margin 
of the orbit. 
CRANIUM 15 
(Plates XXXVIT, XXXVITTL) 
This skull is excellently preserved, having been taken from a mummi- 
fied skeleton, though fleshy tissues are absent save for shreds in some 
of the cavities. It is quite thick and strong, with remarkably developed 
and rugose attachments. The bones average 6 or 7 mm. in thickness 
abouttthe three apertures. The teeth are fairly mature, and the union 
of the sutures is well advanced, indicating middle age. 
16 ETH——4 
